Introduction

Therapist and patient are in constant conscious and unconscious communication, where the patient’s experiences and feelings continuously influence and exert pressure on the therapist’s experience, interpretations, and behaviors (Chused, 2003; Vaslamatzis, 2005). The ability to act as a “container” (Bion, 1959) for patients can be hindered by a lack of self-awareness and experience in the beginning therapist and can be exacerbated across levels of clinician experience by the existence and use of race in the transference. Encouraging students to go on a journey of self-discovery is an integral part of clinical training to create avenues for self-reflection and address being able to hold aspects of patient’s identities and emotions; emotions they struggle to hold for themselves. However, the full extent of early object relations that may be surfacing in the dyad will be impacted by cultural context, histories, and concepts given the prominence and trauma of race in Western society (Chapman, 2006; La Roche, 1999). Attention must be given to the sociopolitical context within an individual’s life to localize oneself in the dyad in terms of cultural context—race, sex, sexuality, and other identities (La Roche, 1999). This can be difficult to do, as topics of race signal anxiety in both therapeutic and supervisory dyads (Hamer, 2006). Such countertransference reactions preclude the clinician’s ability to find “a third space” (Aron, 2003, p. 628) to think in the therapeutic encounter.Footnote 1 However, these differences still need to be addressed to work through the functions of racism in the therapeutic dyad as well as to create awareness of how cultural differences can be particularly used in projective identification (Tan, 2006) and may result in racial enactments (Leary, 2012) and enactments of otherness (Sheehi, 2015). Otherness is particularly challenging to tolerate and work through as it invokes anxiety and fear in the therapist of racist and other oppressive attitudes that might arise in the therapeutic or supervisory dyad (Holmes, 2016; Leary, 2000; Tang & Gardner, 2006). This paper and case analysis aims to address some of the pitfalls beginning clinicians may face when beginning their journey of self-discovery and clinical work, identify challenges in training programs when training clinicians on the discourse of race and oppressed identities, and provide a first-person account into some of the struggles marginalized clinicians may experience in training and clinical work.

Race in the Dyad

Race in the United States has been spoken about in terms of “deprivation and domination, powerlessness and control, and privilege and rejection” (Leary, 2000, p. 641). Holmes (2016) captures this sentiment when stating, “in being racially ‘othered’ ... you are stripped of power, including [the power to] expressing affective responses including curiosity, the search for truth, problem-solving, stick-to-itiveness, and the need to establish, pursue, and achieve important life goals” (p. 570). The experience of racism by individuals in Western culture is that it is always implicitly or explicitly present and profoundly damaging (Holmes, 2006; Leary, 2012). Recurrent experiences of racial microaggressions in society are extremely traumatic, and yet are inevitable in the current discourse around race in the United States (Leary, 2000); every person is a participant in his or her role as perpetrator or victim of racism. Holmes (2016) reports research on the development of racial bias and internalized racism in children in the United States, with significant implications for how White children develop a negative bias towards different racial and ethnic groups, while Black children develop a negative bias towards themselves. There is an inherent power differential in therapy, and, in the context of race and culture, such inequality may become more alive in the therapeutic encounter (Chapman, 2006).

Racism affects multiple aspects of daily living and mental health (Holmes, 2016), and due to the history of race in society, its impact will inevitably permeate the therapeutic encounter (Chapman, 2006). Early object relations and, therefore, the therapeutic dyad are impacted by cultural histories and contexts (Chapman, 2006; La Roche, 1999), and some of the resulting dynamics in the dyad may be representative of imbalances in power (La Roche, 1999). This can enhance an understanding of “ongoing relational issues within the therapeutic dyad or the patient’s individual history of relationships” (La Roche, 1999, p. 395). La Roche (1999) summarizes the importance of race in understanding individuals and their experience in relationships, stating when these are “construed within the sociopolitical context, it situates important aspects of human growth not only within the interpersonal context but also within the larger social world, in which sexism, racism, and other oppressive dominant norms limit our lives” (p. 395). Racial enactments are enactments that occur when structural racism enters the therapeutic encounter (Leary, 2012) and are representative of cultural attitudes towards race and racial disparities in society (Leary, 2000). When patients consistently relate to others via power and control, attempts by the therapist to communicate with the patient outside of these dynamics may be futile (Csillag, 2014). I aim to use the case of Adam to exemplify the ways these racialized and gendered oppressive norms may impact the therapeutic dyad.Footnote 2

Adam was a self-identified White, middle class, heterosexual, cisgender male patient in his mid-20s. He completed his associate’s degree after high school and, at the time of therapy, was a self-employed photographer and videographer. In his early life, he described feeling “different” and “othered” in school, where he experienced prolonged bullying resulting in somatic symptoms. Adam expressed being fearful of others taking advantage of him or giving him a false sense of friendship to “use” him or use information he shared with them against him. Still, Adam reported an active social life in his adulthood, often going on outings throughout the week and becoming involved in recreational activities and sports.

