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Joe and Esi were in the therapist’s office wanting help with their relationship. The therapist had just asked the BIG question: How does race impact your lives?”
Esi began with her story about her ethics class, a story that was at sufficient distance from her life. Depending on her husband’s response, she would move in closer. His somewhat patronizing response made her feel both angry and that he lacked any real understanding.
“Me and a mulatto girl were in ethics class,” said Esi, who grew in Kenya. We had a White professor. He seemed to think I had no education. If you are a woman of color, you are automatically thought to have no education and that you don’t know what you are talking about. He tried to shut me up. When I persisted, I know he thought from the tone of my voice that I was an angry Black woman, even although I am not Black and I am not angry! In this country, if you have any color to your skin, you are called Black and relegated to a certain place: The bottom. I was excited about what he was teaching us, but when everyone looked at me with a certain gaze, like something bad was going to happen, all those White people, just looking, I tightened up inside and sat back down.”
Esi looked down at her folded hands. Her husband, who was White, reached over and reassuringly patted her hands.
“Yes, Esi, they are wrong. They shouldn’t have treated you that way. White people can be insensitive.”
Then, she continued, “Joe, you do the same to me!”
“What do you mean, Esi?” responded Joe, with an innocent and anxious look scanning back and forth between her and the White male therapist.
“Well, Joe, do you really want to hear how I felt last week after we came back from that party at your sister’s house?”
“Yes, Esi.”
“But do you really? Are you sure you want to hear this?”
“Yes, Esi.”
“Remember when we went over, me and the kids sat with the other people of color and you sat with your sister and her side of the family?
“Yes, I remember. What is wrong with that?”
“Well, me and my colored friends got loud and excited, and you shot me a look, like ‘pipe down over there.’ THEN, after we got home, the next day, your sister called you and said that you had better control your wife; she is too loud. Do you remember all that?
“Yes, well you do get loud – especially when you are around your people.”
“So why is it I have to fit in with your relatives and not the other way round? Why do I have to conform to the whiteness in your sister’s world, not the other way round?”
“Well, we were in her house.”
“So if they came to our house and were too quiet, how would you feel if I called them up and said they needed to participate with more enthusiasm?”
“Esi, that’s not fair, and you know it isn’t.”
Esi stops and looks at the therapist.
“So I check myself. It is the same all over, White people imposing their values and beliefs on me, on us. I am not an angry Black woman. I am just frustrated. People, White people, always want an explanation for what they think is my loss of control. You can see when their demeanor changes, they pull back, sit up, back away, fidget, and won’t look you in the eye. All these little tics that show that they are trying to get out of the situation.”
Esi took a breath and saw that her husband and the therapist were listening.
“These signs are ingrained in your brain ... these signs ... I saw it when I first came here to this country. The first time I had a good dose of it ... was in that ethics class in college. You can’t use words that you are accustomed to, ’cause they mean something else here, something bad.”
“Oh, Esi, I am so sorry,” said Joe, looking concerned.
“You may be sorry but you are not willing to stand up for me against your sister and her White values. You want me to conform.”
“What do you want me to do?”
“I want you to call your sister out.”
“But she may not ever speak to me again!”
“OK, don’t then,” and Esi looked down at her hands. She was finished talking. Joe looked at the therapist, waiting for something.
The therapist resisted intervening on the issue. “Keep talking this through,” he instructed them.
Joe could see that Esi had done talking and that it was his move.
“Do you really want me to call my sister out, even if it means that she will not talk to me again?”
“Yes.”
“I don’t know if I can do that.”
The therapist now intervened: “What does that mean to you, Esi, that he doesn’t know if he can do that.”
“It means he doesn’t really love me or value me or even value our mulatto children. What do think our daughter is learning?”
“That’s not true, Esi.”
The therapist, Dr. Swarthmore, watched Esi, who has very a dark, blue-black skin tone, with a flawless complexion and a shapely body. She wears her hair cropped and she looks like that Black model, what’s her name. Joe was short, a little plump with ultra White skin and freckles on his nose. He had been brought up in the Midwest and had had little exposure to Africans before his internship abroad in Kenya. Dr. S. thought he had probably not really thought much about Esi’s dilemma.
