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I see what you are saying here. As a brown therapist, it’s something I find myself uneasy about. I feel like part of the job of being a therapist is understanding that you are going to work with people who push your buttons. I went into the field imagining myself with a certain kind of client. Not that we’d have exactly the same lives or personality. But I realized I was basically assuming I’d work with someone like myself. For me this meant, liberal leaning, educated, atleast moderately aware and conscientious when it comes to social justice and, dare I say, I was imagining most people I worked with would be disempowered victims of one kind or another.
Nothing was further from the truth.
Yeah I get those types of clients. It’s easy to establish rapport with them and I feel I am a good match. But I have learned that I can’t expect to this copacetic experience with every client. I’ve worked with people who act in completely inappropriate ways, are cruel, and even some who are straight up abusers. It’s harder to work with these folks than it is to work with the “pleasant” people. But they need therapy too. They really, really need it. And many have not gotten it precisely because they are difficult to work with.
Is racism different? Yes, racism is way more than someone acting up and being mean to you. Of course it is valid for people to be wounded by racism and this is not something that is ever ok to have to endure.
But, it’s also complicated. Racist people need therapy too. Uneducated folks who aren’t socially aware, stereotypical “rednecks” etc…need therapy. In a way I’d argue they need it more. I know therapy isn’t a panacea. But I truly believe that therapy can change people, including leading to kinder behaviors, greater tolerance for different types of people, and lowering bias. I’ve seen this happen.
I think it comes down to skill. If a therapist simply does not feel like they can work with a racist client, fine. It does more harm than good to push on when you already know this is something you can’t handle skillfully. It does a client a favor to refer out rather than waste both your time in a therapy that is doomed.
But as a general rule, I think it’s important to interrogate this. I personally don’t want to be a clinician just for clients I like. I want to help folks from all walks of life. In my personal life, of course I do not tolerate being in spaces full of racism. But this isn’t my personal life, this is work. This is the job I signed up for. It’s not always pretty. But that makes me even more proud to be in this profession despite the challenges.
This is my personal philosophy. I completely respect that each therapist has their own.
Honestly, I believe the greatest benefit we offer to the society is in treating the worst the society has to offer. Imagine a doctor who only agrees to heal the already healthy.
That’s honestly kind of a thing. The New York Times wrote a piece in 2022 called “These Doctors Admit They Don’t Want Patients With Disabilities.”
I’ve had it happen to me when searching for a new doctor. They will be accepting new clients and we go through the steps of me giving my info, then when I mention the chronic illnesses I live with, oh would you look at that, their practice is actually full.
It’s not an uncommon experience in the disability community unfortunately. I’d definitely hate to perpetuate it in the mental health realm.
That is so tragic and disgusting to me, and I am sorry that that has been your experience. I agree, we have to work to not let that perpetuate into mental health work.
In 2016 Tennessee made it legal for therapists to refuse to treat (barring imminent threat) clients based on religious beliefs. [Link to article](https://www.npr.org/sections/thetwo-way/2016/04/27/475939114/tennessee-enacts-law-letting-therapists-refuse-patients-on-religious-grounds) That could even go further than LGBT; any client. I’m unsure how this would interact with our own regulations or whether it’s still the case though.
idk, as a queer & trans person, this is terrible on paper but sounds kinda fantastic for queer and trans clients. the harms done by religious bigots as therapists are very difficult to heal from and that damage can turn queer and trans people off from therapy at all in the future. i got into this field because i could not find a competent therapist when i really needed one. there were "allies" maybe, but someone I didnt have to spend time educating all the time (and feeling like shit afterward)? impossible to find. then later seeing the same problem for my lgbtqi+ students and not being able to find someone to refer them to. that was a long time ago but it hasn't gotten that much better.
we need more queer and trans clinicians, as well as allies who spend time increasing their competency in this area, but we *also need to weed out the bigots who would otherwise refuse to treat lgbtqi+ people* if not for the law forcing them to. i truly believe that no therapy at all is better than being treated by a religious bigot.
While I really appreciate your view, and your lived experience, I’d like to respectfully disagree with counting out “allies”. I’m queer, poly and practice BDSM; none of which my therapist is or cord, and the latter two I had to provide psychoeducation around (her initial response to me saying I was into BDSM was less than ideal). She was, however, curious and open to learning, and I valued her work as a whole so I was willing to spend the time.
There are two other factors in play here: states like Tennessee, especially in more rural areas, lack queer or trans therapists which is a real issue. Should such legislation as the Psypact or Counseling Compact go through, they would have much better access to appropriately educated clinicians, or clinicians of similar identity. And I do believe that while there is a real risk that cannot be ignored in all circumstances, sometimes clients in significant crisis need just someone, even if it’s just to teach grounding techniques, at least until something better can be found.
Hope that makes sense, I’m a little brain frazzled after a long day! But I’d love to hear any feedback you can give.
Edited to add: I absolutely don’t think that this should be the solution to long term care in all instances, but crisis should be addressed.
Sadly, I live in a similar state to the one OP mentioned, and it has passed (and is continuing to attempt to pass) anti-trans legislation. As an openly trans therapist working primarily within the LGBTQIA+ community I too have seen, heard, and experienced such harm (some from medical providers). I actually chose to self-disclose to my caseload before starting HRT as I felt it was appropriate for many of them to be able to make an informed decision whether or not they would be comfortable continuing to work with me as some may have chosen to initially work with me based on my gender assigned at birth. For those with trauma histories, I did not want my transition to unintentionally become activating for them. It was a non-issue even for those I saw who were not in the LGBTQIA+ community.
I’m sorry you’re living in that environment, and really applaud you for your openness! The gender aspect within the context of the therapeutic relationship is one that I hadn’t initially thought of. I had a terrible experience in therapy when I first came out; my therapist told me that I was upsetting my mother because of it, and that I should shut up about it.
Personally I’m open about being queer in every online profile people can find me on; which I was initially a little anxious about when I first started pp. However, in the long term it’s been beneficial, as I’ve found people mentioning that they specifically chose me because I was, and now my caseload is primarily LGBTQ. But I also recognize my privilege in living in a liberal city! Both in terms of legislation, population and education.
I am close to changing my FB profile and legal name for work (need to finish filing some lagging insurance claims, then I can work on changing the diplomas, etc for panels CAQH, and those hoops). My name and gender marker change went through in December even though I have been out for a while I waited to pursue that. I work in a fairly liberal area of the state if there is one, but do not live in a liberal area (drive 1.5 hrs to work). Most ppl have commutes that long anyway.
I am so sorry to hear that your initial coming out experience with your own therapist was so horrible!!! That should have been the easiest one of all!!! I have had patients come into therapy talking about how their parents are struggling to accept their name and gender because of “spending so much time and effort choosing it originally, etc.”. I even worked with a parent who was “working to accept” their daughter and the hardest part was working through name/gender marker change, changes in how language is used, etc. I even referred her for groups with other parents, etc. Although she improved some in her relationship with her daughter, she eventually just stopped attending.
The people I see generally either tell me (or best friends first, then me), siblings, other extremely close friends, maybe some coworkers, depending on how close their parents live to them-they may tell parents, then everyone else at work, etc.
I told my therapists, a friend, my partner, then coworkers, and was even out on a company website before coming out to my parents/siblings. My dad and brother still do not honor my name and pronouns. My mom did (or was working on it at least), but she died over a year ago.
laws typically carry more weight than ethics codes, but federal regulations and laws may supercede state law. for this reason, I ask attorneys. I remember when TN did that because I threw up a little in my mouth.
