Radical transformations
Therapy Today, October 2021

An increasingly obvious known is the depth and complexity that arises when exploring relational, power and authority dynamics in the therapy room, in therapy and allied professional trainings and in supervision. Continuous reflective study is necessary in order to be working towards recurrently developing good practice and better emotional and psychological health. This begs the question: who is responsible for transforming what, exactly?

We are all responsible for the ongoing transforming needed. Perhaps it is in the form of depth of acceptance and coming to terms with doing something about limitations in our thinking and practice; perhaps it is in creating sounder structures that invite, embrace and support the challenging of insular and unaware ‘sacred cows’. I suggest we are all responsible for ensuring both, demanding nothing less from ourselves, each other and, vitally, from our various institutions and practice settings. If not, the ‘serious (philosophic, practice, moral and ethical) negligence’ referred to by Lago and Charura¹ not only remains but also becomes increasingly and dangerously further embedded.

Mckenzie-Mavinga,² citing a Sainsbury Centre for Mental Health review from 2002, reminds us of an absence when it comes to ‘accounting for the historical and sociocultural context of situations’ in relation to black clients, service users and others. My experience is that this is equally true in training, CPD, supervision, conference and workshop situations for black-identified professionals, trainees and clients, and also for others who are seen as ‘not the majority’.

Equally, I think leaps of understanding are needed in order to appreciate the ‘multidimensional oppressions such as homophobia, sexism, ableism, and cultural taboos’ in the ‘development of intersecting identities’.² This integration of understanding allows a working through of the challenges and obstacles of racism and, by implication, a working through of the challenges of all other oppressive dynamics and practices in relation to the multiplicity of identities that apply in specific situations and contexts. I would like to start this exploration by describing Claudine’s story.

Claudine

Claudine had been seeing a white, straight, woman counsellor for a couple of years after the break-up of her marriage. At age 40, Claudine felt that she needed to look again at who she was and how she would approach the rest of her life. Claudine had good established friendships in her community. A tall, dark-skinned, black British woman, she had questioned her sexuality and come to realise she was not sure about it, or even about her gender identity. When she found the courage to disclose these thoughts for the first time, her counsellor responded, ‘I’ve never heard of a black woman your age doing this.’ She paused and then added, ‘How do you think your community will react?’

Claudine more or less shut down at this point, said she didn’t really know and then said she needed to leave early and would see her counsellor next week. Claudine got up and left the session and did not go back.

This example helps us to explore several things that are vital in good therapeutic work:

• to appreciate and acknowledge how complex one communication from a client can be
• to recognise and develop the ability not to use generalisations in our work
• to recognise and practise the ability not to ask questions but rather encourage exploration, especially when faced with an area that we are uncomfortable and/or unfamiliar with
• to develop the capacity to simply state when we are in territory that is new for us and to be transparent about this, with and in the interest of the client.

In terms of good practice, Claudine’s disclosure required a sensitive and nuanced response from the counsellor; one that stayed with the client’s experience in the moment of telling her counsellor something new about herself. The first words in response to Claudine were what the counsellor had heard of, or not heard of – this is a common reactive mistake by practitioners, as well as trainee therapists, when faced with something outside their experience: to speak from their experience or from their lack of experience. In making the focus their own experience or their limitation of experience, they are not staying in the moment with their client, even when they ‘know’ to do otherwise. Practitioners can, through good reflective practice and supervision, come to realise how often what we ‘know’ and what we ‘do’ are not the same.

I am aware of what is taught about staying with the client’s experience across different modality approaches. However, the vignette is an accurate reflection of what can often come into my practice room from the work of trainees and supervisees, where reactive responses, sometimes masked in the language of therapy or the therapist’s position, are substituted for actual being with what is happening in the room, in the moment.

The trap of comfortable

We can speculate that the counsellor had become comfortable with seeing Claudine, maybe thinking she already knew the client’s issues after a couple of years of working with her. The disclosure may have been a surprise or may have been something she had, somehow, out of awareness, not welcomed in the room.

When the counsellor says ‘…a black woman, your age, doing this…’, this is both a generalisation about black women and also a change of focus from the client’s ‘personal experience’ of questioning herself to a blander comment to the client about ‘black women her age’. The client becomes much less visible in this exchange.

