Leary Article

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PSYCHOANALYTIC PSYCHOLOGY, 72(1), 127-140Copyright 1995, Lawrence Eribaum Associates, Inc.

CONTRIBUTIONS TO PSYCHOANALYTICPSYCHOTHERAPY

' Interpreting in the Dark": Race andEthnicity in PsychoanalyticPsychotherapyKimberlyn Leary, PhD

University of Michigan

In this article, I discuss the impact of race and ethnicity on the psych otherape u-tic process of three patients in psychoanalytic psychotherapy with an AfricanAmerican therapist. The influence of race on the treatment process has beenexplored infrequently in psychoanalytic writing, despite consensus that it isconceptually and clinically relevant. This outcome stems from the complex webof attitudes attending talk about race in this country. Race and ethnicity remaintopics that engender anxiety in social and clinical discourse. I selectively andcritically review the psychoanalytic literature on race, which has been ham-pered by incomplete conceptualizations and overgeneralizations that often limitits clinical utility. I then explore, through clinical examples, the way in whichattention directed at racial issues provided a framework for the treatmentalliance and illuminated key transferences and resistances for these patients.Disc ussion of racial issues is most fruitful when racial them es are situated inbodily and social contexts and when the meaning that race has within thetherapy dyad is negotiated by patient and therapist, apart from idealized orsocially correct conceptualizations from outside of the treatment situation.

In this article, I discuss the impact of race and ethnicity on the psychothera-peutic process and the development of meanings associated with race for

Requests for reprints should be sent to Kimberlyn Leary, PhD, University of Michigan, 527East Liberty Street, Suite 209D, Ann Arbor, MI 48104.


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128 LEARYthree patients in psycho analytic psychotherapy with an African Am eri ;antherapist. I begin with a brief critical review of the psychoanalytic litera ureon race. I then illustrate, through the use of case examples, the way in wl icithe therapist 's race provided a framework for the treatment alliance indilluminated transferences central to the personality dynamics of each pati< nl.Th e case ma terial focuse s on the technical interv ention s that either fac ili-tated or hindered the emergence of racial themes and the range of dyna: lieissues associated with their presence.

The role that race and ethnic ity play in the psy cho ana lytic treatm ;ntprocess has been discussed infrequently in psycho analytic writing des] itebroad consensus that this issue is both conceptually and clinically relev; nt.The reasons for what might be termed the only "occasional interest" (M in-day, 1992) of psychoanalytic theorists in the topic of race are many. Incontem porary Am erica, a comp lex web of attitudes surrounds talk about r ceand ethnicity. Despite its democratic ideals, the United States continues to bea highly "racialized" society (cf. Morrison, 1992)that is, a culture whi severy existence is intertwined with the politics of immigration, integrati inand the assimilation of many diverse peoples.

In most instances, race and ethnicity remain topics that are treated astaboo in both socia l and clinical pr acti ce. Discuss ion about rac e is eitl eravoided altogether (as, e.g., when every pertinent detail about a patient ispres ente d in a case confe rence exce pt his or her racial b ack grou nd or si incolo r) or quickly disp ensed with after only supe rficial c onsi dera tion a idwith a sigh of relief. More than talk about sex or even money, talk about n ;eand ethnicity tends to engender anxiety.The sensitivities associated with discussions of race are, in part, rooted inhistor ical pra ctic es. In this country, race and ethnic origin ha ve been t leoccasion for exclusion and margina lization, with slavery re presenting t leextrem e of disenfranchisem ent. Conversely, and m ore recently, race a idethnic background have also been the basis for particular kinds of recogi i-tion and red res s, as throug h program s of affirmative action.The imp orta nce of race and ethn icity in psyc holo gica l life is furfh 2rund ersc ored by its necessary conn ection with the body. To talk about ra :eand ethnicity involves im mersion, however temporary, in a body w ho ;esight, textu re, and even smell may be alike or dissimilar from on e's ow i.Thus, talk about race can arouse powerful affects and key human concerns- among them, the problem of difference, wishes for recognition, and desir :sfor domination and control (cf. Holmes, 1992; W. Myers, 1977).Tho ugh psycho ana lytic authors have recognized the import of race nhuman psychology, psychoanalytic accounts of the impact of race on tl etreatment processin the mainhave been hampered by incomplete co i-ceptualizations and overgeneralizations that l imit the usefulness of the rf ind ings . In her review of the psy cho an alyt ic l i ter atu re on race ar dethnicity, M unday (1992) detailed a number of early inves tigation s th itcentered on Black a nalysan ds in treatm ent w ith W hite analysts (Adam ;,