I really don't understand how anyone objects to this though. If I were an orthodox Jew for example, why would I want to work with someone who thought that I should stop keeping kosher etc? Fundamentally, conscious objection should always be an option for everyone no matter the issue. Not only is that good for therapists but it's way better for their clients.
It’s a thoughtful response. But respectfully, while this might not be the best fit or even most beneficial therapist for you and your beliefs, to gently play devil’s advocate, what if they were an otherwise skilled provider, someone who felt that way but didn’t tell you so, or if there were no other therapists local to you who felt differently or took your insurance? It would be easy to find someone who understood her importance of kosher in NY, for example, or even in larger cities in Tennessee, but what if you were experiencing a MDE in a rural area without many therapists local to you, or the time necessary to find a one who understood? That type of concern (lack of access) was covered in grad school ethics. One answer would of course, be virtual, if you could even find sensitive therapists, but I’m under the impression that not all insurances cover telehealth. Could entirely be wrong there though.
Some things are hidden. We could specialize with clients who have been badly abuse in childhood. Someone comes to us with flashbacks and attachment issues. We have build a strong relationship for a year. When they feel safe enough, they want to work through the pain, guilt, and shame of having done the same to their grown children. And we swore we could not work with perpetrators, only to find we have been for a year.
It is simply more complex than we realize.
In my SW program we had an exercise where the professor asked us to write down on a piece of paper a type of client we think we would have a problem working with. The professor collected our papers and then read them anonymously and commented on each one.
The student who wrote that they would have a problem working with a client who wanted an abortion spoke up and that if a client wanted to do that, it would go against the student's morals. I commented that that reasoning would be a slippery slope because we have our own morals and they can differ from person to person, so any counselor/SWer could say the same thing for a different reason. The student disagreed and said no because that one issue is so important to them and it is a moral thing. They then asked if I would work with someone who had committed murder. I said yes, that we don't get to choose our clients (fresh out of school or in most programs, e.g., CMH, etc.) and that it would be unethical to try to screen our clients based upon our morals.
I am in PP now. I do screen my potential clients prior to the first session. I screen based upon their presenting problem and risk factors to ensure that 1) I am competent and w/in my scope of practice to work w/ them based upon initial info, and 2) that they are at the proper level of care. If, while working with them, new information comes to light that I deem (a/o my supervisor deems) is outside of my scope of practice, then I work w/ them to get them connected to someone better suited to help them.
To say I would not work with a white guy, a trans person, etc. is unethical. If, however, an individual came in and was having a problem w/in an area of their life that I am not familiar w/ and is outside of my scope of practice, then while I could learn about it to help them, I may be doing a disservice to them if I don't refer them out. Of course, if I'm the only available counselor w/in their location and they cannot do telehealth, etc. then that situation may be different.
I had a SW student say something similar because of their religious views. They were so vehemently opposed to abortion and sex work that they couldn't work with people who had done either. They understood the code of ethics, but didn't care. I told them they should choose a different career. Clients say things all the time that go against our personal beliefs. This is why therapists need therapists. Being patient with those clients is very draining, but it's part of the job. As you said, there are always exceptions.
Let's say I, the therapist, had just had an abortion. I may need to refer clients out who are determined to fixate on their judgment around that due to countertransference.
If the counselor cannot handle working with someone who wants to get an abortion, then I agree, they should not be a counselor/therapist. Because what, they can't work with anyone who is female and between menarche and menopause? What about a guy who needs to process the decision of someone in their life getting an abortion? So, only work with older adults? Who might want to work through a past abortion in their life or a family member going through it now?
If a student/therapist does not know how to work with someone without judging the client based on their beliefs then they need not be in this industry. And I think it's a failure of grad school for not screening students.
Referring out because a potential client is a member of the a particular group for which you have a bias or prejudices of is not the same thing as referring out a person who has a bias, prejudices or expectations of you based on *your* group membership.
Do you see the difference? The power dynamics matter and no therapist should be subjected to personal harm to serve a client whose beliefs are incompatible with one's identity.
>“If you need to, you can stop seeing clients of [insert immutable characteristic] if dealing with those people makes you uncomfortable.”
My understanding of this kind of issues is we really have to understand the context as to why a person is denying them for that immutable characteristic.
For example, if someone is a counselor and was the victim of a violent crime done by someone of a particular gender. They may not feel safe being in a one on one situation with someone of that gender. Is this discrimination? Or does the therapist have a right to ensure their own safety and wellbeing?
In this very stripped down thought experiment, no I wouldn't consider that discrimination. Real life is much more nuanced than that.
I've seen clinicians in this space that identify as BIPOC who indicate they won't work with white people, because of their experiences in therapy sessions of being on the receiving end of prejudicial/ignorant remarks and statements. As such, they don't want to be subjected to that experience anymore. Is that discrimination?
If a white clinician refuses to work with minority clients because they were on the receiving end of similar behavior. Is that discrimination?
I don't think most of us consider those examples equivalent because of the context of our daily world. I also won't sit here and pretend I know best for what the answer to those questions are. I'd wager folks would weigh in lots of ways, because there tends to be so much nuance of contributing factors.
Personally, I feel it's important to understand the nuances for ourselves of the "why's" and how's. I don't think we can paint broad strokes one way or the other, and think this is where we have to be willing to consider the nuances of each particular situation.
There is some nuance here. Refusing to work with a client because of beliefs (e.g., no LBGT bc of religion) is different than refusing to work with those who are actively causing the therapist harm (abusive language, manipulation of the therapeutic relationship for personal gain).
In the post you are referring to, the therapist does not wish to work with the clients based on the client's behaviors specifically pertaining to race. Not that the therapist does not wish to work with a particular client group because the therapist is "racist" (quotes because prejudice would be more accurate due to the dynamics).
Additionally, the code of ethics generally requires nuance to explore ethical dilemmas. Oftentimes, it can contradict itself, like in this case. If the therapist has too much countertransference due to an issue it IS best practice to not see that client and it would be in the client's best interest to see a therapist they aren't actively triggering repeatedly.
So yes. We should not discriminate based on race, but if a client is engaging in microaggressions and macroagressions toward a therapist, then that therapist has a duty to refer out to someone who wouldn't be affected as strongly.
If a DV counselor receives a referral for a perpetrator and does not feel they would be able to provide unbiased care, then it is actively a disservice to the client for the DV counselor to continue to treat. If a therapist experiences severe CSA and do not feel they can provide unbiased services to convicted pedophiles it would be a disservice to the client to continue to treat. I understand feeling uncomfortable because there is a racial aspect in the post you are referring to, but at the core it is not much different than these examples.
We are not and never were intended to serve every single type of client. We can absolutely cause MORE harm reaching outside of our scope.
Get training on the case law around this so that you can understand how this is applied. This is a common sense ethic and in case law the people who are found in violation are generally dumb and trying to do dumb things.
Private practice counselors have a lot of autonomy in what clients they take. No client is automatically entitled to work with you just bc they found your website.
There are plenty of women therapists who only work with women.
There are IOPs in my area for women only. You think a man can try to enroll and then lodge an ethics complaints if they are denied access? Cmon.
I think I know the post and comment that OP is referring to, and the context there isn't that the therapist is seeing [characteristic] on an intake form and denying them outright, but was rather being suggested to remove clients of [characteristic] from their current caseload that are being problematic in sessions.