In therapy, he examined how he engaged in relationships, and continued to question multiple aspects of his identity, including gender, sexuality, and occupation, and felt a sense of urgency in determining these aspects of himself due to his aging parents. Throughout therapy, Adam appeared his stated age and was of average height and weight. He usually arrived casually dressed and on time to his twice-weekly sessions. He presented as lively, anxious, and motivated to be in sessions. He seldom canceled and often rescheduled if he could not make his usual time. He would often shake his leg and shift in his chair. When sharing more vulnerable feelings, Adam would employ narcissistic defenses and would also struggle to maintain eye contact—he would remove his glasses and look at the ceiling. He had difficulty expressing his feelings and attempted to have a more practical and detached approach to doing so. When becoming emotionally activated, he would also withdraw and become increasingly vague; he would philosophize about the universe and “voids.”

At the beginning of each session, Adam would provide a lengthy summary of his week and any symptoms of depression or anxiety he may have experienced. He spoke quickly and in abstract and vague terms, and in long, drawn-out statements. There was a tendency for his speech to become tangential. He gave the impression of having to fill the therapy space and an urgency to unburden his mind in the allotted time. He would not allow me to intervene or speak during these monologues, often not leaving space for me to speak and, at times, interrupting me if I began to speak. With consistent intervention and time, Adam began to slow down his speech patterns, and catch himself in moments where he would begin to monologue, remarking, “I don’t even know what I’m talking about anymore. I need a moment.”

When speaking about gender identity and sexuality, Adam often wondered if he is “too privileged as a White, middle-class man,” and expressed desire to experience “being a minority.” He would question his gender and sexuality in the context of how others experienced him and his own view of heteronormative gender roles. For example, if Adam thought others would feel close to him, he would identify with different sexualities (i.e., demisexual, pansexual or bisexual) when contributing to conversations about identity and would subsequently return to therapy expressing that these identifications did not capture his experience and resulted in increased anxiety about maintaining this view of himself to others. He communicated significant distress at his perceived inability to connect with others when identifying as a cisgender, White, heterosexual middle-class male. He denied sexual attraction or interest in relationships with men; however, he reported a wish to be attracted to men as he received “attention from gay men” and therefore it would be “easier” to develop relationships with men rather than women. He spoke about gender by referring to his “feminine side,” which represented his seeking attunement to his emotion, physical displays of emotions (i.e., crying, affection), wearing skinny jeans (experienced as feminine clothing), and being “sensitive” and “submissive”—qualities that invalidated his perception of himself as masculine. His social life was experienced as a source of anxiety, and he often attended sessions questioning and ruminating on his interactions. He also spoke at length about fantasies of the potential course of a relationship, future interactions, and ways he could behave to maintain friendships. These fantasies appeared to interfere with Adam’s ability to engage in new relationships (romantic or platonic), as he often reported feeling disappointed his fantasies were not realized and the relationships remained superficial. Halfway through our work together, Adam began a romantic relationship that lasted for approximately three months with a heterosexual, cisgender woman. He spoke about this relationship within a fantasy of being a professor, helping his romantic partner navigate the loss of her virginity and new sexual experiences, and ended the relationship due to “boredom” and “finishing his teaching”—defensive mechanisms to cope with his vulnerability and inexperience in relationships, and a distancing from being known.

Role of Therapist’s Identity

Both patient and therapist come into the therapeutic situation with their own cultural background and prejudices, and these can emerge in the transference (Hamer, 2002, 2006; La Roche, 1999; Leary, 2000; Tan, 2006)—this has been termed “cultural transference” (La Roche, 1999, p. 391). Cultural transference and resulting countertransference reactions can provide information on the patient’s experience in their sociocultural context and how the patient experiences the “therapist’s authority and assumed group membership [in society]” (La Roche, 1999, p. 391). This is also impacted by social and historical context, perceived identifications with specific racial groups, and role valences (Hamer, 2006). Race incorporates psychological and social experiences beyond that of designating color and has a social construction. When speaking of race, many individuals can have a set impression of a person’s color, education, income, and livelihood, among other things (Leary, 2000).