Dr. Swarthmore encouraged Esi to talk about her immigration experience.
“Esi, can you talk more about what it is like to be an immigrant from Africa?”
“Well, I just have to check myself so that I can fit in with this White culture. If you want to see how I feel about it, you will have to see an angry Black woman and I have learned not to give you that satisfaction. You will just dismiss me. Please Dr. Swarthmore, can we move on?”
Dr. Swarthmore was caught between his desire to accept her wish to move on and his wish to have her express herself fully. He realized that it was not his desire that mattered; that the couple had to work this out between them if they were going to move forward. So he punted it back to them.
“Esi and Joe, you are both caught in an important dilemma. Esi, you want more respect from your husband and his family. Joe, you do not want to upset your family by confronting them. Is that right? You are both dammed if you do and dammed if you don’t.”
“I agree,” Joe and Esi both said, nodding.
“Do you want to work on this issue?”
They both agreed with equal enthusiasm.
“Ok, can you spend the next 10 minutes to work on this?”
They agreed.
“Ok, let’s start. What skills do you have that can help you resolve this important issue?”
Dr. Swarthmore framed the issue as one to be solved by the couple. The couple discussed that they are usually good at communication and solving problems. This problem is about whether or not Joe is more aligned with his White family than with Esi and their children.
Dr. Swarthmore encouraged them to think about this more deeply and over time; that this is such an important issue that it requires time and deep conversation.
“How do you think you can educate yourselves about the issues at hand?”
Esi’s reading list
1. “Why I’m No Longer Talking to White People About Race” by Reni Eddo-Lodge (London: Bloomsbury, 2018).
2. “Americanah” by Chimamanda Ngozi Adichie (New York: Alfred A. Knopf, 2013).
3. “How to be an Antiracist” by Ibram X. Kendi (New York: Random House, 2019).
Joe suggests that Esi think about what it might mean if his sister and their children were no longer part of their lives. She agrees to do this.
Dr. Swarthmore asks if they can each do their homework before they come back. They agree and thought they could manage that and the book for 2 weeks out.
Dr. Swarthmore decides that he will read one of the books Esi suggested, as he does not know much about racism and White privilege and he wants to learn more. Dr. Swarthmore demonstrates his desire to become more racially sensitive. The following steps can be taken by therapists who want to become more racially sensitive, according to TA Laszloffy and KV Hardy (Fam Process. 2000 Spring;39[1]:35-50):
1. Read and watch movies that address the experience of other cultural groups.
2. Go to and participate in cross-cultural events.
3. Engage in a racial self-exploration process. The following questions can begin the racial identity exploration process:
- How do I define myself racially?
- When did I first become aware of race/skin color in general, and mine in particular?
- What messages did I learn about race/skin color based on that first experience?
- What direct and indirect messages did I receive about race/skin color?
- How did the messages that I received about race/skin color affect how I thought and felt about myself racially?
- What benefits did I gain because of my race/skin color?
- What did I lose because of my race/skin?
- Have I ever dated cross-racially? Why or why not?
- How many friends of a different race do I have?
4. Internal commitment. This means committing to addressing racism in therapeutic encounters.
Lessons learned for psychiatrists
1. Therapeutic space is allocated to discuss the issue.
2. The time is strictly limited to 10 minutes, so the couple won’t feel that their emotions will overwhelm them.
3. The space is to focus on the strengths that they can bring to resolving the issue.
4. Give patients the impression that they can solve this and that it is an important issue.
5. Do not put yourself in the patients’ argument; take neither side.
Dr. Heru is professor of psychiatry at the University of Colorado at Denver, Aurora. She is editor of “Working With Families in Medical Settings: A Multidisciplinary Guide for Psychiatrists and Other Health Professionals” (New York: Routledge, 2013). She has no conflicts of interest. Dr. Heru wrote the article in collaboration with Lynette Ramsingh Barros, artist and social commentator.