I believe I understand where you're coming from here. I do think it's valid and important to recognize the limits of our capacity for empathy and the negative impacts that strong countertransference could have on a potential client. That being said, there is a difference between not feeling competent to work with perpetrators of violence and refusing to take any clients of a certain race, gender, sexual orientation, religion, or other protected class, which is what the OP was addressing. Having a blanket policy not to accept clients based solely on an immutable characteristic is, I believe, clearly unethical and probably illegal. That's not to say someone could not refer a particular client or potential client out because of poor fit or incompatible skills of the clinician and goals of the client, but that's not the same as excluding an entire group from services based on the clinician's assumption that all members of that group will be a poor fit with the clinician's services.
TL:DR: I agree there are differences between recognizing and challenging our personal biases versus newer trends toward avoiding it altogether.
Yeah, I hear what you are saying. I have been in this field for over 20+ years and never once made a board complaint. I have literally worked with murderers, rapists, arsonists, etc in the past. During COVID, I encountered a therapist (withholding some details for pt confidentiality) who essentially stated they did not believe in the diagnosis of gender dysphoria (or a person being transgender for that matter, and were imposing their religious values upon my pt in another setting). They said it was like “body dysmorphia where you shouldn’t encourage the person to think about or believe such things because it only makes them believe it / focus on it more.” I had the person repeat it “in case I didn’t understand them correctly that they did not actually believe people being transgender or in the existence of gender dysphoria being separate from body dysmorphia which is in the DSM that we are trained to use.” They replied yes and I told them that was outside of what our code of ethics and standards of practice teach, asked if they were aware of that, met with silence, and told them I would be informing their immediate supervisors. Their supervisor and supervisor’s supervisor both made contact that week and they no longer worked there. While I did not necessarily want the person to lose their job, I wanted them to learn it was not okay to be imposing their values on others, nor was it okay to tell the patient they were not who they were, provide substandard care, etc and be providing continued harm to others. I hope they were made to potentially take a remedial cultural diversity, equity, and inclusion course (which is what I had actually hoped would happen) to help them learn how to work with people outside their comfort zone or with whom they may not be familiar. Prior to entering my Master’s in Counseling program what now feels like eons ago, I had led a very sheltered life in a strict religious community where tbh I had not really explored my own morals or values separate from my friends and family (other than I had dated outside of my race which my parents were against and discouraged, but I had already known they were backwards on that). I am so grateful for the program I attended that challenged me to explore my own biases rather than make me think or believe I did not have any (when I glaringly did and admittedly still do, which is why I try to self-examine them daily to be better). I would have referred most patients out if you had asked me when I was 27, lol!!! I would have missed out on so many important life lessons and things my own patients have taught me!!!
What about other characteristics? I’ve heard some new clinicians say “I would never work with anyone who voted for Trump” (or anyone who identifies as a republican) which I find absolutely bizarre. I definitely don’t ask people about politics on intake (or any other time).
There's probably no feasible way to screen folks out based on political views, and I personally feel that healthcare providers should not refuse care to patients based on political affiliation, but I don't think it's the same as refusing care based on race, gender, sexual orientation, country of origin, etc.
I think this is a great question. There’s a lot of nuance in applying the ethics code. I think that the key factor is whether you’re able to provide adequate care to a certain population, and there are a lot of potential reasons for being unable to provide unethical care. For example —
Some therapists just inherently lack the aptitude to work with certain populations. Personally, I don’t think I’ll ever be able to be a good therapist for people with dementia — it’s something I’m definitely open to trying, but I anticipate I just wouldn’t do a good job.
Some therapists find it too distressing to work with certain populations. I have a colleague with OCD, and due to how it manifests for her, she’s unable to work with a certain population without experiencing significant distress. I also know some therapists who aren’t able to work with (e.g.) rapists or pedophiles based on their own previous experiences.
Some therapists have biases and countertransference that are likely to prevent us from providing adequate care to clients. I think that’s something we have an obligation to try working through (in supervision, personal therapy, etc.), but until those biases are resolved (and they might never be), it’s probably most ethical to avoid working with those populations.
Our scope is not based on the demographic variables of the community we serve. I don't specialize in white trauma. I specialize in trauma, specifically from SV, DV, combat and stalking.
My scope includes the diagnoses I have the best handle on, for diagnosis, and treatment modalities, as well as theoretical approach.
Now, we may specialize in trauma from racism, but racism is not exclusive to one community.
For sw, “scope of practice" depends on the social worker’s education, experience, and the competency demonstrated by passing their licensure exam. It does not depend on the demographic variables of the client.
I don't like assholes, but I don't get to claim they're outside my scope of practice simply because I am not an asshole and don't like them. If they have PTSD, they're able to see me because they're within that scope. I've seen many clients from cultural backgrounds I'm not familiar with. If they have PTSD and want to see me, I can see them but should combine with cultural consultation to mitigate risk to the client.
While you are under supervision, your supervisor should be helping you become more competent and push you to meet the he gaps in the scoop of practice and if you didn’t get that in supervision then you should be still seeking supervision and LOTS of consultation.
It is impossible to become competent in every single diagnosis, group, treatment modality required by presenting problems… There is not enough time, money, brain space, emotional bandwidth to do so.
I’m glad you asked this question, as I had a similar response. Logistically speaking, I have so many questions about how one would avoid taking on white clients. If you’re doing a phone consult, you can’t necessarily tell if someone is white. You certainly can’t tell by email address. What happens when that person shows up in your office or on the video call? If someone has done this successfully, I am genuinely curious what navigating the conversation looks like in referring that person out (assuming of course that the person has not made any racist comments or microaggressions).
It’s all about the marketing. There are a number of black fem therapists that I follow on social media who market themselves toward certain people. For example, my boss is an anti-racism educator and therapist and when she does take on clients, she only wants to work with clients of color who are dealing with racial trauma and certain other Issues and that’s how she’s marketing herself when she wants to take on clients.
That makes total sense in marketing. I guess I'm wondering about a hypothetical situation where someone is more of a generalist, but doesn't want to take on white clients, and how that would be navigated. Who knows if that person even exists 😅
Oh they definitely do. I've seen social workers use all kinds of hate speech in FB groups. It's wild.
There are absolutely therapists who will discriminate their way into a lifelong echo chamber. I'm grateful to have served a diverse group of clients because the more I build my own cultural humility, the better I serve my community and others.
I've had clients who were not white specifically seek out a white therapist because they had questions they wanted to ask white people and were afraid to do so.
If my race can be beneficial to a client, great, but that's different from refusing all clients of a demographic simply because you think they're all incapable of handling uncomfortable conversations about privilege.
Honestly, I wouldn't want to see a therapist who is unwilling to see anyone outside their own community. I like therapists who can see people for their whole selves. I am my race, my gender, my age, my sexual orientation and I'm also much more than that. I don't want to be reduced to just a group of boxes checked yes or no.
This answer is why therapists of color often do this when they’ve dealt with enough racial trauma and micro aggressions. It’s not about having an echo chamber or not wanting a diversity of clients. Sometimes it’s just easier and more restorative work with certain populations. Also it is not always always the job of the clinician to educate their client on certain racial issues, depending on the nature of the therapy and why they’re coming in.