The potential analytic underpinnings of racism may be seen in various ways, among them, “as an inability to accept and acknowledge difference without attempting to control and dominate the object that is felt to be different and separate. The control and dominance aim to reinforce the phantasy that the quality of separateness does not exist” (Tan, 2006, p. 119), and therefore, there is a “distorted omnipotent feeling of sameness” (Tan, 2006, p. 120). Racism is also experienced as a “constraining social regulator” where racialized individuals are forced into “socially imposed limitation[s]” (Holmes, 2016). In this way, society creates a wariness and fear within the individual of a racialized identity in expanding beyond societally imposed limitations and engenders guilt for any behaviors deemed outside of these racial (and gendered) socially implicit or explicit norms (Chapman, 2006). Chapman (2006) reports on the difficulty and shame associated with holding such a position of power in being a therapist of marginalized racial identities and how “part of the power of racism that becomes internalized lies in the acceptance of the ‘I am something wrong’ identity” (p. 221).

I entered the therapeutic relationship with Adam with my own identities, past experiences and internal relational world. As such, it seems important to share some of my identities in showcasing the similarities and differences between Adam and I, and the experiences that were activated in the therapeutic dyad. When I first moved to the United States from the Dominican Republic, I was in my late teens. I moved to the United States with proficiency in hearing and reading English, however, still with a thick accent and difficulty in expressing myself in English. I moved to a small town in Florida, where there were very few immigrant families or families of color; I was one of three other Latinas in grades K-12 at the first school I attended. I was bullied throughout the entirety of the year for my accent and appearance, and my intelligence and belonging were frequently questioned. I was made to feel insecure, othered, inept, and hopeless. I struggled to make friends and connections because of the language barrier, the differences in culture, and overt racism and homophobia. Statements such as “Go back to your country” and “Stupid Mexican” were statements I heard weekly, if not daily. I worked diligently to get rid of my accent by joining several speech and debate classes to protect myself from further backlash. My insecurities in my race and abilities followed me from those early experiences in the United States to more recent feelings in my graduate program as a person with various marginalized identities: an immigrant, light-skinned cisgender female from Afro-Latinx descent, queer, with chronic illnesses, and of lower socioeconomic status compared to my graduate peers. I felt self-conscious due to my dress, financial situation, my language, and differences in culture. Even though many in my program, well seemingly, expressed not noticing my accent or any difficulty for me in the English language, I often struggled with readings and my confidence as I felt I spoke more simplistically and colloquially than others in my cohort, whose language appeared to be more educated and refined. These factors culminated in making me feel more incapable, othered, and out of place—wrong within this setting.

Meeting with Adam brought all of these experiences into focus as he questioned my intelligence and competence in the context of my cultural background, insulted my physical appearance, and impacted my actions and accent. “Words—how and when they are said or withheld in the psychoanalytic situation—do indeed become sticks or stones to splint or crack psychic bones” (McLaughlin, 1987, p. 558). My work with Adam also brought into focus some of my own internalized racism and the split I had made between my life in the United States and the Dominican Republic to cope and assimilate more easily, as well as my experiences of trauma as a queer woman of color. Perhaps what felt so absolutely disorganizing in the work with this patient was the unexpected clash between my past and present.

Thinking Through Otherness and Projective Identification in the Dyad

Due to my experiences in the United States as a racialized person, it was difficult for me to separate my insecurities as a beginning clinician from my ethnic identity, and how gendered and racially charged I experienced all of Adam’s devaluing comments. Some included, “What kind of education level could you really have if you’re not from here?” and “You can barely speak English, how am I supposed to trust you when you can’t speak properly or understand me?” I understood Adam targeting these aspects of me to re-establish control in the therapy room by positioning us in our cultural and historical context where he, as a White man, could be in a position of power and have dominance over feelings of guilt and shame that follow trauma and race in our society. Adam used race and bullying tactics in the transference to resist dependency and intimacy with me by creating distance as well as to communicate emotional boundaries and various levels of trauma through projective identification. For example, I experienced Adam as setting emotional boundaries in his use of my name; he tended to call me “Natalie” when he was upset and reaching a threshold of emotional tolerance and “Natalia” during sessions in which he expressed feeling close and validated.