Joe and Esi were in the therapist’s office wanting help with their relationship. The therapist had just asked the BIG question: How does race impact your lives?”
Esi began with her story about her ethics class, a story that was at sufficient distance from her life. Depending on her husband’s response, she would move in closer. His somewhat patronizing response made her feel both angry and that he lacked any real understanding.
“Me and a mulatto girl were in ethics class,” said Esi, who grew in Kenya. We had a White professor. He seemed to think I had no education. If you are a woman of color, you are automatically thought to have no education and that you don’t know what you are talking about. He tried to shut me up. When I persisted, I know he thought from the tone of my voice that I was an angry Black woman, even although I am not Black and I am not angry! In this country, if you have any color to your skin, you are called Black and relegated to a certain place: The bottom. I was excited about what he was teaching us, but when everyone looked at me with a certain gaze, like something bad was going to happen, all those White people, just looking, I tightened up inside and sat back down.”
Esi looked down at her folded hands. Her husband, who was White, reached over and reassuringly patted her hands.
“Yes, Esi, they are wrong. They shouldn’t have treated you that way. White people can be insensitive.”
Then, she continued, “Joe, you do the same to me!”
“What do you mean, Esi?” responded Joe, with an innocent and anxious look scanning back and forth between her and the White male therapist.
“Well, Joe, do you really want to hear how I felt last week after we came back from that party at your sister’s house?”
“Yes, Esi.”
“But do you really? Are you sure you want to hear this?”
“Yes, Esi.”
“Remember when we went over, me and the kids sat with the other people of color and you sat with your sister and her side of the family?
“Yes, I remember. What is wrong with that?”
“Well, me and my colored friends got loud and excited, and you shot me a look, like ‘pipe down over there.’ THEN, after we got home, the next day, your sister called you and said that you had better control your wife; she is too loud. Do you remember all that?
“Yes, well you do get loud – especially when you are around your people.”
“So why is it I have to fit in with your relatives and not the other way round? Why do I have to conform to the whiteness in your sister’s world, not the other way round?”
“Well, we were in her house.”
“So if they came to our house and were too quiet, how would you feel if I called them up and said they needed to participate with more enthusiasm?”
“Esi, that’s not fair, and you know it isn’t.”
Esi stops and looks at the therapist.
“So I check myself. It is the same all over, White people imposing their values and beliefs on me, on us. I am not an angry Black woman. I am just frustrated. People, White people, always want an explanation for what they think is my loss of control. You can see when their demeanor changes, they pull back, sit up, back away, fidget, and won’t look you in the eye. All these little tics that show that they are trying to get out of the situation.”
Esi took a breath and saw that her husband and the therapist were listening.
“These signs are ingrained in your brain ... these signs ... I saw it when I first came here to this country. The first time I had a good dose of it ... was in that ethics class in college. You can’t use words that you are accustomed to, ’cause they mean something else here, something bad.”
“Oh, Esi, I am so sorry,” said Joe, looking concerned.
“You may be sorry but you are not willing to stand up for me against your sister and her White values. You want me to conform.”
“What do you want me to do?”
“I want you to call your sister out.”
“But she may not ever speak to me again!”
“OK, don’t then,” and Esi looked down at her hands. She was finished talking. Joe looked at the therapist, waiting for something.
The therapist resisted intervening on the issue. “Keep talking this through,” he instructed them.
Joe could see that Esi had done talking and that it was his move.
“Do you really want me to call my sister out, even if it means that she will not talk to me again?”
“Yes.”
“I don’t know if I can do that.”
The therapist now intervened: “What does that mean to you, Esi, that he doesn’t know if he can do that.”
“It means he doesn’t really love me or value me or even value our mulatto children. What do think our daughter is learning?”
“That’s not true, Esi.”
The therapist, Dr. Swarthmore, watched Esi, who has very a dark, blue-black skin tone, with a flawless complexion and a shapely body. She wears her hair cropped and she looks like that Black model, what’s her name. Joe was short, a little plump with ultra White skin and freckles on his nose. He had been brought up in the Midwest and had had little exposure to Africans before his internship abroad in Kenya. Dr. S. thought he had probably not really thought much about Esi’s dilemma.