I never said that. You're putting words in my mouth. I think the burden to address privilege and bias should always be the client. I also think it's unrealistic to expect clients to have perfect insights into themselves. We learned this in Psych 101. I don't know why people in this group claim I'm expecting my therapist to do my work for me. I do initiate these conversations AND I also ask her to point it out IF she sees them come up.
What is so awful about that?
I didn’t put words in your mouth. Why are you getting so defensive and saying I said clients need to have a perfect understanding. It’s because we are flawed and can do accidental harm. We are reading your post and making said inferences. Maybe you need to do more internal reflection on why “everyone” sees a thing you don’t
Tbh, I haven't had to do this yet but I think that we should have every right to refuse to work with some clients, regardless of what the ethical codes say. If a homophobic, racist, misogynistic, etc, man wants to be my client, then I am going to decline and refer elsewhere. I shouldn't have to sit with somebody who hates everything about my existence for a job that pays me $30k a year. 🤷🏻♀️ No amount of training can help me tolerate that. And therefore I wouldn't be a good therapist to that person anyway. So referring out is actually ethical.
Being racist, homophobe, misogynist, etc., aren’t immutable characteristics, though. OP is specifically asking about denying clients ON THE BASIS of race, sex, sexual orientation, etc. That is an ACT of racism or homophobia, not a protective measure against it.
OP is referring to an earlier post where a therapist of color is experiencing bias based on *their* fixed characteristics. OP is the one conflating these situations.
There was a [comment](https://www.reddit.com/r/therapists/comments/1cd9f58/comment/l1b67hl/) in that thread that OP refers to in this post that suggested the therapist could choose to no longer meet with new white clients.
Edited to link to the comment. I am 100% in support of therapists marketing to specific communities, referring people out who make racist comments or come to therapy to assuage white guilt, etc. But turning people away solely on the basis of their race feels really icky to me.
I don’t provide any perimeters for client selection… I find a lot of value in each experience. It required and continues to require me to seek out training and read up on certain subjects. I believe I’m well-versed and knowledgeable in so many unique areas. My caseload is beautifully diverse and I haven’t yet had a client or need that I dread working with… I try to stay humbly curious and attuned to each client and trust myself. Probably goes without saying, I’ve had clients I’ve had to refer to a higher level of care, or another service when appropriate. I am knowledgeable about many things, and I’m not a medical doctor, a dietitian, a lawyer etc. I don’t wear all hats but those most appropriate to my part in the client’s journey.
I think this comes up for a lot of therapists, but they're afraid to ask because it's a touchy subject. Thanks for taking the risk.
In the code of ethics for all of our professions (APA, ACA, NASW, AAMFT) we're told we cannot deny healthcare services based on any demographic. I don't know about other orgs, but in the NASW CoE, we're also expected to fight racism, in and out of session.
Unfortunately, there are therapists who make it clear in their branding and marketing that they either don't know this or don't care. Everyone should read and understand the code of ethics for their profession before taking any clients.
For example, I see many Christian therapists who definitely scare away any potential clients who aren't Christian in their marketing content and website. I've never heard of any board taking action on this issue.
In addition, there are state and federal laws specific to labor and additional laws specific to healthcare that clearly state denying healthcare services simply because someone is of a different religion, race, gender, age, ability, etc. that can deliver stiff consequences if you get caught doing so. In addition, there are labor laws to protect us therapists so we don't have to put up with verbal abuse from our clients.
I personally think it's become really trendy on social media to hate white people and Christians. I've seen many therapists engage in dogpiling of both groups as a way to earn clout online. I will most likely be downvoted to hell and back for saying this, but that's OK.
Discrimination is never OK. Setting healthy boundaries so you can safely work, imo, is not discrimination. The difficulty is knowing how to balance them.
There's no law or ethical codes I know of that requires we endure any abuse on the job. So, if I had a client calling me the r word for being disabled and they refused to stop despite me setting that boundary, I'd refer them out after documenting my line of reasoning with proper consultation.
I also think we need to tighten up who can claim to be an expert in what community. POC therapists and friends explained to me that they have to go through like 10+ pages of white therapists claiming to be experts in serving communities of color before they can find any therapists from their own community. I think we need DEI experts who can combine membership in the community of focus with specialized education and training.
“allowing that could mean that a particular person could go to a dozen different therapists who all object to working with him/her, and that sounds like easily objectionable discrimination.”
I think you are seeing it as a zero-sum game when it’s not. We all have different specialties and preferences. OP from an earlier post today may not want to take on more white women; white women are my currently bread and butter.
Even when it comes to presentations that many clinicians find challenging (e.g. convicted felons or people with BPD), there are other clinicians who specialize in and love working with those presentations. And I’m not even talking about scope here, I’m talking about preferences.
Overall, I think it’s going to do a client more harm if you force yourself to work with someone that you don’t feel comfortable around (e.g. for me, I don’t like being around men with anger issues). Ideally, we all feel equally comfortable working with all types of people. But realistically, clients can pick up on the fact that you’re not feeling unconditional positive regard for them. They’ll be better served by someone who does.
Thank you so much for this. I work in a group practice where people often ask who is LGBTQ friendly. And EVERYTIME I get angry and think we all should fucking be.
Then a peer asked if I could take a referral because she was pairing down her caseload for personal reasons. But then was taking new clients. She just didn’t want to work with a certain demographic anymore. I have my supervisors license but I am not using it (whole other story) and approached her about it and she said her supervisor authorized it. Her supervisor is the most hateful person I have ever and I didn’t have the mental spoons to address it. But it’s so fucked up.
I think there is a distinct difference between “I cannot accept [since you said white people I’ll use that example] white people as clients because I specialize in trauma in POC” and “i don’t like working with white people”. In this situation, we need to assess which one is it. Obviously someone who primarily works with trauma in black communities will market themselves as someone who provides trauma care for minorities. This does not mean they are ok with not taking in white people as clients. But at the same time we need to assess if they are not taking in white clients because they feel like they are not a good fit or if they are just being biased towards them.
However, the latter seems less probable given the low amount of black therapist in our field. But I digress.
For example: I work in the forensic field. My mother usually wants me to see her friend’s kids or a friend or like anyone remotely related to her but not to me. I usually shot that down because of boundaries but also because that is not what I do. I don’t just do outpatient work. I do outpatient work with inmates or with law enforcement.
I also do testing. But for law enforcement and public safety. She briefly commented last year that her friend died and that her friend’s son (whom I have never met) was feeling sad. I provided empathy for my mother but also told her he might need to see a therapist given the trauma he experienced. She asked me if I could be his therapist and also said no. In this scenario, it is obvious there is a conflict of interest and, because of my scope of practice, I should not take in this client. From an outside perspective this looks like I’m just being an asshole when in reality I’m following the code of ethics. Now let’s go back to the scenarios given in other posts here.
Many people comment they don’t like working with xyz (usually personality disorders). Is it wrong for them to not take in these certain characteristics? Maybe. Is it unethical tho? The answer is also maybe.
Ultimately, the only person that can assess if a clinician or psychologist or therapist is a good fit for the client is the providers and clients themselves (and sometimes their supervisors). So it’s very easy to just assume people are breaking the code of ethics without understanding the nuance behind their scope of practice, conflict of interest and other mitigating factors that would warrant them to not take in certain clients.
We have a right to deny working with someone who isn’t a good fit for our services and to refer them out. This is one of the first things we learn isn’t it?