Adam framed difficulty with dependency and trust in the context of education, language use, and xenophobia, as well as my being a nascent therapist, which prevented me from seeing that such mistrust (of himself and others) was a key feature of his relationships with others. He continuously emphasized the importance of language and education within his own identity, and language became a major part of our therapy as he also used it to fill the space to cope with his anxiety. His focus on language and level of education were synonymous with trustworthiness, emotional attunement, privilege, and societal status from which he tried to localize our identities in society (i.e., socioeconomic status, education, immigration, etc.). One such instance of this dynamic is shown in the following excerpt from a transcript of one of our sessions:

Adam: It’s more than that. Like I don’t feel entirely comfortable expressing this, because I have biases and prejudices, like the fact that you get so close to naming what it is I might be feeling, but you’re not perfect, like it doesn’t perfectly describe what I’m feeling, and so those mistakes really make me not trust you. If you could just say the right words, if you had the language. But I guess you’re learning, and I know that you have so much potential and that you’re going to be great when you learn how to do this; I don’t even know why I’m saying this, like I don’t know why I’m trying to make you feel better. That’s not my job.

Therapist: It’s not.

Adam: I guess I’m just uncomfortable with expressing my biases and prejudices towards you. Like I never thought I would feel this way, but I have them and like I am just having such a hard time trusting you, and like that’s really conflicting, because you’ve done things that have proved to me that you know what you’re doing and like I’ve been able to identify how I’m feeling and things about myself, like how I feel disconnected from myself thanks to you, but like at the same time I feel like how do I know those things are true, you know? How do I know you know what you’re doing, and it just makes me feel so fragile.

[Later in the session]

Adam: I don’t think I have thought of myself in these therapy sessions as annoying or anything, like this is what therapy is about. I think to that effect, this is more of an idle thought instead of me having internalized this or thought about acting on this, but I wonder about the cross section of patients you’ve had or have experienced … from this sense of like, where do I fit in, how unique are my experiences, and that is particularly more significant in that being newer in your career, your sample set would be smaller, or in other words … there are two trains of thoughts here. Like in last session we talked, how much have you seen and have thoughts and perspectives in, and being able to anticipate and know the chess moves of where I’m going to get to and knowing when I’ll get there. And I don’t know how to express this, but in terms of how different a range of personalities is a therapist equipped to work with… Ok, what it is is that I have thoughts along the lines of what if I came in one day and did this how would you respond, and that is entirely an idle thought from the perspective that I either catch you off guard cause I’m doing it or catch you off guard cause it can happen.

Similarly, after expressing some feelings of vulnerability in reflecting on a previous session, and feeling as though I am “holding the key” (have the power) in my capacity as therapist, the following vignette unfolded:

Adam: It just felt like I needed to remember, like maybe I needed to do that for myself. Like if I’d had the chance to remember that myself it might have been more useful. There’s a benefit in me being able to name things myself, or to even be able to get to different conclusion or something by myself. I’m so frustrated.

Therapist: It sounds like you’re frustrated with me.

Adam: I don’t know if I would say that I’m frustrated with you. That doesn’t seem like the right word, I think maybe disdain … Like I just can’t trust you. Like I told you before, you’re a grad student and I feel like asking about your credentials, like if I just knew what your background is, like where you’re from and what education you have and if you actually know what you’re doing then I would feel more comfortable, like those answers could really let me know whether you know what you’re doing, because you put all these thoughts in my head and I don’t know if they are true or not, or even if you know if they are true or not, but I’m just believing that what you’re saying about me is true and I can’t figure that out for myself.

Given Adam’s propensity to relate in terms of power and control, I understood this devaluation as a difficulty in tolerating differences in cultural background and education levels, as well as a defense through his focus on biases against his feeling “fragile,” vulnerable, seen in his “sickness” and “evil,” and tolerating the natural dependency of therapy. Through his commentary, he is also asking about his belonging, trust, and safety in therapy and in relationships. As you can see though, my responses were brief, with limited opening of the space for further discussion; these areas of thought and interventions felt inaccessible to me in these moments of aggression.

Due to Adam’s verbalization of gender and sexuality within the context of belonging and rejection of his own privilege, I also understood some of his struggle in identifying as a privileged individual as deriving from his difficulty forming connections in relationships, a lack of a cohesive sense of self, strict perception of heteronormative masculinity, trauma, and an inability to tolerate the emotions that may arise from awareness of privilege. Adam often had the experience of being misunderstood and neglected, and it appeared to be comforting to Adam to relate to others as a “minority,” which may capture some experience of emotional trauma in society. I also began to understand these sessions as moments of Adam’s desire for closeness in the therapeutic encounter, where he could fantasize about sharing identities and the experience of otherness with me.

