I work for a counselling organisation where, when new clients are notified of their first appointment date, they are given the name of their therapist. I have an African name and clients sometimes guess (correctly) that I am of black African origin. This is rarely an issue, but occasionally clients have asked to see a different therapist, to which the organisation always agrees. The staff responsible for allocating clients to therapists also have a habit of giving me a disproportionate share of ethnic minority clients – not just black African but anyone of colour – saying I’ll be the best person ‘to get them’. This means that I rarely get to work with a white client. I’m unhappy with both of these practices, but I’m reluctant to challenge the organisation or the clients. How far does client autonomy have to stretch?
Stephen Hitchcock, BACP’s Ethics Consultant, replies:
This is one of those situations where ‘it is impossible to reconcile all the applicable principles’ (Ethical Framework – ‘Ethics’, ‘Principles’, point 7). We might wish to prioritise client autonomy, but what about self-respect, integrity, courage and congruence? The client is prejudging the therapist before they have even met, imagining that they are less likely to be able to help them because of their perceived difference. By allowing a client to turn down a therapist on the basis of their assumed ethnicity, we are not only colluding with the client’s prejudice but reinforcing it, instead of modelling acceptance and inclusivity and using the opportunity to challenge a blatant racist attitude.
On the other hand, there is the ethical principle of autonomy – ‘respect for the client’s right to be self-governing’. So whose rights do you respect the most – the client’s or the therapist’s, bearing in mind our commitment to ‘Put clients first by: making clients our primary concern…’ (Our commitment to clients, 1a)? We may well accept other preferences a client might express, such as to select a particular therapist on the basis of their gender, sexuality or religious belief, so is this any different? It is worth noting here that counselling services are themselves legally allowed to discriminate when recruiting therapists where there is a ‘genuine occupational requirement’: for example, to appoint a Christian counsellor to work in a Christian counselling service, or a female counsellor for a women’s refuge, or an Asian counsellor for an Asian counselling service. So it could be argued that, if counselling services can discriminate on the basis of ethnicity, then so can clients. They have a right to choose.
However, in many respects client autonomy is not absolute. We might proudly hold to the provision of unconditional positive regard, but is it really that unconditional? We offer clients only a limited choice of appointment days and times, and our services might be made available only on payment of a fee. Similarly, if a client is seeking therapy from an organisation, they might have to accept whoever is available to see them. All the therapists may claim as much of a right to be allocated clients as their colleagues. Maybe some staff training around allocations is called for, and a policy that is visible to clients as well as staff, to help manage their expectations.
We are committed to ‘providing services that endeavour to demonstrate equality, value diversity and ensure inclusion for all clients’ and to ‘make adjustments to overcome barriers to accessibility, so far as is reasonably possible, for clients of any ability wishing to engage with a service’ (Good Practice, point 22a and f). These commitments need not mean, though, that we have to accommodate prejudice.
If a client is turning down a counsellor because of their name or ethnicity, one suggestion would be to listen to the client’s reservations and to assure them that all the counsellors (if true) are qualified, experienced and equally competent to provide an effective service. Some would see this as an opportunity to challenge racism, to educate clients, and for those in the ‘majority’ group to do some gentle ‘calling out’ rather than leaving it to those in the minority to have to do it for themselves.
If you did get to see the client, it would be interesting to find out whether their racist attitude manifested itself, and if so what you would do about it – whether, in the name of congruence, to challenge it and disclose your own feelings or, in the name of acceptance, to let it go. There could be real therapeutic potential here, not just for you to be honest about your feelings but for your client to reflect on the impact their attitude has on others, or on where it has its origins, or how it may actually be disabling them.
As for being allocated a disproportionate share of ethnic minority clients by staff in the organisation, some less subtle calling out seems overdue. Their naive assumptions about clients’ expectations need to be corrected, and their bracketing together of all people of colour needs to be challenged. They might usefully be reminded of the need to:
‘b. avoid unfairly discriminating against clients or colleagues
c. accept we are all vulnerable to prejudice and recognise the importance of self-inquiry, personal feedback and professional development…
h. [be] open-minded with clients who appear similar to ourselves or possess familiar characteristics so that we do not suppress or neglect what is distinctive in their lives’ (Good Practice, point 22).
What is behind your reluctance to take this up with the organisation? Are you feeling silenced by a culture of discrimination and exclusivity, perhaps? Maybe this is an opportunity, with your supervisor’s support, to call them to account and to ask how they justify their practices in light of the Ethical Framework? In so doing, you would be demonstrating the effort involved in managing the tension between autonomy and (self-)respect in a way that the organisation has so far failed to do.
‘We are in danger of internalising these messages’
My first response after reading this dilemma was concern. The practitioner is clearly unhappy with the discrimination outlined but unwilling to challenge the team around them without explicitly saying the reason(s) for their reluctance. I can appreciate it might feel difficult if they are new to the profession or service, but I wonder if they are experiencing, consciously or unconsciously, many more such micro- or macroaggressions, as well as the dilemma described. If these are not acknowledged and processed, over time we become desensitised to these experiences and they begin to inform our thoughts and beliefs about ourselves. This, in turn, negatively impacts how we view our rights as black individuals, often doubting our experiencing of feeling silenced and/or worried that, in speaking out against the injustices we suffer, we are being unreasonable or overreacting. With each unprocessed micro- or macroaggression, we are in danger of internalising these messages as being of lesser importance than they are and consequently might inflict a similar hurt onto those of similar race.