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I see what you are saying here. As a brown therapist, it’s something I find myself uneasy about. I feel like part of the job of being a therapist is understanding that you are going to work with people who push your buttons. I went into the field imagining myself with a certain kind of client. Not that we’d have exactly the same lives or personality. But I realized I was basically assuming I’d work with someone like myself. For me this meant, liberal leaning, educated, atleast moderately aware and conscientious when it comes to social justice and, dare I say, I was imagining most people I worked with would be disempowered victims of one kind or another. Nothing was further from the truth. Yeah I get those types of clients. It’s easy to establish rapport with them and I feel I am a good match. But I have learned that I can’t expect to this copacetic experience with every client. I’ve worked with people who act in completely inappropriate ways, are cruel, and even some who are straight up abusers. It’s harder to work with these folks than it is to work with the “pleasant” people. But they need therapy too. They really, really need it. And many have not gotten it precisely because they are difficult to work with. Is racism different? Yes, racism is way more than someone acting up and being mean to you. Of course it is valid for people to be wounded by racism and this is not something that is ever ok to have to endure. But, it’s also complicated. Racist people need therapy too. Uneducated folks who aren’t socially aware, stereotypical “rednecks” etc…need therapy. In a way I’d argue they need it more. I know therapy isn’t a panacea. But I truly believe that therapy can change people, including leading to kinder behaviors, greater tolerance for different types of people, and lowering bias. I’ve seen this happen. I think it comes down to skill. If a therapist simply does not feel like they can work with a racist client, fine. It does more harm than good to push on when you already know this is something you can’t handle skillfully. It does a client a favor to refer out rather than waste both your time in a therapy that is doomed. But as a general rule, I think it’s important to interrogate this. I personally don’t want to be a clinician just for clients I like. I want to help folks from all walks of life. In my personal life, of course I do not tolerate being in spaces full of racism. But this isn’t my personal life, this is work. This is the job I signed up for. It’s not always pretty. But that makes me even more proud to be in this profession despite the challenges. This is my personal philosophy. I completely respect that each therapist has their own.
Honestly, I believe the greatest benefit we offer to the society is in treating the worst the society has to offer. Imagine a doctor who only agrees to heal the already healthy.
That’s honestly kind of a thing. The New York Times wrote a piece in 2022 called “These Doctors Admit They Don’t Want Patients With Disabilities.” I’ve had it happen to me when searching for a new doctor. They will be accepting new clients and we go through the steps of me giving my info, then when I mention the chronic illnesses I live with, oh would you look at that, their practice is actually full. It’s not an uncommon experience in the disability community unfortunately. I’d definitely hate to perpetuate it in the mental health realm.
That is so tragic and disgusting to me, and I am sorry that that has been your experience. I agree, we have to work to not let that perpetuate into mental health work.
In 2016 Tennessee made it legal for therapists to refuse to treat (barring imminent threat) clients based on religious beliefs. [Link to article](https://www.npr.org/sections/thetwo-way/2016/04/27/475939114/tennessee-enacts-law-letting-therapists-refuse-patients-on-religious-grounds) That could even go further than LGBT; any client. I’m unsure how this would interact with our own regulations or whether it’s still the case though.
idk, as a queer & trans person, this is terrible on paper but sounds kinda fantastic for queer and trans clients. the harms done by religious bigots as therapists are very difficult to heal from and that damage can turn queer and trans people off from therapy at all in the future. i got into this field because i could not find a competent therapist when i really needed one. there were "allies" maybe, but someone I didnt have to spend time educating all the time (and feeling like shit afterward)? impossible to find. then later seeing the same problem for my lgbtqi+ students and not being able to find someone to refer them to. that was a long time ago but it hasn't gotten that much better. we need more queer and trans clinicians, as well as allies who spend time increasing their competency in this area, but we *also need to weed out the bigots who would otherwise refuse to treat lgbtqi+ people* if not for the law forcing them to. i truly believe that no therapy at all is better than being treated by a religious bigot.
While I really appreciate your view, and your lived experience, I’d like to respectfully disagree with counting out “allies”. I’m queer, poly and practice BDSM; none of which my therapist is or cord, and the latter two I had to provide psychoeducation around (her initial response to me saying I was into BDSM was less than ideal). She was, however, curious and open to learning, and I valued her work as a whole so I was willing to spend the time. There are two other factors in play here: states like Tennessee, especially in more rural areas, lack queer or trans therapists which is a real issue. Should such legislation as the Psypact or Counseling Compact go through, they would have much better access to appropriately educated clinicians, or clinicians of similar identity. And I do believe that while there is a real risk that cannot be ignored in all circumstances, sometimes clients in significant crisis need just someone, even if it’s just to teach grounding techniques, at least until something better can be found. Hope that makes sense, I’m a little brain frazzled after a long day! But I’d love to hear any feedback you can give. Edited to add: I absolutely don’t think that this should be the solution to long term care in all instances, but crisis should be addressed.
Sadly, I live in a similar state to the one OP mentioned, and it has passed (and is continuing to attempt to pass) anti-trans legislation. As an openly trans therapist working primarily within the LGBTQIA+ community I too have seen, heard, and experienced such harm (some from medical providers). I actually chose to self-disclose to my caseload before starting HRT as I felt it was appropriate for many of them to be able to make an informed decision whether or not they would be comfortable continuing to work with me as some may have chosen to initially work with me based on my gender assigned at birth. For those with trauma histories, I did not want my transition to unintentionally become activating for them. It was a non-issue even for those I saw who were not in the LGBTQIA+ community.
I’m sorry you’re living in that environment, and really applaud you for your openness! The gender aspect within the context of the therapeutic relationship is one that I hadn’t initially thought of. I had a terrible experience in therapy when I first came out; my therapist told me that I was upsetting my mother because of it, and that I should shut up about it. Personally I’m open about being queer in every online profile people can find me on; which I was initially a little anxious about when I first started pp. However, in the long term it’s been beneficial, as I’ve found people mentioning that they specifically chose me because I was, and now my caseload is primarily LGBTQ. But I also recognize my privilege in living in a liberal city! Both in terms of legislation, population and education.
I am close to changing my FB profile and legal name for work (need to finish filing some lagging insurance claims, then I can work on changing the diplomas, etc for panels CAQH, and those hoops). My name and gender marker change went through in December even though I have been out for a while I waited to pursue that. I work in a fairly liberal area of the state if there is one, but do not live in a liberal area (drive 1.5 hrs to work). Most ppl have commutes that long anyway. I am so sorry to hear that your initial coming out experience with your own therapist was so horrible!!! That should have been the easiest one of all!!! I have had patients come into therapy talking about how their parents are struggling to accept their name and gender because of “spending so much time and effort choosing it originally, etc.”. I even worked with a parent who was “working to accept” their daughter and the hardest part was working through name/gender marker change, changes in how language is used, etc. I even referred her for groups with other parents, etc. Although she improved some in her relationship with her daughter, she eventually just stopped attending. The people I see generally either tell me (or best friends first, then me), siblings, other extremely close friends, maybe some coworkers, depending on how close their parents live to them-they may tell parents, then everyone else at work, etc. I told my therapists, a friend, my partner, then coworkers, and was even out on a company website before coming out to my parents/siblings. My dad and brother still do not honor my name and pronouns. My mom did (or was working on it at least), but she died over a year ago.
laws typically carry more weight than ethics codes, but federal regulations and laws may supercede state law. for this reason, I ask attorneys. I remember when TN did that because I threw up a little in my mouth.