Throughout therapy, Adam attempted at “teaching” me and sought the role of “perfect” supervisor and professor in our therapy; the same way he spoke about his relationship with his romantic partner. These interactions were, in part, a form of communication through projective identification in which he made me feel as he often did in relationships—indebted, vulnerable, and exposed—that also directly aligned with my own internalized oppressed identities. In this way, he succeeded in controlling the object in a defense against difference: we were the same in our feelings of wrongness, being othered, vulnerability, and dependency. In fact, Adam succeeded in making our relationship generally feel intimate and close, given his commitment to twice-weekly therapy, shared emotional experience, and the sense that I knew much that he withheld from others. This impacted the level of shock, hurt, anger, and betrayal that would surface in the countertransference, and the time that I would need after sessions to process our encounters.

Enactments of Otherness

Sheehi and Sheehi (2016) coined the term “enactments of otherness” to capture the “pre-emptive defensive processes that safeguard the object from further oppression and denigration” (p. 81) in interactions between a dominant and dominated person. Sheehi (2015) addresses how enactments of otherness occur in therapeutic dyads, which are wrought with power-laden content. These enactments act as “performative moments where subjects inhabit their ‘otherness’ as a means of control, precisely because all other psychic spaces are precluded” (Sheehi & Sheehi, 2016, p. 83). Enactments of otherness are seen as unconscious acts from the dominated object intended to protect, reassert power, and prevent further attack on the object or ego. This can be derived from historical ethnic imbalances in power from the patient or therapist, or identification “with a denigrated internalized object” (Sheehi, 2015, p. 138). This kind of transference can trigger a sense of anxiety in the dyad that may cause regression to the paranoid-schizoid position. The dyad is understood to be in a paranoid-schizoid position when splitting occurs between “good, idealized” aspects—such as White non-POC communities—and “undesirable, bad, devalued aspects”—such as marginalized race and ethnicities (Tan, 2006).

In our twice-weekly, year-long therapeutic relationship, enactments of otherness occurred between a privileged, White cis-male assuming control and power over an immigrant cis-female queer Latina. Adam’s pervasive use of narcissistic defenses (i.e., primary defenses of projective identification, denial, and splitting) often led to these enactments in three predominant ways: where my insecurities on competence and identity mirrored his projections and often led to a struggle in power to rid our anxieties; in Adam’s perceived role of “teacher” and “good” patient working with an incompetent, bad therapist; and, where Adam projected his “bad” and “evil” parts onto the immigrant identity of the therapist. Adam consistently questioned my knowledge, competence, and ability to care for him and guide our therapy. These questions were laced with comments about my education and my command of the English language and often alluded to my identities.

I joined him in this questioning as an enactment, instead of interpreting such projections, because of my own questions about my preparedness as a first-year clinician, as well as an immigrant queer woman of color who already felt inferior in my environment. I began to internalize feelings of incompetence, lose the power of my speech and my mastery of the English language, and was often left feeling defeated, powerless, and enraged after sessions. I questioned my ability to help Adam, whom I saw as having more severe issues than my other patients; a myth that paralleled Adam’s thoughts and feelings about parts of himself as “evil” and “incurable” and myself as incompetent in not being able to understand or help him. Contrary to our shared questioning of my competence, I had worked with trauma, specifically with survivors of sexual trauma and human trafficking and with perpetrators of sexual trauma prior to my graduate school education.

With the experienced pressure around language and my accent throughout our therapy, I quickly began to experience a loss of language in the therapy room. It became difficult for me to speak and formulate thoughts in English—an experience I had become unfamiliar with as an adult after those initial years in the United States and one I had not experienced with other patients. When I was with him, my accent would severely thicken. I would have to pause to collect my thoughts and would manage my anxiety by commenting on how “my English brain is failing me today” or say “I’m thinking” with long pauses and subsequent wordy interventions that I would have to further explain as they usually were English translations of formulated thoughts in Spanish. These interventions paralleled Adam’s own ways of communicating in tangents and becoming lost in his own speech. They also made Adam even more wary of me and reinforced his wondering out loud if he should trust me. It appeared to confirm his suspicion that, as an immigrant and first-year clinician, I would not be competent to work with him, much like he would express not trusting himself or his own thoughts. One can understand my own loss of language as an over-identification with his projective identification as well as an internalization of his aggression through the racially charged comments he made in sessions doubting my abilities as a clinician due to my identities.

