Prioritising the therapeutic alliance

Simran Dhillon responds to a recent letter.

In the October issue, Jonathon Dawson asked how to address racism in therapy. Dawson mentioned that a key aim of therapy settings is to build therapeutic alliance, yet his proposed graded scale for dealing with implicit and explicit remarks may be damaging.

Firstly, setting these boundaries prior to therapy risks assuming clients are (potentially) racist. Yet consideration of context is crucial. For instance, a client walking into a therapy session is most likely vulnerable and distressed. In this case, such boundary-setting can be overwhelming, inappropriate, and likely to damage the therapeutic alliance irreparably. Clients should feel secure and accepted, with their thoughts and feelings sympathetically unpacked. Building rapport should be the top priority within therapy. As an exception, setting boundaries is appropriate if, upon arrival, the client’s first reaction to the therapist is blatantly discriminatory. This would be a strong cue to set boundaries before commencing.

When addressing repeated remarks, it is wiser to challenge behaviour rather than the person, in a non-confrontational manner. This depersonalises the issue, and the client should recognise and perhaps change the prejudice/stereotyping in their behaviour. But even this could cause discomfort depending on the terminology used. Considering the context is crucial. Challenging a client can come across as demeaning if responses are not friendly and respectful. After all, the therapeutic relationship is a collaborative effort.

Dawson also suggests removing the client from the caseload if there are repeated comments. There are always exceptions, but this is clearly the last thing a therapist should do. Often the first secure relationship a client has in their life is with their therapist, hence it can be difficult to build a new relationship with a new therapist.

Racism in therapy should be addressed with equality and inclusivity at its core and should cut both ways. Just as we should not see the client (or ourselves) as the problem, we need an inclusive narrative when dealing with racial prejudice too. As Dawson points out, there is no specific guidance for therapists to deal with discrimination in practice. The BPS could provide guidelines specifically for psychology practitioners looking to address racism in therapy in more appropriate ways. More discussion and debate are needed in this complex domain.

Simran Dhillon
Honorary Research Assistant
Nottingham Trent University
[email protected]

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