The Diversity Gap in Psychotherapy
The Supreme Court decision helps --but there's a long way to go
BY ROB WATERS
When the U.S. Supreme Court ruled in June that the University of Michigan's law school may consider the race of applicants in creating a diverse student body, it was welcome news to many concerned with the underrepresentation of people of color in the mental health professions. The American Psychological Association, for instance, filed an amicus brief in support of the university, proclaiming that "diversity in higher education is of paramount importance to the APA."
But it'll take far more than a legal brief to address this stark reality: a profession whose main purpose is to promote the healthy change of individuals and systems has been unable to fundamentally alter its own makeup. Today, mental health workers at all levels--psychologists, social workers, family therapists, and counselors--continue to be overwhelmingly white. In 1999, for example, more than 90 percent of Ph.D. psychologists in the workforce were white, according to the National Science Foundation. So were 87 percent of the 2,000 members of the National Association of Social Workers surveyed last year and more than 95 percent of family therapists surveyed in 1998.
"We've been making progress," says Bertha Holliday, director of the APA's Office of Ethnic Minority Affairs, "but there's a lot of room for improvement." In the year 2000, Holliday points out, 18 percent of doctoral degrees in psychology were awarded to ethnic minorities, up from 11 percent in 1992 and 7.5 percent in 1977.
Still, these increases in the number of minority therapists fail to keep pace with the growth of the minority population, now at 31 percent and growing. The effect of this lack of diversity in the nation's postgraduate programs isn't just that it bars people of color from becoming therapists, but that, as a result, millions of people in minority communities can't get the help of someone who shares their culture and language.
"The severe scarcity of therapists of color is an indicator of the terrible health disparities that we face in this country," says Ramon Rojano, director of human services for the city of Hartford, Connecticut, and former director of the Institute for the Hispanic Family, a mental health center serving Hartford's Latino community. "It severely limits the ability of people of color to receive high-quality treatment for both physical and mental health conditions and reduces the chances that they'll seek treatment and follow recommendations."
Holliday agrees. She points to studies that suggest that people tend to delay seeking mental health services--or don't seek them at all--when the providers don't come from their culture. The result, she says, is that few people of color get help from outpatient programs early in the course of their distress, and many end up in psychiatric hospitals, emergency rooms, or jail cells.
Why is a person's culture or ethnicity such a big factor? White therapists unschooled in the cultural traditions of clients often make key mistakes in treatment, says Sonia Palacio-Grottola, a clinical social worker in Suffolk County, New York. "Here's a classic one: a Latino woman from the Caribbean comes into a session and says 'I'm hearing voices and seeing things.' An Anglo psychiatrist might identify her as a schizophrenic and put her on medication. But it's a cultural thing for women to have these visions."
Cultural misunderstanding can also keep services from being offered. When Bob Suzuki, a former administrator at California State University at Northridge, asked why none of the 30 counselors at the school's student counseling center were Asian, he was told that few Asian students used the center's services. The staff, he realized, "was strongly influenced by the 'model minority' stereotype." At his urging, the center eventually hired an Asian counselor, who quickly found herself inundated with students seeking help. …