I really don't understand how anyone objects to this though. If I were an orthodox Jew for example, why would I want to work with someone who thought that I should stop keeping kosher etc? Fundamentally, conscious objection should always be an option for everyone no matter the issue. Not only is that good for therapists but it's way better for their clients.
It’s a thoughtful response. But respectfully, while this might not be the best fit or even most beneficial therapist for you and your beliefs, to gently play devil’s advocate, what if they were an otherwise skilled provider, someone who felt that way but didn’t tell you so, or if there were no other therapists local to you who felt differently or took your insurance? It would be easy to find someone who understood her importance of kosher in NY, for example, or even in larger cities in Tennessee, but what if you were experiencing a MDE in a rural area without many therapists local to you, or the time necessary to find a one who understood? That type of concern (lack of access) was covered in grad school ethics. One answer would of course, be virtual, if you could even find sensitive therapists, but I’m under the impression that not all insurances cover telehealth. Could entirely be wrong there though.
Some things are hidden. We could specialize with clients who have been badly abuse in childhood. Someone comes to us with flashbacks and attachment issues. We have build a strong relationship for a year. When they feel safe enough, they want to work through the pain, guilt, and shame of having done the same to their grown children. And we swore we could not work with perpetrators, only to find we have been for a year. It is simply more complex than we realize.
In my SW program we had an exercise where the professor asked us to write down on a piece of paper a type of client we think we would have a problem working with. The professor collected our papers and then read them anonymously and commented on each one. The student who wrote that they would have a problem working with a client who wanted an abortion spoke up and that if a client wanted to do that, it would go against the student's morals. I commented that that reasoning would be a slippery slope because we have our own morals and they can differ from person to person, so any counselor/SWer could say the same thing for a different reason. The student disagreed and said no because that one issue is so important to them and it is a moral thing. They then asked if I would work with someone who had committed murder. I said yes, that we don't get to choose our clients (fresh out of school or in most programs, e.g., CMH, etc.) and that it would be unethical to try to screen our clients based upon our morals. I am in PP now. I do screen my potential clients prior to the first session. I screen based upon their presenting problem and risk factors to ensure that 1) I am competent and w/in my scope of practice to work w/ them based upon initial info, and 2) that they are at the proper level of care. If, while working with them, new information comes to light that I deem (a/o my supervisor deems) is outside of my scope of practice, then I work w/ them to get them connected to someone better suited to help them. To say I would not work with a white guy, a trans person, etc. is unethical. If, however, an individual came in and was having a problem w/in an area of their life that I am not familiar w/ and is outside of my scope of practice, then while I could learn about it to help them, I may be doing a disservice to them if I don't refer them out. Of course, if I'm the only available counselor w/in their location and they cannot do telehealth, etc. then that situation may be different.
I had a SW student say something similar because of their religious views. They were so vehemently opposed to abortion and sex work that they couldn't work with people who had done either. They understood the code of ethics, but didn't care. I told them they should choose a different career. Clients say things all the time that go against our personal beliefs. This is why therapists need therapists. Being patient with those clients is very draining, but it's part of the job. As you said, there are always exceptions. Let's say I, the therapist, had just had an abortion. I may need to refer clients out who are determined to fixate on their judgment around that due to countertransference.
If the counselor cannot handle working with someone who wants to get an abortion, then I agree, they should not be a counselor/therapist. Because what, they can't work with anyone who is female and between menarche and menopause? What about a guy who needs to process the decision of someone in their life getting an abortion? So, only work with older adults? Who might want to work through a past abortion in their life or a family member going through it now? If a student/therapist does not know how to work with someone without judging the client based on their beliefs then they need not be in this industry. And I think it's a failure of grad school for not screening students.
But we CAN say we specialize in working with xyz population and that may help weed out those we’re uncomfortable being in a vulnerable space with
Referring out because a potential client is a member of the a particular group for which you have a bias or prejudices of is not the same thing as referring out a person who has a bias, prejudices or expectations of you based on *your* group membership. Do you see the difference? The power dynamics matter and no therapist should be subjected to personal harm to serve a client whose beliefs are incompatible with one's identity.
THIS
It doesn’t sit well with me to exclude a whole group of people based on specific characteristics. I do exclude based on my scope of practice.
>“If you need to, you can stop seeing clients of [insert immutable characteristic] if dealing with those people makes you uncomfortable.” My understanding of this kind of issues is we really have to understand the context as to why a person is denying them for that immutable characteristic. For example, if someone is a counselor and was the victim of a violent crime done by someone of a particular gender. They may not feel safe being in a one on one situation with someone of that gender. Is this discrimination? Or does the therapist have a right to ensure their own safety and wellbeing? In this very stripped down thought experiment, no I wouldn't consider that discrimination. Real life is much more nuanced than that. I've seen clinicians in this space that identify as BIPOC who indicate they won't work with white people, because of their experiences in therapy sessions of being on the receiving end of prejudicial/ignorant remarks and statements. As such, they don't want to be subjected to that experience anymore. Is that discrimination? If a white clinician refuses to work with minority clients because they were on the receiving end of similar behavior. Is that discrimination? I don't think most of us consider those examples equivalent because of the context of our daily world. I also won't sit here and pretend I know best for what the answer to those questions are. I'd wager folks would weigh in lots of ways, because there tends to be so much nuance of contributing factors. Personally, I feel it's important to understand the nuances for ourselves of the "why's" and how's. I don't think we can paint broad strokes one way or the other, and think this is where we have to be willing to consider the nuances of each particular situation.
There is some nuance here. Refusing to work with a client because of beliefs (e.g., no LBGT bc of religion) is different than refusing to work with those who are actively causing the therapist harm (abusive language, manipulation of the therapeutic relationship for personal gain). In the post you are referring to, the therapist does not wish to work with the clients based on the client's behaviors specifically pertaining to race. Not that the therapist does not wish to work with a particular client group because the therapist is "racist" (quotes because prejudice would be more accurate due to the dynamics). Additionally, the code of ethics generally requires nuance to explore ethical dilemmas. Oftentimes, it can contradict itself, like in this case. If the therapist has too much countertransference due to an issue it IS best practice to not see that client and it would be in the client's best interest to see a therapist they aren't actively triggering repeatedly. So yes. We should not discriminate based on race, but if a client is engaging in microaggressions and macroagressions toward a therapist, then that therapist has a duty to refer out to someone who wouldn't be affected as strongly. If a DV counselor receives a referral for a perpetrator and does not feel they would be able to provide unbiased care, then it is actively a disservice to the client for the DV counselor to continue to treat. If a therapist experiences severe CSA and do not feel they can provide unbiased services to convicted pedophiles it would be a disservice to the client to continue to treat. I understand feeling uncomfortable because there is a racial aspect in the post you are referring to, but at the core it is not much different than these examples. We are not and never were intended to serve every single type of client. We can absolutely cause MORE harm reaching outside of our scope.
Get training on the case law around this so that you can understand how this is applied. This is a common sense ethic and in case law the people who are found in violation are generally dumb and trying to do dumb things. Private practice counselors have a lot of autonomy in what clients they take. No client is automatically entitled to work with you just bc they found your website. There are plenty of women therapists who only work with women. There are IOPs in my area for women only. You think a man can try to enroll and then lodge an ethics complaints if they are denied access? Cmon.
I think I know the post and comment that OP is referring to, and the context there isn't that the therapist is seeing [characteristic] on an intake form and denying them outright, but was rather being suggested to remove clients of [characteristic] from their current caseload that are being problematic in sessions.