Dr. Swarthmore encouraged Esi to talk about her immigration experience.
“Esi, can you talk more about what it is like to be an immigrant from Africa?”
“Well, I just have to check myself so that I can fit in with this White culture. If you want to see how I feel about it, you will have to see an angry Black woman and I have learned not to give you that satisfaction. You will just dismiss me. Please Dr. Swarthmore, can we move on?”
Dr. Swarthmore was caught between his desire to accept her wish to move on and his wish to have her express herself fully. He realized that it was not his desire that mattered; that the couple had to work this out between them if they were going to move forward. So he punted it back to them.
“Esi and Joe, you are both caught in an important dilemma. Esi, you want more respect from your husband and his family. Joe, you do not want to upset your family by confronting them. Is that right? You are both dammed if you do and dammed if you don’t.”
“I agree,” Joe and Esi both said, nodding.
“Do you want to work on this issue?”
They both agreed with equal enthusiasm.
“Ok, can you spend the next 10 minutes to work on this?”
They agreed.
“Ok, let’s start. What skills do you have that can help you resolve this important issue?”
Dr. Swarthmore framed the issue as one to be solved by the couple. The couple discussed that they are usually good at communication and solving problems. This problem is about whether or not Joe is more aligned with his White family than with Esi and their children.
Dr. Swarthmore encouraged them to think about this more deeply and over time; that this is such an important issue that it requires time and deep conversation.
“How do you think you can educate yourselves about the issues at hand?”
Esi’s reading list
1. “Why I’m No Longer Talking to White People About Race” by Reni Eddo-Lodge (London: Bloomsbury, 2018).
2. “Americanah” by Chimamanda Ngozi Adichie (New York: Alfred A. Knopf, 2013).
3. “How to be an Antiracist” by Ibram X. Kendi (New York: Random House, 2019).
Joe suggests that Esi think about what it might mean if his sister and their children were no longer part of their lives. She agrees to do this.
Dr. Swarthmore asks if they can each do their homework before they come back. They agree and thought they could manage that and the book for 2 weeks out.
Dr. Swarthmore decides that he will read one of the books Esi suggested, as he does not know much about racism and White privilege and he wants to learn more. Dr. Swarthmore demonstrates his desire to become more racially sensitive. The following steps can be taken by therapists who want to become more racially sensitive, according to TA Laszloffy and KV Hardy (Fam Process. 2000 Spring;39[1]:35-50):
1. Read and watch movies that address the experience of other cultural groups.
2. Go to and participate in cross-cultural events.
3. Engage in a racial self-exploration process. The following questions can begin the racial identity exploration process:
- How do I define myself racially?
- When did I first become aware of race/skin color in general, and mine in particular?
- What messages did I learn about race/skin color based on that first experience?
- What direct and indirect messages did I receive about race/skin color?
- How did the messages that I received about race/skin color affect how I thought and felt about myself racially?
- What benefits did I gain because of my race/skin color?
- What did I lose because of my race/skin?
- Have I ever dated cross-racially? Why or why not?
- How many friends of a different race do I have?
4. Internal commitment. This means committing to addressing racism in therapeutic encounters.
Lessons learned for psychiatrists
1. Therapeutic space is allocated to discuss the issue.
2. The time is strictly limited to 10 minutes, so the couple won’t feel that their emotions will overwhelm them.
3. The space is to focus on the strengths that they can bring to resolving the issue.
4. Give patients the impression that they can solve this and that it is an important issue.
5. Do not put yourself in the patients’ argument; take neither side.
Dr. Heru is professor of psychiatry at the University of Colorado at Denver, Aurora. She is editor of “Working With Families in Medical Settings: A Multidisciplinary Guide for Psychiatrists and Other Health Professionals” (New York: Routledge, 2013). She has no conflicts of interest. Dr. Heru wrote the article in collaboration with Lynette Ramsingh Barros, artist and social commentator.
