Psychotherapy in Black and White: An Examination of How Race Is Discussed in a Sample of Black American Clients and White American Counselors

Psychotherapy between Black/African American clients and White American counselors poses unique challenges and can be fraught, especially when race is discussed. The present study seeks to identify what counselor behaviors or sequences of client and counselor behaviors tend to occur when Black American clients and White American counselors discuss race during counseling, and which behavioral sequences are associated with more positive therapy processes. Twenty psychotherapy sessions in which Black American clients broached race-related topics with non-Hispanic White American counselors were selected from a larger study of broaching race in cross-racial therapy (data collected in 2012). Video recordings of psychotherapy sessions were analyzed qualitatively using pattern coding. Black American clients were more likely to broach the topic of race than the White American counselors. When clients broached the topic of race, counselors who asked exploratory questions, attended to the racial content, shared experiential self-disclosures, validated and affirmed the client’s unique racial experiences, and managed their anxiety tended to elicit deeper self-disclosures from clients and fewer rupture events. In order to improve the quality of mental health care provided to minoritized clients, White counselors are encouraged to seek out training; education; and supervision to increase their multicultural awareness, apply microcounseling skills during discussions of race, and manage racial anxiety.