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195 0;Cu rry, 1964; Kennedy, 1952).In general, race was viewed as something of an interference in the treat-ment pro cess. For exam ple, the Black pa tient's race as well as the potentiallyprejudicial attitudes of White analysts were viewed as obstacles to conduct-ing successful treatments. As an illustration, Kennedy (1952) suggested thatBlack patients enter treatment already fearing and distrusting White thera-pists because of specific prior life experiences. As a corrective, she arguedthat the Black patient acquire an ego ideal not predicated on skin color toparticipate fully in treatment and to accept the White therapist as a col-league.Such an approach is, of course, problematic in the view of contemporaryeyes. In effect, Kennedy (1952) enjoins the Black patient to resolve whatevercomplicated experience of Whites she has to make her treatment a success.Here, the Black patient is put in the curious position of needing to cure

herself before the treatment may take place.Additional difficulties surface in other early analytic formulations of raceand treatment process. Holmes (1992) noted that in many of these earlydiscussions, the impact of race and ethnicity was often narrowed to aninquiry concerning the influence of racism on personality development andinterpersonal dynamics. In these accounts, clinical attention was directed atthe truncated experiences of self and other that result from the Blackpatient's membership in a stigmatized social group (Munday, 1992).For instance, Kardiner and Ovesey (1951) and Karon (1958), amongothers, offered descriptions of the "negro pe rsonality." The personality func-tioning of Black people living under segregation and with discrimination

was said to be typified by a constellation of traits, including low self-esteem,apathy, fears of relatedness, mistrust, problems with the control of aggres-sion, and an orien tation to plea sure in the mo me nt. Existing differencesbetween Blacks and W hites in such things as values, preferences, and familydynamics were assumed to be symptomatic accommodations to racism andto reflect compensatory efforts to cope with feelings of inferiority andself-hate. Gardner (1971), Jones (1985), and others cautioned that the find-ings from these investigations are limited because of a wide array of meth-odological difficulties, including experimenter effects and samples thatincompletely represented the populations under study. In these conceptual-izations, the cultural practices of Black patients do not have any independ entstatus in their own right, apart from reflecting personality deficits.The effect of many of these early analytic authors is that the Blackanalysand is portrayed as someone distinctly different from the White thera-pist. The Black patient is portrayed as an enigmatic "other, " an unfamiliaralien. Given the tenor of the timesmany of these articles were publishedbefore the mid-1960sthese clinical reports document the often problem-atic though well-intentioned efforts of analysts who struggled to make thealien stranger known. Making the other familiar most often meant renderingall that typified Blacks as aliennamely skin color and cultural back-


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130 LEARYgroundassimilable to psychoanalytic structures of meaning. Sterba (19< 7),for examp le, observed through his analytic work with White patients hatrejection of Blacks by the majority culture is based on repressed sib: ingrivalry because Blacks are equated with unwanted younger siblings. Bla< ks,reconfig ured in the terms of analytic disco urse , were rendered w ell knc wnand no longe r foreigne rs, even tho ugh it seems likely that many Bla ;kswould no longer recognize themselves.

With the advent of widespre ad in tegration in the 1960s, later anal; ticarticles highlighted the impact of race and ethnicity in treatment dyad; inwhich the therapist was Black (Curry, 1964; Gardner, 197 1; Schactei &Butts, 1968). The Black therapist was held to be a novelty for White ; nclBlack patient alike . Curry (1964), for exam ple, highlighted the importa ceof the patie nt's com m unica tions about the therap ist's race. Curry viev eeldiscussions of the Black therapist's race as a preview to the patient's h tertransferenc es and caution ed against confusing racial respo nses with hetransfere nce. Instead, Curry viewed the pati ent 's comm ents about hetherapist's Blackness as "mythological responses" that reflect the residue offairy tales , ch ildr en 's stories, and other cultural artifacts that deal with, orexam ple, "devils and darkn ess." According to Curry, these reactions sh; pethe transference but do not constitute it.