Two years ago, I joined a children and young people service, inheriting clients previously assessed by a white clinician. A parent of one of these clients, with whom I had built a strong rapport over the phone, appeared visibly disconcerted on finally meeting me in person. A long email correspondence from the parent ensued, first to me and then the organisation, requesting details and proof of my qualifications and experience. Struggling to manage my thoughts and feelings around this experience, I spoke with a few members of the team, all white, before then speaking with my line manager – all were empathic and supportive in their response. The service drafted an email to the parent detailing the interview process and checks that all clinicians go through. A meeting was finally arranged between the client and their parent, myself and my line manager. It was an invaluable opportunity to not only hear the parent’s concerns but for me, as a black clinician, to present an important area for consideration in our therapeutic relationship – racial difference and the thoughts or assumptions that might consciously or unconsciously be attached to this. Had I remained silent, we would have lost the opportunity to think cross-racially as a team about an area that many black people experience, sometimes several times a day. The hope is to normalise such discussions.
Your situation might play out differently but remaining silent rarely has the desired effect. I believe you have a moral responsibility to speak out. In line with the ‘personal moral qualities’ we are strongly encouraged to aspire to (in the Ethical Framework, ‘Ethics’, point 12), we must treat ourselves with care, value and respect our identity, and act with integrity and courage in naming what is happening to us when it feels discriminatory albeit subtle, indirect, or unintentional.
As a fellow black practitioner, I would ask the dilemma writer what messages they have internalised in being given more clients of colour and what would having a fairer proportion of white British clients translate as to them. Would it change the way they view themself as a black therapist and, if so, why? Their monthly line management and supervision should allow space for reflection, to share their concerns and their racial experiencing. Speaking out can feel frightening and emotionally draining, so I would encourage them to engage with any black network support forums within their organisation or through the Black, African and Asian Therapy Network (BAATN). Depending on how engaged and proactive your organisation is in becoming anti-racist, there is also a risk of their views not being taken seriously. If they feel this is happening and they are not satisfied with the response/actions, the next step would be to follow their organisation’s guidelines on formal complaints procedures, with the support of their union, if they belong to one.
Billie-Claire Wright MBACP (Accred) is an integrative counsellor working with children, young people and families
‘I would experience this as my organisation not being supportive of me’
There are nuances that lie within this dilemma and this will be quite an emotive topic for a lot of people, as it is for me. Starting with the more straightforward issue of matching black therapists with black, African, Caribbean or other minority groups – they are not one homogenous group. So, this practice is at best misguided and at worst, it’s discriminatory, reinforcing the othering and microaggressions that black people often experience. It also raises the question of what makes a therapist the right match for a client and whether the client is best placed to make that decision.
The ethics of whether a client declines to see a therapist with an African name is an organisational issue – it’s not as simple as saying it’s client choice. I would be curious about the rationale behind the organisation choosing to support a client’s decision. As a therapist, I would experience this as my organisation not being supportive of me. If a therapy organisation wants to be anti-racist and develop its anti-racist practices, then an open dialogue is the first step, and I would be requesting a conversation. While I recognise that being anti-racist might not be on the agenda or a priority for some organisations and/or therapists, the conversation is still important. When it comes to prejudice and bias, a clear stance should be taken.
A policy that encourages clients to at least meet the therapist and have an initial session gives both the therapist and the client an opportunity to have a meaningful discussion, after which an informed choice can be made. The current practice leaves the therapist uncomfortable within their organisation and allows the client’s judgments and assumptions to remain unchallenged. If one of the functions of therapy is growth and healing, then this is a missed opportunity for clients to think about their blind spots and biases.
Kemi Omijeh MBACP is a therapist, mental health consultant, trainer and speaker
‘It’s important that organisations have anonymous ways for therapists to feed back on their experiences’
I went through a range of emotions reading this dilemma. First, I don’t know what it is like to be discriminated against initially because of my name alone, but it saddens and annoys – but never surprises – me when I hear that this still happens. If an organisation colludes with a client by agreeing to offer a different therapist without question or challenge, I do not believe that it is behaving responsibly towards this therapist, as a human being first, and as a professional. Our names are part of our identity, culture and heritage, and should be something we are proud to share without the fear of being treated differently.
I believe that the benefit of working for an organisation with a variety of clients is the opportunity to work with difference. If a counsellor is limited by not being able to work with white British clients, that hinders their own development and learning. It potentially screams ‘token black therapist seeing the token clients’ – apologies if I have put that too bluntly – because those allocating the clients do not know how to work with them, or are not willing to do the work on themselves to understand that they can.
I believe in client autonomy, but some services are too small to be able to accommodate every ideal. If a client were to say, ‘I just don’t want to see them because they are black’, I’d ask them whether this service is right for them because this is who we have. This would offer an additional message of support and validation for all our therapists.
Ultimately, it is an issue that an employee should not have to raise, and the responsibility should not rest with them, the person on the receiving end. It is the responsibility of those making the allocations or other relevant people, in my opinion, who need to first challenge the client. Organisations cannot expect their therapists to become better counsellors/psychotherapists if they are only offering them clients who, in their opinion, they will be the best person to ‘get’ them. I wonder if there is a way to anonymously feed back to the organisation and ask for more support? I would like to commend the counsellor for working with the clients they have been allocated, and also for expressing that they wish to work with more white British clients. I hope the organisation reads this. It’s important that organisations communicate with their therapists or have anonymous ways for them to feed back on their experiences of working with clients – and that they take real action to improve their processes.
Nicholas Rennie, BACP EDI Task and Finish Group member and owner of You First Therapeutic Services