Joe and Esi were in the therapist’s office wanting help with their relationship. The therapist had just asked the BIG question: How does race impact your lives?”
Esi began with her story about her ethics class, a story that was at sufficient distance from her life. Depending on her husband’s response, she would move in closer. His somewhat patronizing response made her feel both angry and that he lacked any real understanding.
“Me and a mulatto girl were in ethics class,” said Esi, who grew in Kenya. We had a White professor. He seemed to think I had no education. If you are a woman of color, you are automatically thought to have no education and that you don’t know what you are talking about. He tried to shut me up. When I persisted, I know he thought from the tone of my voice that I was an angry Black woman, even although I am not Black and I am not angry! In this country, if you have any color to your skin, you are called Black and relegated to a certain place: The bottom. I was excited about what he was teaching us, but when everyone looked at me with a certain gaze, like something bad was going to happen, all those White people, just looking, I tightened up inside and sat back down.”
Esi looked down at her folded hands. Her husband, who was White, reached over and reassuringly patted her hands.
“Yes, Esi, they are wrong. They shouldn’t have treated you that way. White people can be insensitive.”
Then, she continued, “Joe, you do the same to me!”
“What do you mean, Esi?” responded Joe, with an innocent and anxious look scanning back and forth between her and the White male therapist.
“Well, Joe, do you really want to hear how I felt last week after we came back from that party at your sister’s house?”
“Yes, Esi.”
“But do you really? Are you sure you want to hear this?”
“Yes, Esi.”
“Remember when we went over, me and the kids sat with the other people of color and you sat with your sister and her side of the family?
“Yes, I remember. What is wrong with that?”
“Well, me and my colored friends got loud and excited, and you shot me a look, like ‘pipe down over there.’ THEN, after we got home, the next day, your sister called you and said that you had better control your wife; she is too loud. Do you remember all that?
“Yes, well you do get loud – especially when you are around your people.”
“So why is it I have to fit in with your relatives and not the other way round? Why do I have to conform to the whiteness in your sister’s world, not the other way round?”
“Well, we were in her house.”
“So if they came to our house and were too quiet, how would you feel if I called them up and said they needed to participate with more enthusiasm?”
“Esi, that’s not fair, and you know it isn’t.”
Esi stops and looks at the therapist.
“So I check myself. It is the same all over, White people imposing their values and beliefs on me, on us. I am not an angry Black woman. I am just frustrated. People, White people, always want an explanation for what they think is my loss of control. You can see when their demeanor changes, they pull back, sit up, back away, fidget, and won’t look you in the eye. All these little tics that show that they are trying to get out of the situation.”
Esi took a breath and saw that her husband and the therapist were listening.
“These signs are ingrained in your brain ... these signs ... I saw it when I first came here to this country. The first time I had a good dose of it ... was in that ethics class in college. You can’t use words that you are accustomed to, ’cause they mean something else here, something bad.”
“Oh, Esi, I am so sorry,” said Joe, looking concerned.
“You may be sorry but you are not willing to stand up for me against your sister and her White values. You want me to conform.”
“What do you want me to do?”
“I want you to call your sister out.”
“But she may not ever speak to me again!”
“OK, don’t then,” and Esi looked down at her hands. She was finished talking. Joe looked at the therapist, waiting for something.
The therapist resisted intervening on the issue. “Keep talking this through,” he instructed them.
Joe could see that Esi had done talking and that it was his move.
“Do you really want me to call my sister out, even if it means that she will not talk to me again?”
“Yes.”
“I don’t know if I can do that.”
The therapist now intervened: “What does that mean to you, Esi, that he doesn’t know if he can do that.”
“It means he doesn’t really love me or value me or even value our mulatto children. What do think our daughter is learning?”
“That’s not true, Esi.”
The therapist, Dr. Swarthmore, watched Esi, who has very a dark, blue-black skin tone, with a flawless complexion and a shapely body. She wears her hair cropped and she looks like that Black model, what’s her name. Joe was short, a little plump with ultra White skin and freckles on his nose. He had been brought up in the Midwest and had had little exposure to Africans before his internship abroad in Kenya. Dr. S. thought he had probably not really thought much about Esi’s dilemma.