From a supervision viewpoint, some key words for me in starting to explore what happened and what can be learned would be ‘I’ve never heard of…’ By encouraging the supervisee to notice they started with what they have heard/not heard of, it can allow them to recognise, take ownership of and make meaning out of their ‘delegitimising’ of the client’s experiencing of herself. It also draws attention to where the therapist puts their focus. This can often become an unconscious and unexplored power and authority issue between the therapist and their client. In choosing ‘I’ve never heard of…’ as my invitation to the therapist to explore in supervision with me, I am attempting to model staying with the supervisee’s actions, thought processes and behaviours. I am not giving a reactive response that brings the attention to me.

Some questions and thoughts I might offer as part of the reflecting on the processes at play are:

• What does the therapist get from doing this, in this way?
• What is deflected or avoided in the response and the quickness of the response?
• How does the therapist understand their reaction? Not in the context of their own story – although this may have relevance; rather, in the context of how this has impacted the therapeutic space between therapist and client.
• What is the nature of the power dynamics underlying how the counsellor ‘holds’ the therapy space?

Reflection on the therapist’s understanding in relation to their own story might also be called for. However the key point here is the client’s experience with the therapist as the exchange happens and the consequent impact on their relationship. What the above leads me to is a question that I believe is vital for us all as practitioners: ‘Are we willing to deconstruct ourselves and thus make the possibility of ongoing repeated reconstruction a way of working in future?’

In the vignette, ‘I’ve never heard of…’ becomes an out-of-awareness benchmark of ‘normality’ in the exchange, implying somehow that what the client says is less valid simply because the counsellor (psychotherapist, psychologist, psychiatrist, trainer, service manager, trustee) has ‘not heard of it’. There is an important reality to add here that is perhaps more difficult to face: the experience of people from ‘different’ groups of being made less visible also occurs for the ‘different’ therapist, supervisor, manager and trustee. It happens when the client, supervisee, trainee, staff member, other trustees and so forth seem unaware of acting and speaking from their place of privilege.

Earlier, I stated, ‘This can often become an unconscious and unexplored power and authority issue between the therapist and their client.’ I have had British-born and/or British-raised supervisees tell me of incidents where a client (usually white and educated) ‘corrected’ their pronunciation of a word or offered a class-based test such as, ‘Well, as you know…’ followed by some quote in Latin, or exclaimed, ‘You haven’t read/seen…?!’ They take a normative that relates more readily to their background and apply it ‘as if’ all should know or have experienced the same. This subtextual ‘putting in place’ happens also between therapists and other professionals on email listings and in other forums.

Revisiting Claudine’s session

This time, I imagine a different and longer exchange. I offer it as a possibility for differentiated experiencing and meaning-making. The words used below are not meant to tell the reader ‘this is how you say it’. The ideas and intentions behind the words, the attention to the moments, are what is important in the reimagining.

Here, I am looking to show reflectively informed interventions and concepts. In this reimagining, I attempt to show how a more reflective response, and one that is not attached to the therapist’s own experience, could have a very different effect. What is offered below hopefully simply encourages you to think about what you would say in similar circumstances and how else you might respond to your client and your client’s disclosures.

Claudine’s story – version two

When Claudine found the courage to disclose these thoughts for the first time to her (straight) counsellor, the counsellor (after breathing and taking in the client and herself in the moment as she spoke) responded:

Therapist: You are not sure about your sexuality, and you are not sure about your sexual identity… (breath) Notice how it is for you to say this to me here, today…

Claudine: Um… It’s strange… I have not told anybody else this… I mean, I haven’t been sure I could tell you…

Therapist: You weren’t sure you could tell me? Say more… if you want.

Claudine: I… look, we haven’t talked much about you, about how you are different from me… Like I said, it’s strange…

Therapist: (after breathing and settling in own body) Well, what you have just said is my experience also… (offers gap for client response, then continues) We have not talked here about how I am different from you… (offers gap for client response, then goes on) I am realising I have never asked you directly what it is like for you to have me as your counsellor… It sounds like it has had an effect on you (pauses) and has somehow stopped you saying more about what goes on for you…

The therapist maintains some eye contact for moments while saying the above, and again allows the client space to take in her words. She does not ask questions of the client. Not asking questions of the client at this point is crucial; the therapist needs to stay with the client and allow her space to respond. This allows the client to know that this is a relational exchange, and that the therapist welcomes her questioning and is giving it her full consideration. It can potentially rebalance some of the power dynamics always at play in the therapy room.