For this idea to work, a pa tie nt's stereotyp ed notion s of the Bh ;ktherapist's racefor example, that his Blackness mirrors his wickedness -isunderstood to convey som ething that is necessarily true about Blackn ess a idnot to com mu nicate som ething that is necessarily true of the patient, cc n-structed by her in accord w ith her own wishes and need s. Under these terr s,skin color, hair texture, and body shape are treated as having specific a pri. >rimea nings. Race is treated as a "content" whose symbolic meaning is alrea lyestablished. With such a conceptualization, the therapist does not set out tolearn about the patient's experience of race but looks at the patient's encoi n-ter with racial meanings that appear to have an autonomous life of their ow n.In my view, this way of thinking represents a peculiar distortion of analy icwork. S uch a persp ectiv e emp hasize s static , reified m eanin gs and not t lefluid productions of a treatment process involving the elaboration of psycr icreality and idiosyncratic fantasy.Schacter and Butts (1968) were among the first to discuss the inadequacy )ftraditional psych oanaly tic theory to account for the impa ct of race on t letreatment process. Instead of viewing racial differences as necessarily limiti .gand constraining, they argued that clinical attention to racial issues could ha rea "cata lyti c" effect and mob ilize the treatment process. Sim ilarly, Gardn jr(1971) discussed the impact of mixed-race and same-race therapy dyad s, ei I-phasizing the way in which patient and therapist expectanc ies about race ai dethnicity could, when understood, enhance effective therapy process.The findings of these authors (i.e., Gardner, 1971; Schacter & Buti;,1968) foreshad owe d contem porary observ ations that sugg est that clinic ilattention directed tow ard the realities and fantasies associated with race nu y


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facilitate psychotherapeutic work or even be a precondition for its success,especially in mixed-race therapy dyads and in psychotherapies where patientand therapis t share minority status (see also Fischer , 19 71; Griffith, 1977;Holmes, 1992; W. Myers, 1977).Other analytic clinicians also advocate discussing racial themes and issuewhenever and with whomever they emerge, including treatments where bothpatient and therapist are W hite because race, ethnicity, and skin color rem ain ofpivotal importance in both social and psychological life (cf. Calnek, 1970;Holmes, 1992). In our increasingly pluralistic society, both minority and major-ity patients are more likely to have transactions with those from a variety ofethnic backgrounds in face-to-face exchanges as well as through the media andpopular culture. Critical aspects of these real and fantasies encounters are, ofcourse, internalized and form a backdrop against which any number of dynam icissues may be brought to life. Holmes (1992), for instance, argued that the

analysis of racial issues may even provide a critical point of contact with thepatient's core transferences, conflicts and resistances.Despite consensus among most psychoanalytic clinicians as to the import-ance of attending to race as a ubiquitous carrier of crucial meanin gs, psyc ho-analytic accounts of race and ethnicity have remained incomplete andlimited to the "occasional theorizing" of only a few clinicians. Psychody-namic authors who have directed themselves to the relative dearth of ana-lytic writing on racial and ethnic issues suggest that less clinical attentionhas been directed to racial issues because patients and therapists of color arethemselves underrepresented in the population offering and receiving psy-chodynamic treatment. According to this perspective, the dynamics of race

and ethnicity remain unarticulated because most therapists are unfamiliarwith the clinical issues such patients present.This explanation, however accurate in terms of statistical representation,seems once again to obscure more central issues. Such a perspective appearsto conceptualize race and ethnicity as a kind of local geography, vital to thejourney if you happen to be in the area but only a passing curiosity, at best,to those from other locales. Discussions of this sort treat race and ethnicityas if they we re qualities possessed only by people of color and ignore the factthat White patients also have a race and an ethnicity.As this brief survey of the literature illustrates, race, like gender, contin-ues to be an especially vexing problem within psychoanalytic theory. Thepersistent difficulties analytic authors encounter when discussing race haveled some clinical practitioners to suggest that psychoanalytic models areinappropriate ones for Black patients (cf. Ivey, Ivey, & Simek-Morgan,1993). These clinicians question the relevance of a "Eurocentric" paradigmdeveloped in the 19th century for the struggles faced by contemporaryAfrican American in a racialized society, despite evidence that Black andWhite patients appear to benefit about equally from psychodynamic therapyin either racially similar or dissimilar dyads (Jones, 1982).As a solution, it has been suggested that African Am erican patients would