Dr. Swarthmore encouraged Esi to talk about her immigration experience.
“Esi, can you talk more about what it is like to be an immigrant from Africa?”
“Well, I just have to check myself so that I can fit in with this White culture. If you want to see how I feel about it, you will have to see an angry Black woman and I have learned not to give you that satisfaction. You will just dismiss me. Please Dr. Swarthmore, can we move on?”
Dr. Swarthmore was caught between his desire to accept her wish to move on and his wish to have her express herself fully. He realized that it was not his desire that mattered; that the couple had to work this out between them if they were going to move forward. So he punted it back to them.
“Esi and Joe, you are both caught in an important dilemma. Esi, you want more respect from your husband and his family. Joe, you do not want to upset your family by confronting them. Is that right? You are both dammed if you do and dammed if you don’t.”
“I agree,” Joe and Esi both said, nodding.
“Do you want to work on this issue?”
They both agreed with equal enthusiasm.
“Ok, can you spend the next 10 minutes to work on this?”
They agreed.
“Ok, let’s start. What skills do you have that can help you resolve this important issue?”
Dr. Swarthmore framed the issue as one to be solved by the couple. The couple discussed that they are usually good at communication and solving problems. This problem is about whether or not Joe is more aligned with his White family than with Esi and their children.
Dr. Swarthmore encouraged them to think about this more deeply and over time; that this is such an important issue that it requires time and deep conversation.
“How do you think you can educate yourselves about the issues at hand?”
Esi’s reading list
1. “Why I’m No Longer Talking to White People About Race” by Reni Eddo-Lodge (London: Bloomsbury, 2018).
2. “Americanah” by Chimamanda Ngozi Adichie (New York: Alfred A. Knopf, 2013).
3. “How to be an Antiracist” by Ibram X. Kendi (New York: Random House, 2019).
Joe suggests that Esi think about what it might mean if his sister and their children were no longer part of their lives. She agrees to do this.
Dr. Swarthmore asks if they can each do their homework before they come back. They agree and thought they could manage that and the book for 2 weeks out.
Dr. Swarthmore decides that he will read one of the books Esi suggested, as he does not know much about racism and White privilege and he wants to learn more. Dr. Swarthmore demonstrates his desire to become more racially sensitive. The following steps can be taken by therapists who want to become more racially sensitive, according to TA Laszloffy and KV Hardy (Fam Process. 2000 Spring;39[1]:35-50):
1. Read and watch movies that address the experience of other cultural groups.
2. Go to and participate in cross-cultural events.
3. Engage in a racial self-exploration process. The following questions can begin the racial identity exploration process:
- How do I define myself racially?
- When did I first become aware of race/skin color in general, and mine in particular?
- What messages did I learn about race/skin color based on that first experience?
- What direct and indirect messages did I receive about race/skin color?
- How did the messages that I received about race/skin color affect how I thought and felt about myself racially?
- What benefits did I gain because of my race/skin color?
- What did I lose because of my race/skin?
- Have I ever dated cross-racially? Why or why not?
- How many friends of a different race do I have?
4. Internal commitment. This means committing to addressing racism in therapeutic encounters.
Lessons learned for psychiatrists
1. Therapeutic space is allocated to discuss the issue.
2. The time is strictly limited to 10 minutes, so the couple won’t feel that their emotions will overwhelm them.
3. The space is to focus on the strengths that they can bring to resolving the issue.
4. Give patients the impression that they can solve this and that it is an important issue.
5. Do not put yourself in the patients’ argument; take neither side.
Dr. Heru is professor of psychiatry at the University of Colorado at Denver, Aurora. She is editor of “Working With Families in Medical Settings: A Multidisciplinary Guide for Psychiatrists and Other Health Professionals” (New York: Routledge, 2013). She has no conflicts of interest. Dr. Heru wrote the article in collaboration with Lynette Ramsingh Barros, artist and social commentator.