Adam projected his own self-loathing and trauma onto my racial identity as Latinx to create distance and therapeutic resistance as well as to unconsciously communicate his own experiences of trauma. He often spoke of himself as good or evil, and appeared to attribute these aspects of himself with his previous therapist and myself. I typically held his evil and conflicted parts, while he expressed feelings of love, attraction, admiration and respect towards his former therapist—a White, female, heterosexual therapist of higher socioeconomic status. Adam often mentioned my acquiring a master’s degree even though he acknowledged his previous therapist’s seeking a PsyD and knew of my own pursuit for a PsyD in a community mental health clinic embedded within a doctoral program. He had also spoken about not completing his college education with his previous therapist but felt the need to misrepresent his college education to me, as if it was intolerable that I had achieved a higher education than him. Adam explicitly communicated that he needed to keep me and his previous therapist separate—she was good and “beautiful” and I was bad and “ugly.” He expressed not being able to be his “true self” with the previous therapist because he wanted to “impress her,” but he could share various aspects of himself with me because he “could never be attracted to [me].”

Another way Adam’s split was evident was in his disclosure of “lying” about his sexual identity in relationships, being a non-consensual voyeur to—and masturbating to the thought of—his mother, sister, and female cousins during his teenage years. He disclosed looking through door cracks, the bathroom window, and inviting them to sit on his lap. He further disclosed an instance of sexual intercourse with a woman he reported was cognitively impaired. He had not made these disclosures to his previous therapist in an attempt to protect her from his “evil.” Adam’s disclosure of voyeurism and sexual assault felt like a punishment to me in this way, being left to hold his denigrated self. I felt the experience of having been used ruthlessly as a receptacle in which he had dumped his disclosures of sexual perpetration. He communicated in more than one way that my being a Latinx woman was unwanted and potentially repulsive. While he protected his prior therapist from what he saw was his “ugliness” and “evil,” he felt no such need to protect me from his sadism, sexual impulses, and history of unethical sexual acts.

Pitfalls in Enactments

Sándor Ferenczi’s (1988) “Confusion of Tongues between Adults and the Child” provides a framework to understand the clinician’s difficulty in understanding and verbalizing the mechanisms of such trauma-laden enactments to the patient. Ferenczi discusses three potential traumas including incestuous seduction, passionate punishment, and the terrorism of suffering. To defend against this trauma, children may introject the aggressor to protect themselves psychically and preserve the feelings of tenderness and safety that were previously present in the relationship (Gutiérrez-Peláez, 2012/2018). “In this way, the child introjects the adult feelings of guilt … trying to recover from the aggression, the child finds himself split, being guilty as well as innocent; the links with his own feelings, perceptions, and senses having been destroyed, he lapses into a state of confusion” (Gutiérrez-Peláez, 2012/2018, p. 14). The adult has imposed themselves—their will, reality, senses, and communication—unto the child. Ferenczi addresses the difficulty of remembering traumatic events in this state of confusion, where the trauma becomes psychically split off. In this way, the child/adult cannot access this material—self-destruction of conscience—that psychotherapy naturally tries to unveil. Ferenczi argues that “it is, initially, accessible by repetition but not, given its experiential character, by rememberance” (Gutiérrez-Peláez, 2012/2018, p. 15), and therefore not actively, verbally spoken about but naturally enacted in the transference. The clinician’s goal is to awaken dissociated and split-off aspects of the client and allow these experiences to be remembered and named. However, in my work with Adam there was an awakening of the aggressor through Adam’s xenophobia that precluded a space from which to work through his trauma.

As summarized by Gutiérrez-Peláez (2012/2018), Ferenczi has argued that due to the shock of trauma,

the person abandons himself before the traumatic situation. Subjectivity is ruined, there is a destruction of the person and total surrender to that other who has committed the aggression ... and discovers in his clinical work how trauma, as the confusion of tongues, leads to the silencing of the child’s word by the imposition of the adult’s, to the extent that the child’s own voice and his own experience are erased and his reality denied. It is the other’s reality that begins to operate as the measure of the world. (pp. 17–18)

This understanding through Ferenczi’s lens on childhood trauma can provide insight into the intersection of dual trauma in the dyad, combined loss of language, and Adam’s racial aggression. In working through, Adam imposed his reality and subjectivity onto the therapy and onto the therapist—effectively impairing the therapist’s objectivity and ego functions; this was a reenactment “of one over the other, of silencing the one so that the other can impose itself. This is the violence of the word and the dominant power of language. It seems that there is no possible dialectic that can resolve this confusion of tongues” (Gutiérrez-Peláez, 2012/2018, p. 14). Even though Adam did not overtly disclose a history of sexual abuse, he hinted at potential sexual boundary violations from an unidentified man in his childhood and disclosed various self-harming instances where he verbally consented to sexual interactions that he reported internally feeling uncomfortable with. He reported feeling “punished” in these instances for his own sexual misconduct.

