Representation in Therapy
Military and veteran representation
When undergoing graduate studies for social work, I was assigned to an internship position at our nation’s largest healthcare provider for military veterans. Specifically, I assisted with caring for veterans who experienced traumatic events during their service.
As a veteran with service-connected posttraumatic stress disorder (PTSD), and having already earned a master’s degree in counseling by that point, I found it interesting how many former military members advocated representation in regards to their treatment. I approached this matter with curiosity.
Among the PTSD clinical team patients, a significant portion of veterans demanded representation in therapy—declaring that only another veteran who also had PTSD could understand their issues. They were advocating an emic approach to treatment—that which stems from members of the same group.
At the time, I recognized the situation as a form of gatekeeping— the activity of controlling, and usually limiting, general access to something—and it was facilitated by a moral framework. The requirement was that non-veterans and people without PTSD shouldn’t, mustn’t, or oughtn’t to treat veterans with PTSD.
What makes this declaration true?
Veteran X may claim, “Those without PTSD can’t understand what we go through,” which assumes that all veterans with PTSD share the same experience. I assure you, we do not.
For instance, I served in the Marine Corps from 1996 to 2007, in the field of military police (MP). I have no idea what service was like for an Air Force pilot who served from 1953 to 1961.
I couldn’t begin to describe what the experience of military service was for an Army infantry member who served from 2013 to 2017, or what it is like for a Navy cook who joined in 2021 and is currently on active duty.
Even within the same branch of service, for other MPs who served during my enlistment period, I could only speculate about what they may have experienced. Confounding variables relating to gender, sex, race, ethnicity, religious affiliation, or age further limit my understanding.
Suppose one was able to find another biracial male MP of similar age, height, and weight. I still may know nothing of his time aboard Marine Corps Air Station (MCAS) Cherry Point, North Carolina—or he of mine from MCAS Miramar, California—if neither of us were stationed in the other’s respective locations.
Even for such a person who was stationed with me aboard MCAS Miramar, representation of our similar identities and common settings doesn’t afford one an opportunity to know what the experience of the other was like. People—even Marines—aren’t a monolith.
Likewise, not all PTSD stressors are the same. For instance, one 2003 source reported that the leading cause of PTSD was motor vehicle accidents (MVA). Considering the relatively low number of people who served in the military, when compared to motorists in general, it seems plausible that this statistic may remain relevant.
Still, in regards to PTSD associated with a military member who endured an improvised explosive device detonation, and PTSD concerning a civilian MVA, would either of these people inherently know anything about the other’s traumatic stressor event? The experience of PTSD also isn’t monolithic.
Therefore, a limiting demand regarding treatment provision from only a veteran with PTSD may have little value beyond novelty. I could say to the fellow MCAS Miramar MP, “You know where I’ve been,” though the Devil Dog may not know what I’ve been through.
Representation among other populations
Since gaining graduate degrees in counseling and social work, I’ve encountered a significant number of people who have expressed a perceived need for shared identity in therapy. Person Y may say, “I need representation in therapy from a Latinx practitioner.”
Not only do my ancestors originate from non-Latin populations, I likely wouldn’t use the culture-erasing term “Latinx,” had my forbearers come from places like Brasil, Mexico, of El Salvador. Therefore, person Y would have automatically dismissed my ability to help based largely off of prejudice— preconceived opinion that is not based on reason or actual experience.
The person Y’s within our nation seem to be growing in number. Whether black, indigenous, and people of color (BIPOC); lesbian, gay, bisexual, transgender, queer, plus (LGBTQ+); or additional identity alliances, the demand for representation among other populations is a legitimate barrier to mental health treatment provision.
Still, I’m aware of how some people attempt to rationalize prejudice for such requirements. Per one source, “Representation matters in mental health because it can interrupt that distrust when underserved communities have access to therapists that struggle and fight the same system through lived experiences.”
If person Y distrusts me, because I don’t share a similar identity, this is not the problem of a system of oppression. Rather, it’s an iss-YOU, not an iss-ME. It’s person Y’s issue, not mine.