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132 LEARYbe better served through the provision of culturally specific psychothen py(cf. Sue, 1987 ). "Afr ocen tric" psych oth erapie s, for exam ple, rest on hepremise that traditional psychotherapy models are not effective for Afrii anAm ericans (L. M yers, 19 88). These mod els reconfigure psych otherapy toinclude treatment techniques, usually cognitive-behavioral, believed to beconsonant with the cultural practices and beliefs of African American p o-ples (e.g. egalitarian labor and group decision making rather than reliance ana single expe rt). In addition , many of these approache s also em ph asize hevalues of cultural affiliation and identification. Consequently, Afrocent icperspectives offer new norms for the behavior, health, and pathology ofAfrican Americans apart from those provided by the majority culture.

Although these models offer the potential of reaching underserved poj u-lations and may, in instances, make treatment more accessible to those w 10might otherwise reject itand are valuable in that respectin my view, th iyalso raise trou bling new con cerns . Amon g them is the way in w hich the semo dels offer, in effect, "a new psy cho log y" for African Am erican s a idprovide standards for a racialized identity. There is the danger that specil y-ing the rules for racial identity inadvertently serves to minimize the indiv: i-uality of African Am ericans in contem porary Am erica (see also, Jom s,1985). Further, these approaches also appear to extend a bias encountered nearly psychoanalytic formulations of the role of race.

Early analytic writing and Afrocentric revisio ns co nverg e on the beli ;fthat the Bla ck pa tient m ust be set apart to be unders tood . Both of the ;epers pec tives ab rogate the notion that race and ethnicity can be discus sed na "shareable" world in which Blacks and Whites may have different poir :sof view about themselves and each other but still create meaningful unds r-standings in ways that maintain the personal integrity of each.The assertion that psychoanalytic formulations fail to appreciate the exp :-rience of African American patients rests on historical accounts of particul irpsychoan alytic treatm ents that were themselves riddled with theoretical ai dclinical difficulties. The incomplete conceptualizations of these earlier ps -choanalytic writers speaks to the necessity for developing new theory, but c onot, as I see it and as a matter of course, require a move to a new conceptu tlneighborhood.

Psychoan alytic treatment itself has undergone something of a revolutic nas of late. New approaches to jpsychoanalytic process emphasize the way : nwhich the analytic encounter is profoundly relational. Meaning is not som< -thing that is exclusively discovered or encountered. In certain respect ,analy tic reality is now und erstood by many to be join tly constru cted an inegotiated by the analytic partners themselves (Goldberg, 1987; Hoffmai ,1983; Ren ik, 1993). Recogn ition of the imp ortan ce of interactio n and th ;ubiquity of enactments in the clinical situation may generate new ways c farticulating the complexity of clinical transactions as they relate to race an 1ethnicity . In fact, the psycho analy tic situation may offer a uniqu e oppo rti -nity for elaborati ng the meaning of race and ethnicity to the extent tha t th ;


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RACE AND ETHNICITY 1 3 3analytic clinician can focus on the amalgams of fantasy and reality to whichtalk about race is heir and discover the idiosyncratic purposes to which it hasbeen put.The following clinical material illustrates some of the difficulties inherentin this kind of work as well as the potential benefits. The clinical approachpresented here extends the work of Holmes (1992) in discussing how racemay function as a vehicle through which core developmental issues, keytransferences, and related countertransferences may be transported to theclinical situation. How that vehicle may be driven or be halted in its tracksis the topic that will be considered next.

