Do I need to work with someone who looks like me? A look at how “change” happens in therapy

When searching for a couples, individual, or family therapist, clients often want to know, “does this therapist have experience helping other people with the thing I’m going through.” Whether that be an affair, parenting issues, communication problems, sexual dysfunctions for couples, or anxiety, depression, PTSD, OCD, ADHD for individuals, we all want to know that we will be working with someone who understands what we are struggling with and has a plan for how to help us. But another common factor we often consider when looking for a therapist is, do I need to work with someone who shares similar life experiences as I do?

History of Identity in Therapy

It was once believed that therapists should be as much of a “blank slate” as possible for their clients. In fact, Freud believed that “the doctor should be opaque to his patients and, like a mirror, should show them nothing but what is shown to him.” (source). 

How Things Have Changed

However, modern therapy is quite different from Freud’s psychoanalysis and while most therapists are cautious and intentional about their use of self-disclosure, we also have come to understand that clients want to see our “humanness” during sessions. Not to mention the fact that we live in a diverse society where plenty of differences will be immediately apparent to clients as soon as the first session begins. My clients can immediately notice lots of things about me and make assumptions about how I will or will not be able to relate to them based on these assumptions (how I dress, how my hair is cut, my perceived accent or lack thereof, the color of my skin, the books I keep in my office, my height, etc.). So how much do these factors of our identity (race, ethnicity, sexual orientation, age, gender, ability status, height, weight, religion, etc.) impact the therapeutic relationship and account for the growth that happens in therapy? And how important is it that you work with a therapist that looks like you?

What Really Accounts for Change?

When someone goes to therapy and accomplishes their goals and the therapy has “worked,” what was it about the process that allowed for this change in the client’s life to happen? Lambert’s Common Factors Model estimates that approximately 40% of the change is due to “client factors” (motivation, resources, commitment to change, social support, community involvement, etc.), approximately 30% is due to the therapeutic relationship (quality of this relationship as perceived by the client), approximately 15% due to therapeutic model and techniques used by the therapist, and approximately 15% due to hope (a client’s belief that the therapy will actually be helpful). 

Does Identity Impact the Quality Relationship?

When it comes to creating a quality therapeutic relationship (which accounts for about 30% of the change!), the research shows that what matters more than whether or not your therapist looks like you, is how understood they are able to make you feel. And being able to make someone feel understood is not about being able to relate to everything they are saying. If I, as a male therapist, am working with a male client, and I assume that their experience with masculinity is exactly the same as mine and therefore I will be able to automatically understand his experiences, I will be setting myself up for failure in understanding their experience. I might know what it has meant for me to be male, but I know nothing about what this person sitting in front of me has experienced related to his gender.

I’m still afraid someone who hasn’t been through what I’ve been through won’t get it

Whether or not a potential therapist looks like you or shares your life experiences (younger vs. older, parent vs. non-parent, single vs. married, etc.) is far less important to the outcome of the therapy process than how well they make you feel understood. There are very real and valid reasons for certain groups to feel more comfortable working with a therapist that looks like them, and while thankfully the mental health field is becoming more diverse every year, this is not always possible due to historically marginalized and underrepresented groups not being able to access the career field of mental health. So, as you look for your therapist, if you are willing to give someone a shot that does not look exactly like you, or share all of your same life experiences, ask your therapist to make this an open dialogue. Share your concerns with them about their ability to make you feel understood and comfortable, and ask to be able to have transparent communication around both your own and your therapists’ identities and how they are impacting the therapeutic process. 

Andrew Orchowsky, LCMHC-A

If working with a therapist that understands how identity shows up in the therapeutic relationship is important to you, I might be a good fit! You can read more about me and schedule a session here.