Additionally, “lived experiences” are subjective in nature and not all people interpret events in the same manner. Suppose person Y identifies as BIPOC and insists that only other BIPOC people can assist with this person’s mental health needs.
It seems a bit racist—a person who is prejudiced against or antagonistic toward people on the basis of their membership in a particular racial or ethnic group—for person Y to refuse treatment from a non-BIPOC clinician, based predominately on racial or ethnic makeup.
According to another source, “Approximately 86 percent of psychologists and therapists are white. Studies show people of color lack therapists who look like they do and share similar cultural experiences. For teens and young adults of color, it can often feel like a burden to explain problems and experiences to white therapists.”
Dear reader, did you notice the sleight of hand in that quote? On one hand, presumably objective “studies” were trotted out as a means of appealing to authority—presupposing information from an authoritative source is true, often without evidence or critical analysis of the data.
On the other hand, the subjective assumptions about BIPOC teens and young adults were presented under the umbrella of protection from proposed authoritative “studies.” However, neither the objective nor subjective information has much to do with one other.
Being charitable to the objective claim, it very well may be the case that “studies” suggest a lack of racially, ethnically, or culturally similar therapists in the mental health field. Does this necessarily imply anything beyond mere observation?
Suppose I cited one source that states, “73.8% of all mental health professionals are women, while 26.2% are men.” Would you thusly conclude that the field of mental health is sexist towards men?
Moreover, when BIPOC people believe it is a “burden [when] explain[ing] problems and experiences to white therapists,” this isn’t the problem of these therapists. Instead, this is self-disturbed dilemma of the people who maintain prejudice.
Similar arguments can be made about populations consisting of LGBTQ+, religious or spiritual, gender or sex, veterans or civilians, and people otherwise affiliated. Representation in therapy is only as important as one presumes it is—and this presumption represents the problem of a client, not a therapist or society.
I’m under no illusion that people will read what I’ve stated herein and vehemently disagree with my proposal. I don’t view the need for representation in therapy any more favorably than I do where it concerns entertainment.
The self-centered individual who advocates racebending of characters—such as race-swapped Ariel in the 2023 film The Little Mermaid, supposedly because egotists who watch the film should, must, or ought to see themselves represented on the big screen—are likely similar to those who demand representation in therapy.
While I don’t oppose a person’s decision to choose a practitioner who is a proper fit for services, I do critique behavior of people who, from a distance, appear to behave a lot like the prejudiced white southerner during the Jim Crow era—demanding to be served only by other whites.
One wonders about the utility of cherishing an identity so devoutly that the process of gazing upon the likeness of others begins to serve as an egotistical reflection of oneself. Is it challenging therapy one seeks or to simply peer into one’s own resemblance and remain fastened to familiar experiences?
Dear reader, if you irrationally demand that a clinician must look like you—presumably due to thinking you will have a shared experience that will enrich your sessions—I wish you all the best. Perhaps going into mental health treatment with rigid expectations on which to work may do you well.
For everyone else currently looking for a practitioner, my PTSD diagnosis, identity as a biracial male, and veteran status likely will not impact our sessions. In limited circumstances, I employ professional use of self—the therapeutic intertwining of personal and professional self—if or when self-disclosure serves the client.
Otherwise, it doesn’t matter to me what identity you are. If you maintain a similar non-prejudiced perspective, perhaps I will be an appropriate fit for your mental healthcare.
If you’re looking for a provider who works to help you understand how thinking impacts physical, mental, emotional, and behavioral elements of your life, I invite you to reach out today by using the contact widget on my website.
As a psychotherapist, I’m pleased to help people with an assortment of issues ranging from anger (hostility, rage, and aggression) to relational issues, adjustment matters, trauma experience, justice involvement, attention-deficit hyperactivity disorder, anxiety and depression, and other mood or personality-related matters.
At Hollings Therapy, LLC, serving all of Texas, I aim to treat clients with dignity and respect while offering a multi-lensed approach to the practice of psychotherapy and life coaching. My mission includes: Prioritizing the cognitive and emotive needs of clients, an overall reduction in client suffering, and supporting sustainable growth for the clients I serve. Rather than simply helping you to feel better, I want to help you get better!
Deric Hollings, LPC, LCSW
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