CASE ILLUSTRATION 1:LEARNING FROM ERRORS

In the first case, I describe a series of moments in the psychotherapy of achild during which race was of particular significance. The case was my firstchild treatment, conducted when I was a trainee in supervision with a seniorcoll eag ue. In this vignette , I first discuss how a particu lar coun tertrans fer-ence and collegia] discussions, emphasizing the social reality of race, led toan error in technique.My patient was a 7-year-old, White boy whom I will call Michael. Mi-chael, a sturdy, blonde, blue-eyed boy, was an appealing youngster with theready ability to engage adults quickly. Treatment had been sought for hisencopresis. At school, his symptoms resulted in him being teased and ostra-

cized by his classmates. At hom e, he denied his soiling, despite the evid enceof his stained pants and the unmistakable odor. On at least one occasion,Michael father's confronted him with his soiling by abruptly pulling downMichael's pants, deeply humiliating the boy. His increasingly uncooperativeattitude at home brought further censure: His father spanked him with anopen hand or with a belt for infractions the parents deemed most serious.Michael took to the therapy quickly. He was able to verbalize his feelingsand enter actively into imaginative play; early on, he invited me to be aparticipant. Michael's interest in my race came to life near the end of the firstyear of treatment. During one session, I noted that Michael seemed unusu-

ally preoccupied with a drawing he was making of a superhero, commentingoften and anxiously on the colors he was choosing. When I commented onhow interested he seemed to be in people's colors, he turned to me, studiedmy face, and asked, "Are you Black or White?" I asked what he thought. Heconsidered me judiciously and said, "I think you are tan." I agreed that mycolor was tan but that I was Black. Michael's ensuing silence promoted meto comment that he seemed worried about my being Black. Michael re-sponded by holding his arm up to mine and announcing, "You're not thatBlack ." I commented that his worry about my race was so big that he wantedto pretend I wasn't Black. Michael responded by replying that there were


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134 LEARYslaves w hen his dad was a boy. I agreed there w ere slaves but not when lisdad was a boy. Michael insisted otherwise saying, "There are slaves eve y-where." This time I assented and invited him to say more, but he said nomore about Blacks or slaves during the remainder of the session.

At the next appointment, M ichael began by reciting the colors of heAmerican flag, chanting "red, white and blue" over and over again. I sai i 1thought M ichael was reminding us of the important talk w e'd had abi utpeo ple's colors. M ichael then proposed that we play a game he cal 3d"slave." I immediately noted to myself that I felt some uneasiness with t lisgam e, but I consented . I was instructed that I was the slave and Micha el, i :ieboss. My discomfort increased as the patient, enacting the part of a ruthli ssmaster, demanded a series of increasingly impossible tasks. Michael as i lemaster pretende d to beat me with an imaginary whip. The young p atie it,standing over me, was breathless after his exertions. I learned from him tl atslaves had to go to sleep early, attend school, and were compelled to co n-plete "stupid" chores. In short, in Michael's world, slaves were equivalent tochildren. I could then communicate how scared, little, and humiliated"sla ves " could feel and how much they would rath er be like po w er ul"master" parents so as not to feel so small and ashamed and to exact th irrevenge.In discussion of these hours with my senior colleague, I commented >nmy discomfort with my patient's slave game, especially the relish with whi ;hhe seemed to enjoy being my master. Before supe rvision , I felt vagut lytroub led about how all this wo uld appear to an onlooke r. My collea g leechoed my anxiety. Concern was expressed about the consequences of 1 t-

ting Michael continue in this vein. Both my supervisor and I were quick tonote how stimulated Michael appeared at the end of the session, discuss :dhow b urde nsom e feeling that powerful had been to him, and were worri :dabout the impact of his treating me in a degrading and demeaning mann :r.The supervisor suggested, and I agreed, that as the treatment rules includ :dthe provision that no one got hurt, and because in the slave game the sla 'egot "hurt," that this game would come to an end. It was agreed that I wot Idtell Michael that even though the game would stop, he and I could still U Ikabout slave and master feelings.When I suggested this to Michael, he nodded gravely. And though he la' ;rlistened thoughtfully to me talk about master and slave feelings, never age in

did he speak of slaves directly, even though these themes permeated \ ismaterial through other venues.In this series of intera ction s, I believ e that an error o ccurre d: Talk a idactions con necte d with the topic of race were met with an overem pha sis inreality. I responded to the patient's announcement that I was tan with areality: Though tan, I was "Black." Although accurate, this young patien 'sreluctan ce to conclude that 1 was Eilack went unaddresse d, even thou ;hMichael himself had raised the question of whether I was Black or White. Asimilar misstep was narrowly averted when I attempted again to correel a