After Adam’s disclosure of his sexual perpetration in non-consensual voyeurism, he missed three subsequent sessions (unusual for him), followed by avoiding and silencing my attempts to process and work through his disclosure. His resistance incited feelings in me of wanting to punish him as retaliation for leaving me with his painful feelings of shame and guilt—a parallel process to his own split-off feelings and his internalization of the aggressor as well as his rejection of his “feminine” side in holding and tolerating his emotions. I was left feeling like Adam, with a paranoid fear of persecution and retaliation from others, guilt, and shame, and we were ultimately unable to speak about the disclosure for the remainder of our therapy, leaving me to sort out these feelings and dynamics. It is often the marginalized individual’s experience in White supremacist culture that their own voice, experiences, and reality be denied, silenced, and erased by those in positions of privilege, and this felt like a powerful intersection of Adam’s sexual trauma and my own racial and gender trauma.

The therapeutic encounter may be a form of regression on both the therapist and patient’s part leading to “an escalation of anxiety and of early aggressive impulses, and this may lead to a loosening of ego boundaries [in the therapist] and a temptation to control the patient” (Csillag, 2014, p. 472). There was a collapse in the ability to create a “position of thirdness” (Aron, 2003) to work through enactments and the experience of being silenced. These interactions also contributed to a sadomasochistic manner of communication between Adam and I, as we were both struggling to preserve our self-esteem and striving to regain power in sessions. For Adam, this dynamic was further complicated by desperate attempts to contain his intense fears of abandonment and rejection, likely related to previous disclosed relational and sexual trauma, and some additional potential undisclosed sexual trauma. In acting out these dynamics, he was able to create distance between us and emphasize his fear of intimacy and closeness, recreating his archaic internal objects. As a beginning clinician, it was a challenge to understand and become aware of my intense countertransference, the intent behind his scathing comments, the use of narcissistic defenses, and to create a space for working through. These boundaryless interactions impeded my capacity to create a position of thirdness and to be able to see the underlying dynamics that were occurring both in his outside life and in the therapeutic encounter.

Overall, my attempts at processing his disclosure were rejected and as a dyad we never readdressed this for the remainder of our work together. Not having addressed Adam’s experience of being a perpetrator in this disclosure and his feelings of being a perpetrator and victim in other sexual encounters felt like a therapeutic failure on my part. After several sessions where I attempted to address these traumatic experiences, I realized that I was experiencing countertransference anxiety perpetuated by our racial and gender dynamics, which appeared to be incited by Adam’s aggression and/or this aggression being projected onto me. Adam’s continuous rejection, distancing, and statements that I was not helpful to him led me to feel incompetent, sadistic and shameful, and my internalization of this countertransference led us to enact what Adam had predicted and previously spoken about—he “rid” himself of his painful emotions by giving them to me. Additionally, as a student, I feared losing him as a patient if I injured him and I wanted to avoid the feelings that I was not qualified to be a therapist and avoid the shame of losing a patient and being perceived as incompetent, weak, not worthy, or not belonging in a prestigious doctoral program. An additional contribution to these enactments were the unaddressed instances of racism, misogyny, and xenophobia. It appears, in this instance of disclosure, Adam unconsciously used my cultural background as a receptacle for his denigrated self—his ugly, shameful self—that I was left with and he had further split-off from himself.