Therapist: (after a moment of conscious breathing) I notice I want to say a bit more about our differences… Is that OK for you?

Claudine: (laughs a little) Well, it is the elephant, isn’t it?

Therapist: Yes, it is the elephant in the room between us. (smiles) Um… I am noticing my regret that I did not do this with you before now… (allows space for client to hear her words) So now, I am naming my whiteness, your blackness, my straightness and your questioning of your sexuality… (waits for the client to choose what she wishes to respond to)

Note the therapist is consciously trying to not set the agenda here. She is staying with the client’s interest.

Claudine: Oh well… You named it, you’re white and straight… and I feel, I feel like this is the beginning…

Therapist: The beginning? The beginning for us (therapist clarifies her understanding)?

Claudine: Yes… like we are beginning now… everything we did before was important… but this feels like now we start with each other for real.

Therapist: Now we start for real with each other… and I am discovering something here with you that matters in our relationship… I want to do this here with you…

Claudine: So, have you ever said you are straight to a client before? I mean, is that new for you?

Therapist: (deep steadying breath) I will answer your question but I want to ask you how this matters right now for you… and I will answer in a moment.

Claudine: Umm… I think it tells me if you are being real here with me…

Therapist: I’m doing my best to be that… (pause) Yes, it is the first time I have told a client I am straight… or, as I think about the questions you brought, I’d like to say to you now that straight is how I identify… (silence for a while)

The therapist tries to capture the essence of what the client has brought by correcting to ‘straight is how I identify’. In using these words, the therapist makes a clearer statement and also reflects her awareness of identity as a process.

Therapist: Would you share what you are noticing… right now?

Claudine: (big breath) I’m realising how much not knowing about you has really stopped me from trusting you… not all the time, but how there are parts of me I thought you can’t get… Umm. I think I am more wary here than I had realised… and I am thinking about this… (silence for a while)

Therapist: Maybe what we do today allows something to emerge… that has some meaning around how we handle difference here… (silence for a while) I have things to reflect on and you have things to reflect on… I suggest we can each see what emerges between now and next time we meet… How does that sound for you?

Claudine: I can agree to that… I need time to digest… I’ll be here next week.

Therapist: OK, and I agree to do some digesting also… I’ll see you next week.

Staying with the present

In this version, the therapist is staying with the emergent present experiencing in the room, and not trying to ‘make sense’ in the moment. Trying to make sense can mean the client experiences us as not present enough or they pick up on a kind of scrutiny that can feel objectifying. The reflective scrutiny involving checking speculations and making links to possible aspects of theory for insight is often more suited to post-session reflecting and to supervision.

We may use specific terms, unpacking them to help clients and ourselves understand what is emerging; this use of therapy language is ideally kept to the minimum. The presence of the person of the therapist is key to being with the emergent intercultural (whole being in context), and to the dialogic nature (here-and-now sensing and naming) that is needed when exploring identity and identity processes.

The therapist says to Claudine, ‘I am discovering something here with you that matters in our relationship… I want to do this here with you.’ Similar words naming the therapist’s commitment are important in establishing a human-to-human connection. They say, ‘I am taking time to notice how I am, so I can be here with you more fully.’

Something reparative is then reiterated in the comment, ‘I have things to reflect on and you have things to reflect on’, which allows a recontracting between client and therapist to happen. One major point to note is the client has space and time to reflect on what she wants to bring to the dialogue. When faced with something uncomfortable or brought into our awareness by a client, we may defensively fall into a habit of asking questions, as an unconscious act of ‘taking charge’ again. When clients point out our lack of awareness, inadequate training or lack of ability to be with them in a fullness of presence, we can act from a resentful, shamed and/or offended place. When this involves issues of identity, the action-reaction dynamic gets amplified. Finding ways of owning this amplification with the client is part of the work.

*Extracted from ‘Who is transforming what? Ideas and reflections on training, practice and supervision in radical mode’ by Carmen Joanne Ablack in Black Identities + White Therapies: race, respect + diversity, edited by Divine Charura and Colin Lago (PCCS Books, available from www.pccs-books.co.uk).