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RACE AND ETHNICITY 1 3 5misperceptionnamely that there were no slaves when the patient's fatherwas a boy. The patient's persistence and my ultimate acceptance of this ledto the slave game. This game quite clearly provided a forum for the child tobring to life his own humiliating powerlessness and efforts to protect himselfby identifying with the master aggressor. My supervisor and I, however,responded as though I were actually being enslaved and were, in fact, facingreal degradation that required intervention. Clearly, this was not so. Further,I believe that my supervisor and I extended our discomfort and feelings ofbeing ove rstim ulate d to the child; we felt they were causin g difficulty forhim alone when these feelings seemed to permeate both the clinical andsupervisory situations. Would a therapist and supervisor have been so con-cerned if the therapist were White and the patient Black? Would the patienthave been asked, in effect, to surrender his game if his slave therapist hadbeen White? I suspect not. I believe his game would have remained thefantasy expression of the child's conflicts and concerns that it was. Instead,the game became a vehicle for the clinicians' conflicts and concerns. Thesocial reality of race, especially ongoing discomfort in this culture with thehistorical fact of slavery, interrupted both clinicians' ability to attend to andlive with the patient's psychic reality.

CASE ILLUSTRATION 2: NEGOTIATING RACEIn the following vignette, my race was dealt with differently. The patient andI were able to use my race as a stepping stone to important transferences andto build useful understandings. Mr. A., a 25-year-old gay White man, pre-sented for treatment with concerns about his inability to make long-termcommitments to romantic partners or to enjoy comfortable friendships witheither men or women. In most encounters, he flaunted his considerableintellectual talents and was caustic and cutting. Following such self-dis-plays, Mr. A. suffered enormous anxiety. Now desperately contrite, heawaited castigation. Over time, we came to understand that his driven needto force himself on others and the punishment he expected in return wereconnected to important early experiences with his mother. The ritual ofexposing himself to an expected retaliatory attack reflected, in part, Mr. A.'srather profound anxieties about his maleness, which he dealt with coun-terphobically. While growing up, he had felt painfully excluded by hismother, the provocative autocratic authority of the family home who favoredhis younger sisters. Mr. A.'s posturing with friends and colleagues showedhis efforts to affirm his worth as a male but also brought with them the fearthat such exposure would result in damage and humiliating loss.

Mr. A. mad e a numbe r of references to race and ethnic backgro und duringthe early months of his therapy. During one session, he expressed nearoutrage when a college acquaintance invited him to attend a synagogueservice where she was to be the cantor. As we explored this, it became clear


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1 3 6 LEARYthat Mr, A. was nearly beside himself with envy and rage because his fri ;ndhad so easily assumed that he would want to watch her perform. Mr. A. ra ledagainst this woman's supposed view of herself as special and unique, wl ichhe came to linktentatively at first-with her being a Jew, one of the"chosen people." In the same session, he lacerated Black students at a 1( ca lcolle ge whom he believe d had been offered adm ission bec ause of affirma iveaction. I was able to speak to how outraged Mr. A. felt that Jews and Bte :kscould so easily allow themselves to be "chosen" and "affirmed" when for hispar t, Mr. A. felt so unclaim ed, so ill-cons idere d, and so uncomfort; blebecause of the danger he associated with standing out himself.

With some hesitation, Mr. A. began to refer more specifically to my r; ce.At the time, he viewed me as a wild and provocative woman, similar to hismo ther. For exam ple, when I shifted my leg, Mr. A. wo ndere d if it migh bea seductive invitation. When I moved my hand, Mr. A. reported his expe> ta-tion that I planned to scratch my crotch in his presence. My race becarr s amechanism for greater elaboration of these ideas when Mr. A. found him: elfalternately fascinated and repelled by my hair. When I responded with :herequ est that he tell what he saw and ima gined , he initially limited himse l toa reality, saying "You have a lot of hair." Emboldened by this, he went 01 tosay that my hair was not only big, but untamed, wild, and bushy. Further, hethought I w ore it with ab andon. A dditional assoc iations included his vi ;wthat my hair was like a lion's mane and compared my hair to that ofMedusafull of snakes. He also thought with some amusement that my w ildhair reminded him of his mothe r's pantyhose drawer, entangled and o\ srflowing. When I noted that it is the male lion who has a mane, we be terunderstood his experience of my hair: For Mr. A., my hair was experiem eelas a provoc ative app ropriation of what belonged to men, and to himself inparticular. This reflected his view that his mother's power in his family \ asacquired by dint of disarming men of what was rightfully theirs.

