Should We Discuss Race with Our Clients?

Recently some other faculty and I hosted a workshop for our MSW students on cultural humility and motivational interviewing (MI). The premise was that MI skills and spirit can be a supportive way to discuss culture with clients, which includes race and other social identities. While we spent most of the time looking at HOW to do this, it seemed afterward to me that we didn’t really answer the question of SHOULD we discuss race with our clients?  My answer to this question is: Probably. Of course, it is up to the client (or anyone) whether to discuss race (Oluo, 2017). It should also be noted to the reader that I am writing this from a white perspective.

Why would we want to discuss race with our clients? This is a difficult question as it is something that many are uncomfortable with and not something that is typically done in everyday conversations, at least across racial lines. We might ask clients about the supports they find from their culture or from their family, and these are good questions to ask.  Yet we rarely ask about racism and discrimination experiences.

Most social workers would agree that racism impacts our minority clients (and anyone else who is minority) on systemic/policy (macro), community/school/group (mezzo) and personal (micro) bases, yet we may be reluctant to discuss this with clients. By not acknowledging this fact as well as peoples’ experiences, we may be neglecting a large component of their lives. Research supports how daily experiences of discrimination can affect clients who are dealing with depression, for instance (Finch, Kolodny, & Vega, 2000). Microaggressions, or small, subtle acts of discrimination through actions or words, have been described as like experiencing “a thousand small cuts” (Sue, et al., 2007). Colorblindness (not acknowledging race) and minimizing the role of discrimination were cited as two types of microaggressions experienced by African American clients in therapy in a study by Constantine (2007).  This is essentially white privilege, to not feel the need or even consider the need, to talk about race/discrimination experiences with clients (Hook, Davis, Owen, & DeBlaere, 2017).

Clients may not only have experienced subtle acts of racism but perhaps overt ones as well, and unfortunately, this can happen in social work practice. Social service policies may be discriminatory as well as colorblind. Kolivoski, Weaver, and Constance-Huggins (2014) write that given these experiences of racism (such as in their example of child welfare work), “it is particularly important for workers to be open to listening to clients and learning about their lived experiences…including asking what concerns they may have about working with a professional of a different race and about their past experiences of interacting with someone of that race.” (p. 272).  Social workers can talk with clients about how race affects the therapeutic relationship, and even explore how race, culture and other identities affect how they perceive receiving help from others. These are not easy conversations, and they are often difficult for social workers to initiate and to hear. As a white social worker, when I find stories of discrimination painful to hear, I try to imagine what they are like to have been lived.

Social workers are called to be culturally competent (NASW, 2017). This can mean a variety of aspects, including having knowledge and practices that support clients in their language, customs, values, and the like. And of course culture is more than just race—it can be ability status, LGBTQ, religious, etc.  A critique of cultural competency is that it can be reductionistic: we learn about “X” group and assume that this knowledge can apply to our individual client (Hook et al., 2017). Having discussions with our clients about their culture—and experiences as a member of whatever race they identify with—can help us understand them individually instead of stereotyping them or making assumptions (Lee, 2010). These conversations can set the stage for a strong therapeutic alliance. When these conversations are conducted with the intent to listen and learn, this can be the start to culturally humble practice.

by: Melinda Hohman, Ph.D., SDSU School of Social Work Director and Professor

References

Constantine, M. G. (2007). Racial microaggressions against African American clients in cross-racial counseling relationships. Journal of Counseling Psychology, 54, 1-16.

Finch, B. K., Kolodny, B., & Vega, W. A. (2000). Perceived discrimination and depression among Mexican-American adults in California. Journal of Health and Social Behavior, 41, 295-313.

Hook, J. N., Davis, D., Owen, J., & DeBlaere, C. (2017). Cultural humility: Engaging diverse identities in therapy. Washington, DC: American Psychological Association.

Kolivoski, K., Weaver, A., & Constance-Huggins, M. (2014). Critical race theory: Opportunities for application in social work practice and policy. Families in Society: The Journal of Contemporary Social Services, 95 (4), 269-276.

Lee, E. (2010). Revisioning cultural competencies in clinical social work practice. Families in Society: The Journal of Contemporary Social Services, 91 (3), 272-279.

National Association of Social Workers (NASW), (2017). Code of Ethics. Accessed at: https://www.socialworkers.org/About/Ethics/Code-of-Ethics.

Oluo, I. (2018). So you want to talk about race. New York: Seal Press.

Sue, D.W., Capodilupo, C.M.,Torino, G.C.,Bucceri, J. M., Holder,A., Nadal,K. L., & Esquilin, M., (2007). Racial microaggressions in everyday life: Implications for clinical practice. American Psychologist, 62(4), 271-286.

 

Thanks to Jesse Berg, LCSW, for his feedback on this post. His own blog can be found at: http://www.intrinsicchange.com/change-talk-blog