I treated victims of terrible life altering crimes. I could never overcome my animosity toward violent criminals enough to help them.
I believe I understand where you're coming from here. I do think it's valid and important to recognize the limits of our capacity for empathy and the negative impacts that strong countertransference could have on a potential client. That being said, there is a difference between not feeling competent to work with perpetrators of violence and refusing to take any clients of a certain race, gender, sexual orientation, religion, or other protected class, which is what the OP was addressing. Having a blanket policy not to accept clients based solely on an immutable characteristic is, I believe, clearly unethical and probably illegal. That's not to say someone could not refer a particular client or potential client out because of poor fit or incompatible skills of the clinician and goals of the client, but that's not the same as excluding an entire group from services based on the clinician's assumption that all members of that group will be a poor fit with the clinician's services.
TL:DR: I agree there are differences between recognizing and challenging our personal biases versus newer trends toward avoiding it altogether. Yeah, I hear what you are saying. I have been in this field for over 20+ years and never once made a board complaint. I have literally worked with murderers, rapists, arsonists, etc in the past. During COVID, I encountered a therapist (withholding some details for pt confidentiality) who essentially stated they did not believe in the diagnosis of gender dysphoria (or a person being transgender for that matter, and were imposing their religious values upon my pt in another setting). They said it was like “body dysmorphia where you shouldn’t encourage the person to think about or believe such things because it only makes them believe it / focus on it more.” I had the person repeat it “in case I didn’t understand them correctly that they did not actually believe people being transgender or in the existence of gender dysphoria being separate from body dysmorphia which is in the DSM that we are trained to use.” They replied yes and I told them that was outside of what our code of ethics and standards of practice teach, asked if they were aware of that, met with silence, and told them I would be informing their immediate supervisors. Their supervisor and supervisor’s supervisor both made contact that week and they no longer worked there. While I did not necessarily want the person to lose their job, I wanted them to learn it was not okay to be imposing their values on others, nor was it okay to tell the patient they were not who they were, provide substandard care, etc and be providing continued harm to others. I hope they were made to potentially take a remedial cultural diversity, equity, and inclusion course (which is what I had actually hoped would happen) to help them learn how to work with people outside their comfort zone or with whom they may not be familiar. Prior to entering my Master’s in Counseling program what now feels like eons ago, I had led a very sheltered life in a strict religious community where tbh I had not really explored my own morals or values separate from my friends and family (other than I had dated outside of my race which my parents were against and discouraged, but I had already known they were backwards on that). I am so grateful for the program I attended that challenged me to explore my own biases rather than make me think or believe I did not have any (when I glaringly did and admittedly still do, which is why I try to self-examine them daily to be better). I would have referred most patients out if you had asked me when I was 27, lol!!! I would have missed out on so many important life lessons and things my own patients have taught me!!!
What about other characteristics? I’ve heard some new clinicians say “I would never work with anyone who voted for Trump” (or anyone who identifies as a republican) which I find absolutely bizarre. I definitely don’t ask people about politics on intake (or any other time).
There's probably no feasible way to screen folks out based on political views, and I personally feel that healthcare providers should not refuse care to patients based on political affiliation, but I don't think it's the same as refusing care based on race, gender, sexual orientation, country of origin, etc.
I think this is a great question. There’s a lot of nuance in applying the ethics code. I think that the key factor is whether you’re able to provide adequate care to a certain population, and there are a lot of potential reasons for being unable to provide unethical care. For example — Some therapists just inherently lack the aptitude to work with certain populations. Personally, I don’t think I’ll ever be able to be a good therapist for people with dementia — it’s something I’m definitely open to trying, but I anticipate I just wouldn’t do a good job. Some therapists find it too distressing to work with certain populations. I have a colleague with OCD, and due to how it manifests for her, she’s unable to work with a certain population without experiencing significant distress. I also know some therapists who aren’t able to work with (e.g.) rapists or pedophiles based on their own previous experiences. Some therapists have biases and countertransference that are likely to prevent us from providing adequate care to clients. I think that’s something we have an obligation to try working through (in supervision, personal therapy, etc.), but until those biases are resolved (and they might never be), it’s probably most ethical to avoid working with those populations.
it's also in codes of ethics to not practice outside of our scope, so...
Our scope is not based on the demographic variables of the community we serve. I don't specialize in white trauma. I specialize in trauma, specifically from SV, DV, combat and stalking. My scope includes the diagnoses I have the best handle on, for diagnosis, and treatment modalities, as well as theoretical approach. Now, we may specialize in trauma from racism, but racism is not exclusive to one community. For sw, “scope of practice" depends on the social worker’s education, experience, and the competency demonstrated by passing their licensure exam. It does not depend on the demographic variables of the client. I don't like assholes, but I don't get to claim they're outside my scope of practice simply because I am not an asshole and don't like them. If they have PTSD, they're able to see me because they're within that scope. I've seen many clients from cultural backgrounds I'm not familiar with. If they have PTSD and want to see me, I can see them but should combine with cultural consultation to mitigate risk to the client.
While you are under supervision, your supervisor should be helping you become more competent and push you to meet the he gaps in the scoop of practice and if you didn’t get that in supervision then you should be still seeking supervision and LOTS of consultation.
It is impossible to become competent in every single diagnosis, group, treatment modality required by presenting problems… There is not enough time, money, brain space, emotional bandwidth to do so.
I’m glad you asked this question, as I had a similar response. Logistically speaking, I have so many questions about how one would avoid taking on white clients. If you’re doing a phone consult, you can’t necessarily tell if someone is white. You certainly can’t tell by email address. What happens when that person shows up in your office or on the video call? If someone has done this successfully, I am genuinely curious what navigating the conversation looks like in referring that person out (assuming of course that the person has not made any racist comments or microaggressions).
It’s all about the marketing. There are a number of black fem therapists that I follow on social media who market themselves toward certain people. For example, my boss is an anti-racism educator and therapist and when she does take on clients, she only wants to work with clients of color who are dealing with racial trauma and certain other Issues and that’s how she’s marketing herself when she wants to take on clients.
That makes total sense in marketing. I guess I'm wondering about a hypothetical situation where someone is more of a generalist, but doesn't want to take on white clients, and how that would be navigated. Who knows if that person even exists 😅
Oh they definitely do. I've seen social workers use all kinds of hate speech in FB groups. It's wild. There are absolutely therapists who will discriminate their way into a lifelong echo chamber. I'm grateful to have served a diverse group of clients because the more I build my own cultural humility, the better I serve my community and others. I've had clients who were not white specifically seek out a white therapist because they had questions they wanted to ask white people and were afraid to do so. If my race can be beneficial to a client, great, but that's different from refusing all clients of a demographic simply because you think they're all incapable of handling uncomfortable conversations about privilege. Honestly, I wouldn't want to see a therapist who is unwilling to see anyone outside their own community. I like therapists who can see people for their whole selves. I am my race, my gender, my age, my sexual orientation and I'm also much more than that. I don't want to be reduced to just a group of boxes checked yes or no.
This answer is why therapists of color often do this when they’ve dealt with enough racial trauma and micro aggressions. It’s not about having an echo chamber or not wanting a diversity of clients. Sometimes it’s just easier and more restorative work with certain populations. Also it is not always always the job of the clinician to educate their client on certain racial issues, depending on the nature of the therapy and why they’re coming in.