During another session, Mr. A. mentioned, with a great deal of embarra ;s-men t, that he had expe rienc ed a "rac ist" thoug ht: As child ren, he and lis,sisters had mimicked Black English to tease and amuse one another. I as! erihim to tell me about it. Instead of describing his memory, to our mut lalsurp rise, M r. A. began to speak in a high strung appr oxim ation of Bh ckEnglish in a southern dialect. Mr. A. immediately felt ashamed and out olcontrol. He had the sudden wish that I would respond in kind and speak inBlac k Eng lish w ith him. W hen I again invited him to say more , he s. idperhaps I had spoken this way before I went to college and graduate scho )1,when I was a girl at home. I asked him about Black girls who spoke with h mlike this. He told me that he had known few Black people closely, but so neBlack kids had been bussed to his school. He remembered that a loud gro jpof Black girls had "ad opted " him in jun ior high. He thinks they were troub e-makers, but they called him "sweetheart" and playfully teased him about '. is"skinny White-boy ass." Mr. A. had felt secretly flattered by their attentic nsand cover tly enjoyed being sing led ou t. Reflec ting on this mem ory, I si g-


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RACE AND ETHNICITY 1 3 7gested to Mr. A. that his use of Black English and desire for me to respondin kind reflected a wish that we could be Black girls together. I suggestedthat he felt that if we could both be Black girls together, then we could alsobe provocative and not worry about getting into trouble. I also said that Ithought he felt that if we were both Black girls together, we could appreciatethe attributes that White boys had and what they could offer, in a way he felthis mother had not been able to do for him. With this, we were able toexplore in sharper relief his long, frustrated wish to be admired and cher-ished for his differences, including his maleness.

With this patient, race and ethnic background provided a fertile soil inwhich imp ortant transferences could germin ate. This was so, I believe, to theextent that patient and therapist could negotiate what meaning race was tohave within the dyad. Negotiations of this sort are by no means limited totalk about race and ethnicity but define the framework of all dynamicunderstanding (cf. Goldberg, 1987). In these interactions, for example, atten-tion to the range of meanings the patient attached to Blackness (e.g., thefreedom to be affirmed and provocative and to comfortably draw attention toone's self) as well as establishing the bodily context of race and ethnicity(i.e., my hair and the Black girls' playful comments about his "White-boyass") contributed to understanding the patient's unique concerns and idio-syncratic psychology. Again, such nego tiations stand in counterdistinction tothe social realities of race to which patient, therapist, or both may be boundoutside of the consulting room.

CASE ILLUSTRATION 3: RACE ANDRESISTANCE

In the next case, a clinic's decision to assign an African Amercian patient toan African American therapist emerged as a formidable resistance to thedevelopm ent of a treatment alliance. M s. B. , a single African Am ericanmedical student, sought therapy with the complaint that she felt isolated inher program "with no one to talk to" in a meaningful way about her experi-ence. During the consultation phase, Ms. B. and the consulting therapistcame to frame Ms. B.'s concerns in racialized terms: As Ms. B. was anAfrican American woman, a significant part of her distress was understoodto be centered on Ms. B.'s experience on being a minority in a majorityculture, ambivalent about her presence. The consulting therapist was awarethat there was more to Ms. B.'s storyfor example, Ms. B.'s upper-incomeprofessional family, private education, and successful tenure at an IvyLeague college made her feelings of estrangement something more thanbeing an outsider in an unfamiliar environment alone. Indeed, as Ms. B. wasquick to acknowledge, at her new university she was, in fact, an insider incircumstances very familiar to her. Nevertheless, in consultation with seniorcolleagues, the consulting therapist and Ms. B. decided that the patient's


