Deciding to go to therapy is the beginning of a monumental personal journey that puts you in a very potentially rewarding but also vulnerable position. Making this commitment as a person with a marginalized identity only increases those stakes because it requires you to drop your guard and bare the most intimate details of your life to a person who may not understand your perspective or be fully equipped to help you process your experiences.
Each person will require a mix of unique qualities in a therapist, and some of that will depend on important aspects of the therapy-goer’s identity. What a Black woman from the South needs in a therapist may be very different from what a first-generation Indian immigrant will need in a therapist. What someone who is gay needs in a therapist may differ from what someone who is bisexual will need in a therapist. And the list goes on.
Finding someone who can meet you where you are no matter how many cross-sections of marginalized identity you carry can be difficult. For starters, there aren’t enough mental health clinicians in this country in general. A 2020 report from the Kaiser Family Foundation found less than 30% of the mental health needs of the country are being met due to a lack of available clinicians.
And if you’re specifically trying to find a therapist who shares an aspect of your identity that is marginalized, it can be even harder. When it comes to sexuality and gender, for instance, in a 2015 American Psychological Association survey of 5,325 providers, 90% of respondents reported being heterosexual, while only 2.4% reported being gay, 2.4% reported being lesbian, 2.5% reported being bisexual, and less than 0.1% of respondents identified as transgender overall.
As for race, the American Psychological Association reports that in 2019, 83% of psychologists were white, 4% were Asian, 3% were Black, 7% were Hispanic, and 2% identified as “other.”
As for psychiatrists (mental health professionals who are also trained medical doctors), the National Council for Mental Wellbeing said in a 2017 report that 77% of U.S. counties reported a severe shortage of these experts. And while there isn’t wide-scale, publicly available sexuality and gender data on the sexuality and gender breakdown of U.S. psychiatrists, the American Psychiatric Association’s 2019 census of psychiatry residents found that of the 1,590 students going into psychiatry across the country, only 6% were Black, 8.5% were Hispanic, and 24% were Asian, compared to the 52% of residents who were white.
“I could easily have a three-month wait,” Crystal Clark, M.D., a Black psychiatrist and professor at Northwestern University, tells SELF. Dr. Clark says this dearth of providers comes down to two big factors: The number of people going to school for psychiatry isn’t keeping up with the demand for mental health services, and for those who do go into the field, the turnover rate is high due to factors like burnout and having limited time with their patients. That’s why she urges people who are looking for mental health practitioners to be open to getting the help they need from someone who is different from them if necessary, even when it comes to core facets of identity.
Getting comfortable with this can be easier said than done, of course. But on your search for the right therapist, keep this in mind: Even if your therapist can’t relate to you from a place of shared personal experience, they should have cultural competence in order to give you the support you need.
The meaning of cultural competence in therapy
The American Psychological Association defines cultural competence as “the capacity to function effectively in cultural settings other than one’s own.”
In practice, Dr. Clark says a culturally competent therapist is someone who is sensitive to different cultural backgrounds in their practice—“linguistically and socially sensitive to differences in culture, whether that is race, sexual orientation, or religious or spiritual differences,” she says. “Someone who can connect on that regardless of a person’s background.”
But that definition is still evolving, and so is the language to address what people mean when it comes to finding a culturally competent therapist. For Cadyn Cathers, Psy.D., a trans man and teaching faculty member at Antioch University who specializes in therapy for the LGBTQ+ community, a better term is “cultural humility.” “If I say I’m ‘competent,’ then I could not continue to be humble and look at my internalized racism, for example, or biphobia or whatever it might be,” Dr. Cathers tells SELF.
Before diving in more, it’s worth emphasizing how valuable it can be to find a therapist who can understand your experiences, perspectives, and references in a deeper way specifically because of shared identity. That kind of match can be frankly magical and certainly makes sense to pursue if you’re able. And sometimes, therapists who don't share your identity can absolutely invalidate your lived experiences in a harmful way or straight-up be offensive. But also, the point here isn’t to say someone who shares your identity in key ways will always be the best therapeutic match for you while someone who doesn’t share your identity but is culturally competent is inherently a consolation prize.
For example, LaToya G., a mom of two who works as an early childhood specialist, began looking for a therapist after her divorce. She assumed she’d be able to open up more to a fellow Black woman, specifically one who specialized in divorce and family therapy. And she found someone who ticked those boxes. But after three sessions, it was clear that the therapist she wound up with wasn’t right for her. Instead, LaToya says her therapist was oversharing about her own personal life rather than focusing on her patient’s needs.
“By the third visit, it was all about her, and I decided, ‘I’m not getting anywhere with this,’” LaToya recalls. She’s now looking for someone she can really drop her guard with, even if it’s not the fellow Black woman she expected. “I don’t want to just stick my big toe in the water,” she says. “I want to be able to dive all the way in.”
LaToya’s experience is just one example of how seeing a therapist who shares certain aspects of your identity doesn’t always mean you’ll be a match once you’re actually sitting across from each other (in person or virtually). Ultimately, the goal is to find the right therapist for you—whether that means you have plenty of overlapping identities because that’s understandably non-negotiable for you, or pretty much none.
This is especially true if you need to start seeing someone pretty urgently, like for persistent panic attacks or severe disordered eating behaviors. Sometimes looking for what may, unfortunately, be a unicorn of a therapist who specializes in what you need and also aligns with your identity may be less important than finding one who is culturally competent and able to help you as soon as possible.
Seeing a therapist with a different culture or background
Khalisa Rae, an author and editor for an African American multimedia company, first began going to therapy 10 years ago when she was in undergrad in Wilmington, North Carolina. “I was able to find some really good people, and, ironically, they were white,” Rae, who has seen several different clinicians, tells SELF. “When I talk to them about Black girl stuff, they listen. They’re open and sincere.”
