Your intersecting identities and your experiences of oppression impact your physical health and your mental health. For this reason, it makes sense that you would want to work with a healthcare provider who can acknowledge and integrate your identities during the course of treatment.
Unfortunately, despite receiving diversity training, many providers ignore the importance of identity in treatment or actively perpetuate racism, sexism, transphobia, body shaming, etc. in the therapy room or the doctor’s office.
How can you, as the client or patient, address the importance of identity with a health care provider if you are not receiving the right level of affirmative care? How can you start a conversation about sex, gender, race, ethnicity, etc. with your therapist or your doctor? Here are some tips.
Is it worth it?
If you’ve noticed that your therapist or doctor has not responded to aspects of your identity in the way that you’d hoped, first identify the safety of continuing your work with this professional. If you have a predominantly positive, trusting relationship with this professional and have benefitted from their support, it is probably worth discussing your needs around identity with this person.
However, if you feel like your provider dislikes you or actively does not support your identity, it may be worth looking for another provider who can approach you from a baseline affirmative stance. Sure, therapists and doctors make conversational mistakes from time to time, but you should never have to feel like your provider thinks you are bad or wrong because of who you are.
Identify what isn’t working.
Once you’ve decided that you do want to speak with your therapist or doctor, take some time outside of your appointment to reflect on what you would like your provider to understand and what you will need to feel safe and satisfied in treatment.
When you discuss concerns about identity, power, and socio-cultural dynamics with your provider, you are engaging in emotional labor that will ideally improve your treatment and get your needs met. This type of self-advocacy can be stressful and tiring. Marginalized people have to do extra work to receive competent care which is unfair even though it is a reality. Take time to care for yourself and appreciate yourself during this process.
You can ask yourself these questions:
What experiences have made me feel that my provider does not understand my identity?
What has bothered me about the way my identity has been discussed in treatment?
How has oppression showed up in my treatment?
What would I like my provider to understand about my identity and what it means to me?
What role do I want my identity to play in treatment?
What aspects of my identity feel important to explore in therapy?
What changes would I like my provider to make? What would they need to do to make me feel safe and affirmed?
Hopefully, these questions can help you dig into what aspects of the professional relationship need to shift.
Once you have more clarity on what’s bothering you and how you would like this to change, it’s time to have the actual conversation with your provider. This can be really scary! Giving constructive feedback to anyone can be daunting, much less a professional who has a lot of power in your relationship. However, any therapist or doctor worth their weight in graduate degrees will respond openly and compassionately to feedback, even when it is negative. If your provider cannot do this, you have a clear sign that they do not have adequate skills to treat you and you can begin to look somewhere else.
Since having this conversation can be nerve-racking, it can help to prepare how you’ll begin the conversation and set expectations for what you hope to get out of it.
Here are some ideas for opening lines:
“Would you be open to me sharing some feedback with you?”
“I have been reflecting on my goals in therapy and I would really like to spend time exploring how transphobia has influenced my depression. Can I tell you some of my ideas about how we could do this?”
“I have really been benefiting from our work together but recently something hasn’t felt quite right. Could I share what’s been going on?”
“Hey, this is a little hard for me to bring up, but would you be open to discussing how race impacts my therapy? I have some thoughts I want to share.”
Of course, do what works for you. You may want to be more direct. Or you may want to write a letter or an email to your provider where you have the time to choose your words. Just beginning the conversation can often be the most difficult part. Find a way that is possible for you.
Make a specific request for change.
Ideally, your provider will hold compassionate space for you to express your feelings and thoughts. At some point in this exchange, share as specifically as possible what actionable changes you would like to see. This gives your provider a clear direction for improvement and provides you with a clear way to evaluate whether you are being listened to.
Here are some examples of actionable requests.
“I’d like to use my time in therapy to come up with personal strategies for addressing the daily racism I experience at work and out in the world.”
“It would mean a lot to me if you read this blog on being fat. I feel like it captures the way I’d like to talk about my body in therapy. Perhaps next time we can talk about this blog post together.”
“I would really like it if you used the term queer when we talk about my sexual orientation. Could we talk more next time about what that identity means to me? The word lesbian just doesn’t feel like it fits.”
“As a black woman, I have often felt like my voice has been overlooked. For that reason, I’d really like it if you gave me the time to ask questions about my health when I come to see you. It just doesn’t feel good when I feel rushed or leave without the information I need.”
If you’ve gotten this far in the conversation with your provider, you’ve already done a lot of emotional labor and educating. Giving your provider a resource that you trust can be a way of asking them to take accountability and educate themselves.
If you have an article, website, or book that you feel represents your identity, your experience, or your worldview well, ask your provider to check it out.
Evaluate their response.
After you have this conversation with your provider, observe how they react in follow-up appointments. Ideally, your therapist or your doctor will begin incorporating the changes you requested and will also make an effort to invite continuous conversation about your identity and provide space for feedback. This is very important! If your provider seems hesitant to continue acknowledging that you two had a conversation about your identity, it puts the burden on you to lead them through this conversation again and again. Look for a provider who begins to make space for you to continue talking about your race, gender, sexuality, etc. without you having to ask each time.
If after your conversation your therapist or doctor tries to dismiss your concerns, acts offended, acts awkward, does not make the changes you requested, or does not make space to continue talking about your concerns, you may want to begin looking for a new provider.
Practice self-care and find community support.
If the conversation with your provider does not go as you had hoped, it’s very possible that you will leave feeling misunderstood and invalidated. You may leave feeling like it was wrong or inappropriate for you to bring up concerns about your identity in treatment. This is a very common feeling, especially when someone who has less cultural power speaks to someone with more cultural power. The distress you may feel after an incident like this is very real.
It can be helpful to identify in advance, who you can reach out to for support if the conversation does not go well. This should be someone who affirms your identity and will validate, not minimize, your experience of oppression. It can be a good idea to spend time with those who share your identity and can provide a supportive, understanding atmosphere. As a consumer of mental health and medical services, you always have the right to ask for what you need in treatment. If a healthcare professional cannot give this to you, it is their shortcoming, not yours.
Header image illustrated by Leonor Carvalho
Are you a healthcare practitioner looking for tips on how to provide more affirming, inclusive care? Check out this article!