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138 LEARYtreatment needs would be best served by assignment to a Black thera] ist.This was so, although Ms. B. neither made this request nor independe nlyindicated a preference for a minority therapist, though she accepted theconsulting therapist's referral to a Black therapist in apparent agreemem

In the early sessions, Ms. B. greeted the transfer with a bemused butresentful detachment that came to be her signature for the tenure of thetreatm ent. She explain ed her feelings of alienation within her prog ram s aconsequence of the bureaucratic structure of the university, which she fe.tdid not take "individual circum stances into account." At one level, hisfunctioned as a commentary on Ms. B.'s lifelong complaint that her perse nalneeds w ere ignored b ecause of her develop men tally disabled your gerbrother, whom she guiltily and bitterly resented for absorbing her pare its'attention and the family's resources.On another level, it soon became clear that Ms. B.'s reproach was direc ted

at the clinic and reflected her ambivalent feelings about being assigned o aBlack therapist. M s. B. had respond ed to the fact of her Black therapist asshe had coped with pressures in her family, by manifestly me eting lerobligations. She attended her sessions faithfully, but I also felt the treatm ;ntwas oddly silent despite M s. B.'s evid ent willing ness to speak of her ifeexp erien ce. In response to my queries abo ut her feelings about seein ; aBlack therapist, M s. B. enthusiastically stated that she coul dn't speak ope Uywith a White doctor, though it was soon became apparent that neither co lidshe tell her Black therapist what was on her mind. Once again, and now inthe transference, Ms. B. felt she had no one with whom she could talk ab suther experience.I believe that Ms. B.'s assignment to a Black therapistand the assur ip-tion that Ms. B. would be more comfortable with this arrangement thoi ghshe made no such request herself becam e a major obs tacle to M s. I ,'sdeve loping a tenable treatm ent alliance . This was so, in part, because heclin ic's decision to assign her to a Black th erapis t echoed the back st; gema neuv ering she felt had characterized her pa ren ts' efforts to mana ge th ;irdisabled younger child whose disability was often described euphemistica l>and not directly acknowledged, despite its obvious presence.In time, Ms. B. also revealed additional constraints on her treatm n(imposed by the tacit assumption that her therapeutic work would be > n-hanced if she were seen by a minority th erapist. T hroug h her criticis m o ' aBlack professor at her undergraduate college whose racial views did not fitcomfortably with those of Black student organizations on campus, we ca neto learn about her transference fear that a Black therapist would find Ms. 1 ,'sown ideas about race ob jection able. With recognition of this, M s. B. v asable to discuss, albeit in only a limited way, the many difficulties she r idencou ntered with the Black men she had chosen for roma ntic par tne rs. S lewas also able to allude to heir sexual attraction for White male colleagu :s,which she felt might bring censure from other Blacks, including from 1 letherapist. In fact, Ms. B.'s attraction to White men appeared to be one of 1 le


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Kardiner, A., & Ovesey, L. (1951). The mark of oppression. New York: World.Karon, B. (1958). The negro personality: A rigorous investigation of the effects of culture. I ev/

York: Springer.Kennedy, J. (1952). Problems posed in the analysis of Negro patients. Psychiatry, 15, 3 1 3 - 2 7 .Morrison, T. (1992). Playing in the dark: Whiteness and the literary imagination. Cambri ge,

MA: Harvard University Press.Munday, C. (19 92, April) . The effect of race and ethnicity on psy choth erap eutic proces: : A

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Myers, L. (1988). Understanding an Afro-centric world view. Dubuque, IA: Kendall/Hunt.My ers, W. (197 7). The significance of the colors black and white in the dream s of white ind

black patients. Journal of the American Psychoanalytic Association, 25, 163181.Renik, O. (1993). Analytic interaction: Conceptualizing technique in the light of the anal) st':;

irreducible subjectivity. Psychoanalytic Quarterly, 62, 553-571.Schacter, J., & Butts, H. (1968). Transference and counter-transference. Journal of the Amer, :an

Psychoanalytic Association, 166, 7 9 2 -8 0 8 .Sterba, R. (1947). Some psychological factors in Negro race hatred. Psychoanalysis and theSocial Sciences, 1, 411-427 .Sue, S. (198 7). The role of culture and cultural techn iques in psychoth erapy : A critiqu e ind

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