By Dan Prendergast, M.A.
A fairly large number of clients enter therapy wondering if a given therapist will understand them, as well as their life experiences and issues that they would like to bring into treatment. Many individuals seek out therapists who are similar on variables such as age, gender, race, ethnicity, religion or sexual orientation. Some also seek therapists who have shared similar experiences such as difficulty with substances, combat, racism and discrimination, anxiety, and so on. My personal opinion is that some mix of therapist disclosure and client identification with a therapist with a similar background can have the potential to benefit rapport and treatment, and can be very helpful. However, I don’t think that it is always necessary for successful psychotherapy. In this blog entry I will discuss my own developing perspective on issues related to client-therapist matching based on demographics and lived experience (D&E).
I would like to start by pointing out that no therapist can have D&E that are similar to all of their clients. If such therapists existed, the hypothetical therapist would have a laundry list of psychological issues from Amnesia to Zoophobia, and would need to have quite a complicated life history. To reword a quote from a certain New Jersey politician, if you want to speak to a person who shares 100% of your experience, look in the mirror. Of course this is an exaggeration, but the main point is that every therapist-client dyad must deal with D&E differences on some level. All therapists face the dual task of making sure that the client’s perspective is understood as much as possible while also providing helpful clinical interventions.
The previous point relates to a core tenet of REBT/CBT, which states that the client is the expert on their experience, while the therapist (with help from their supervisor) acts as the expert on effective psychological treatments. Ideally, over time both learn a great deal about what the other person brings to the table. In some forms of psychotherapy, particularly psychodynamic or psychoanalytic modalities, the therapeutic relationship comes first, followed by the work of therapy. REBT is quite different from these perspectives in that the work of therapy comes first, and the relationship typically follows as goals are set and accomplished over time. At the Ellis Institute I have seen that agreement on the tasks and goals of therapy, client-therapist collaboration, and “getting right to work” often result in a strong therapeutic alliance that delivers helpful treatment very efficiently.
At times searching for a therapist with similar D&E assumes that because a therapist went through similar experiences, they will understand a client better. In my experience, many clients who seek and obtain a therapist with similar D&E benefit from it. However, this is not always the case and is in some respects contrary to REBT/CBT theory, which holds that appraisals and beliefs about a situation are stronger determinants of emotion than the situation itself. This means that even if a therapist does share some similarities with a client, they would be wrong to assume that the client made meaning of a situation exactly as the therapist did. For example, perhaps the therapist grew up by the beach and developed a fear of drowning while the client grew up in the same area and became a surfer. Personally, when I do have certain D&E commonalities with a client I try to make sure that these similarities do not bias my understanding of a client’s unique perspective. I also believe that focusing on thoughts, beliefs and behaviors rather than on common ground allow me to help individuals who have dissimilar backgrounds.
When a client seeks out a therapist with similar D&E or is simply curious about a therapist’s background it often involves therapist self-disclosure. At my early stage of training I think disclosure of personal D&E can be a difficult thing to navigate, and in many cases it is best not to disclose too much. One simple reason for this is that my life experience is far less relevant to a client’s treatment than my command of REBT/CBT. In addition, therapy is for the benefit of the client, and I think that therapist self-disclosure should only occur if it advances treatment goals. In the past I have certainly avoided bringing up common experiences because it brought nothing to the table therapeutically.
The information that I disclose most freely relates to my education, training and clinical qualifications, which I believe any client is entitled to know. In fact, I would say that clients should be wary of therapists who are reluctant to discuss their qualifications. I am also very willing to disclose when I do not have D&E in a certain area. In my experience this has been the most helpful form of disclosure, especially when admitting my ignorance about a topic leads a client to describe their own life experiences further. In session this might sound something like, “as it happens I have never worked in finance…what is it like to work in that field, and how is your job in particular?” Less often I will disclose relatively surface level D&E if it will allow a client to communicate more freely using vocabulary or knowledge that we have in common. For instance, in the past I have brought up my experience as a first-responder, which has allowed clients to discuss a “bad call” more freely.
Overall, I expect that my perspectives on disclosure will evolve with time, and I recognize that different therapists deal with this aspect of therapy differently. To the prospective client I would say that finding a therapist based on D&E preferences can be helpful, but I would also emphasize that competence, diligence, the ability to collaborate and the subjective factor of client-therapist “fit” are the most important things to look for.