For Rae, this was clear when her white women therapists would “almost finish my sentence with what I was going to say when I unloaded my frustrations about microaggressions or othering,” she explains. “They would chime in and I would say, ‘Exactly!’” Her therapists also used inclusive language and avoided stereotypes, which signaled to Rae that they had training, worked with diverse clients, and were up to date on the current climate of how to handle varied and nuanced cultural backgrounds.
Rae’s experience is what culturally competent therapy looks like in practice. “For me, as a clinician, I’m going to really focus on your experience, and I’m going to continue outside of the session to educate myself whenever I have a new patient or a patient that’s bringing up something that I’m unfamiliar with,” Dr. Cathers says. “Because if they’re having to educate me, then it’s about me.”
For Monica Johnson, Psy.D., a Black clinical psychologist and founder of Kind Mind Psychology in New York City, this kind of education looks like taking formal cultural trainings offered by professional organizations, such as the New York State Psychological Association, the American Psychological Association, and PESI, a continuing education provider. “As a psychologist, there's a certain number of continuing education [credits] you have to get to maintain your license. But more often than not, it's not a requirement that any of those C.E.s be related to cultural diversity,” Dr. Johnson tells SELF. This year, she’s focusing on trainings about treating transgender and gender-nonbinary people.
How to find a culturally competent therapist
Normally, the first step in advice for finding a therapist is: If you have insurance, reach out to your insurance provider directly and ask for a list of in-network therapists who are taking new patients. And that can be a good place to start. But when you’re specifically looking for someone who is at the very least culturally competent, the more information you have about what they’re actually like—instead of simply a list of names and contact information—the better.
So, consider seeking solid recommendations through trusted friends, family members, or mentors. “Word of mouth is very helpful,” Dr. Clark says. And definitely make use of the many online therapist-finder databases out there, especially those that specifically center the experiences of various marginalized groups. Even if you don’t find someone who is, say, the same race as you, inclusion and/or participation in these kinds of databases can (but doesn’t always) signal that these therapists prioritize cultural sensitivity.
Examples of these databases include:
- Asian Mental Health Collective
- Therapy for Black Girls
- Therapy for Black Men
- Therapy for LatinX
- Inclusive Therapists
- National Queer and Trans Therapists of Color Network
- The Association of LGBTQ+ Psychiatrists
For more, you can check out SELF’s story on mental health resources for marginalized people.
There are, of course, also broader databases of therapists that can be helpful on your search, like Psychology Today’s. But no matter where you’re looking, be cautious if a therapist has all the “specialty” boxes checked in their bio on their personal website or a directory. “A therapist can just click all the boxes,” Dr. Cathers notes. “The more boxes you check, the more searches you’ll show up in. I think that’s a little bit of false advertising.”
Beyond that, while doing your reconnaissance, look for cultural competence cues on clinicians’ websites and database profiles. Ideally, there will be some real space dedicated to discussing how the therapist practices in a culturally aware and empathetic way.
“If you go on my website, we have a full page dedicated to race and culture therapy,” Dr. Johnson says. “We also have a full page dedicated to LGBTQ+ affirming care because we want it to be well-known and easy for people to assess that this is a safe place.”
After you’ve found a therapist you think you’d like to work with, come prepared with a list of specific questions during your first appointment. The experts SELF spoke with all suggested giving the new relationship at least one to three sessions to gauge if it’s a good fit.
If you’re feeling apprehensive about a therapist’s ability to understand aspects of who you are, fully respect you, and help you work through anything identity-related, start by asking about their experience with your background specifically, like, “How often have you worked with someone who is Muslim?” After asking these questions, consider following up with a few more to dig a bit deeper into the areas you’re personally curious about. For example:
- How comfortable do you feel addressing African American issues, and how comfortable do you feel discussing them with me?
- What trainings or consultations do you do around Muslim issues?
- What do you do to stay on top of culturally competent mental health care?
- Do you treat many patients who are LGBTQ+?
- Are you trans-affirming?
- Are you bi-affirming?
- How much antiracism training have you done?
- What sorts of culturally specific resources do you refer your patients to?
- Will you let me know if you don’t feel you can support me in the way that I need?
Their answers will give you valuable insight as to whether this therapist is really open to dealing with all of the complex topics that might pop up in your sessions together. They’re all fair questions to ask, and the therapist should be able to answer these questions openly, Dr. Johnson says.
Building a relationship with your therapist
After you’ve done your research and hopefully received promising answers to your initial questions, how can you tell that you and your therapist are meshing well together? It’s important to recognize if you have a good “therapeutic alliance,” Anisha Patel-Dunn, D.O., a board-certified psychiatrist and chief medical officer at Lifestance Health, tells SELF. Essentially, this means you and your therapist are comfortable with one another and mutually agree that you’re actively working toward your goals. It’s important that both of you are on the same page about your therapeutic relationship.
Part of this recognition requires asking more questions, but this time toward yourself. Dr. Johnson says this internal assessment should really focus on how your therapist behaves during your conversations and how you feel during your time together:
- Is my therapist shying away from topics related to areas of my oppression?
- When these topics come up, are they responding with appropriate concern?
- Do they appear to have a working knowledge of the identities that apply to me, such as my race, gender, sexual orientation, culture, and religion?
- If they don’t know something, do they express an intention to learn more about it on their own?
Establishing a good relationship in therapy is a little bit like dating; you won’t be a good fit for everyone you date, so you shouldn’t expect to be a good fit with every therapist you interview or even begin seeing. When it comes to mental health, the search for The One can be intimidating. But the potential rewards of seeing a therapist who really gets you—no matter how similar you may or may not be—are unparalleled.
See more from our Guide to Caring for Your Mental Health here.
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