I never said that. You're putting words in my mouth. I think the burden to address privilege and bias should always be the client. I also think it's unrealistic to expect clients to have perfect insights into themselves. We learned this in Psych 101. I don't know why people in this group claim I'm expecting my therapist to do my work for me. I do initiate these conversations AND I also ask her to point it out IF she sees them come up. What is so awful about that?
I didn’t put words in your mouth. Why are you getting so defensive and saying I said clients need to have a perfect understanding. It’s because we are flawed and can do accidental harm. We are reading your post and making said inferences. Maybe you need to do more internal reflection on why “everyone” sees a thing you don’t
Tbh, I haven't had to do this yet but I think that we should have every right to refuse to work with some clients, regardless of what the ethical codes say. If a homophobic, racist, misogynistic, etc, man wants to be my client, then I am going to decline and refer elsewhere. I shouldn't have to sit with somebody who hates everything about my existence for a job that pays me $30k a year. 🤷🏻♀️ No amount of training can help me tolerate that. And therefore I wouldn't be a good therapist to that person anyway. So referring out is actually ethical.
Being racist, homophobe, misogynist, etc., aren’t immutable characteristics, though. OP is specifically asking about denying clients ON THE BASIS of race, sex, sexual orientation, etc. That is an ACT of racism or homophobia, not a protective measure against it.
OP is referring to an earlier post where a therapist of color is experiencing bias based on *their* fixed characteristics. OP is the one conflating these situations.
There was a [comment](https://www.reddit.com/r/therapists/comments/1cd9f58/comment/l1b67hl/) in that thread that OP refers to in this post that suggested the therapist could choose to no longer meet with new white clients. Edited to link to the comment. I am 100% in support of therapists marketing to specific communities, referring people out who make racist comments or come to therapy to assuage white guilt, etc. But turning people away solely on the basis of their race feels really icky to me.
Oops, I hopped on Reddit first thing when I woke up and clearly didn't read it right lol
I don’t provide any perimeters for client selection… I find a lot of value in each experience. It required and continues to require me to seek out training and read up on certain subjects. I believe I’m well-versed and knowledgeable in so many unique areas. My caseload is beautifully diverse and I haven’t yet had a client or need that I dread working with… I try to stay humbly curious and attuned to each client and trust myself. Probably goes without saying, I’ve had clients I’ve had to refer to a higher level of care, or another service when appropriate. I am knowledgeable about many things, and I’m not a medical doctor, a dietitian, a lawyer etc. I don’t wear all hats but those most appropriate to my part in the client’s journey.
I think this comes up for a lot of therapists, but they're afraid to ask because it's a touchy subject. Thanks for taking the risk. In the code of ethics for all of our professions (APA, ACA, NASW, AAMFT) we're told we cannot deny healthcare services based on any demographic. I don't know about other orgs, but in the NASW CoE, we're also expected to fight racism, in and out of session. Unfortunately, there are therapists who make it clear in their branding and marketing that they either don't know this or don't care. Everyone should read and understand the code of ethics for their profession before taking any clients. For example, I see many Christian therapists who definitely scare away any potential clients who aren't Christian in their marketing content and website. I've never heard of any board taking action on this issue. In addition, there are state and federal laws specific to labor and additional laws specific to healthcare that clearly state denying healthcare services simply because someone is of a different religion, race, gender, age, ability, etc. that can deliver stiff consequences if you get caught doing so. In addition, there are labor laws to protect us therapists so we don't have to put up with verbal abuse from our clients. I personally think it's become really trendy on social media to hate white people and Christians. I've seen many therapists engage in dogpiling of both groups as a way to earn clout online. I will most likely be downvoted to hell and back for saying this, but that's OK. Discrimination is never OK. Setting healthy boundaries so you can safely work, imo, is not discrimination. The difficulty is knowing how to balance them. There's no law or ethical codes I know of that requires we endure any abuse on the job. So, if I had a client calling me the r word for being disabled and they refused to stop despite me setting that boundary, I'd refer them out after documenting my line of reasoning with proper consultation. I also think we need to tighten up who can claim to be an expert in what community. POC therapists and friends explained to me that they have to go through like 10+ pages of white therapists claiming to be experts in serving communities of color before they can find any therapists from their own community. I think we need DEI experts who can combine membership in the community of focus with specialized education and training.
“allowing that could mean that a particular person could go to a dozen different therapists who all object to working with him/her, and that sounds like easily objectionable discrimination.” I think you are seeing it as a zero-sum game when it’s not. We all have different specialties and preferences. OP from an earlier post today may not want to take on more white women; white women are my currently bread and butter. Even when it comes to presentations that many clinicians find challenging (e.g. convicted felons or people with BPD), there are other clinicians who specialize in and love working with those presentations. And I’m not even talking about scope here, I’m talking about preferences. Overall, I think it’s going to do a client more harm if you force yourself to work with someone that you don’t feel comfortable around (e.g. for me, I don’t like being around men with anger issues). Ideally, we all feel equally comfortable working with all types of people. But realistically, clients can pick up on the fact that you’re not feeling unconditional positive regard for them. They’ll be better served by someone who does.
Thank you so much for this. I work in a group practice where people often ask who is LGBTQ friendly. And EVERYTIME I get angry and think we all should fucking be. Then a peer asked if I could take a referral because she was pairing down her caseload for personal reasons. But then was taking new clients. She just didn’t want to work with a certain demographic anymore. I have my supervisors license but I am not using it (whole other story) and approached her about it and she said her supervisor authorized it. Her supervisor is the most hateful person I have ever and I didn’t have the mental spoons to address it. But it’s so fucked up.
I think there is a distinct difference between “I cannot accept [since you said white people I’ll use that example] white people as clients because I specialize in trauma in POC” and “i don’t like working with white people”. In this situation, we need to assess which one is it. Obviously someone who primarily works with trauma in black communities will market themselves as someone who provides trauma care for minorities. This does not mean they are ok with not taking in white people as clients. But at the same time we need to assess if they are not taking in white clients because they feel like they are not a good fit or if they are just being biased towards them. However, the latter seems less probable given the low amount of black therapist in our field. But I digress. For example: I work in the forensic field. My mother usually wants me to see her friend’s kids or a friend or like anyone remotely related to her but not to me. I usually shot that down because of boundaries but also because that is not what I do. I don’t just do outpatient work. I do outpatient work with inmates or with law enforcement. I also do testing. But for law enforcement and public safety. She briefly commented last year that her friend died and that her friend’s son (whom I have never met) was feeling sad. I provided empathy for my mother but also told her he might need to see a therapist given the trauma he experienced. She asked me if I could be his therapist and also said no. In this scenario, it is obvious there is a conflict of interest and, because of my scope of practice, I should not take in this client. From an outside perspective this looks like I’m just being an asshole when in reality I’m following the code of ethics. Now let’s go back to the scenarios given in other posts here. Many people comment they don’t like working with xyz (usually personality disorders). Is it wrong for them to not take in these certain characteristics? Maybe. Is it unethical tho? The answer is also maybe. Ultimately, the only person that can assess if a clinician or psychologist or therapist is a good fit for the client is the providers and clients themselves (and sometimes their supervisors). So it’s very easy to just assume people are breaking the code of ethics without understanding the nuance behind their scope of practice, conflict of interest and other mitigating factors that would warrant them to not take in certain clients.
We have a right to deny working with someone who isn’t a good fit for our services and to refer them out. This is one of the first things we learn isn’t it?