Challenges in Working Through Race in Therapy and Supervision

There are several challenges in working through race in treatment due to the overall experience of race in culture and its impact at the individual level. In the minority therapist, it can lead to a “counter-resistance” in the countertransference because of the myriad of feelings that speaking about race can evoke (Holmes, 2006), including shock, hurt, harm, lack of safety, recreation of trauma, among others.Footnote 3 Countertransference reactions are the biggest challenge to working through race in the dyad, as minority therapists are more inclined to overidentify with an oppressed status rather than explore it (Holmes, 1992) or challenge it. Minority countertransference is also affected by the degree of internalized racism in the therapist. Often, therapists are inclined to cope by using countertransferential reaction formation to the patient’s racially charged comments, leading the therapist to minimize the patient’s remarks (Holmes, 1992). This creates a parallel to the expectations in society of how individuals with marginalized identities are expected to cope with aggression. For these reasons, supervision and the therapist’s own supports are integral to cope with countertransference and resulting enactments (Holmes, 1992). Tan (2006) explains:

The experience of these prejudices, which may be real or imagined via projections or projective identification, leads to an inability to access the situation realistically. An ability to contain and make sense of these feelings away from immediacy of anxieties is essential to rational functioning. This is even more so when faced with racist feelings from patients. It is not easy, however, to get away from the immediate pressure of racist material from within and without so as to be able to think with clarity. It is often a luxury not afforded to the therapist faced with such infantile/primitive functioning when everything is felt to be immediate and concrete. (p. 120)

The therapist’s reaction to race in the dyad and resulting countertransference needs to be a focus of training to help prepare beginning therapists (Holmes, 1992). However, teaching therapists to talk about race in the therapeutic encounter has historically been impaired due to traditional psychoanalytic attitudes towards race (Leary, 2012). Previously, it has been assumed that race would not impact therapy any more or less than any other aspect of diversity, but more recent approaches focus on race as central to each individual’s psychology (Holmes, 1992). Holmes (2016) posits the tension in how to approach patients and their racially charged comments, and she advocates for a more profound discourse in graduate programs, both in the ways race is taught institutionally and when addressing race and cultural characteristics in supervision. However, “psychoanalysis remains a profession that is overwhelmingly White and the socioeconomic diversity among those who teach, train, or who are treated psychoanalytically is limited,” hindering further discourse and teachings on race through a lack of representation and modeling (Leary, 2012, p. 283).

Visibility of faculty, clinicians, and supervisors of marginalized identities are integral to a clinician’s development, as Hill et al. (2007) highlight how inexperienced clinicians initially learn through modeling and imitating their faculty members and supervisors. They are often insecure about their skill and performance as therapists, lack self-awareness, and may be overly self-critical (Hill et al., 2007). This may further complicate the psychotherapy experience because therapists who are primed to doubt their skills as beginning clinicians may be particularly vulnerable to projective identifications and enactments. They may assume that a patient’s response to the therapist and any patient projections develop secondary to the therapist’s perception of their own incompetence or inability to provide proper and helpful therapy (Goodman, 2005). For inexperienced clinicians, then, the process of tolerating being used as a therapeutic tool is exceedingly more difficult, as they may frequently identify with feelings of incompetence and guilt (Goodman, 2005). With limited prior experience as therapists, beginning clinicians often report feeling overly self-critical, frustrated, anxious, and ignorant (Hill et al., 2007), and have difficulty managing boundaries (Hill et al., 2007; McWilliams, 2004). A guiding principle for beginning therapists is to accept patients as they are and to think about these rising countertransferential emotions as secondary to those of the patient’s experience and projections; otherwise, overidentifying with these projected feelings may lead to problematic boundaries and the emergence of enactments (McWilliams, 2004).

It may be particularly difficult to address race in the therapeutic dyad as therapists of marginalized racial identities in training can struggle with initiating conversations about racial differences in the supervisory and therapeutic dyad (Holmes, 2016; Tang & Gardner, 2006). Conversations about race can feel dangerous, and more than any other type of enactment, racial enactments have the potential to promote working through racial biases or to hinder therapy when not appropriately metabolized and contained for the patient (Leary, 2000). Minority therapists may fear these conversations as they might invite racist attitudes to emerge where they, themselves, would be the object of racism (Tang & Gardner, 2006). There is significant challenge remaining present, curious, and engaged when faced with racial triggers, evidence of prejudice and racism, and the intense affect that accompanies being the object of racism (Holmes, 1992; Tang & Gardner, 2006). Creating a position of thirdness becomes an incredibly hard task given the emotions, aggression, and hostility the minority clinician in training may be holding from these interactions, in addition to the pressure of expectations to be in control and present with the client while being evaluated in their ability to do so. These conversations and dynamics can also come up against the therapist’s own internalized racism (Chapman, 2006). Chapman (2006) addresses the experience of being a minority clinician in training:

What I did not understand at the time was that I was allowing my feelings of internalized racism to protect me from the harsh reality and my fears of not being good enough to become an analyst due to being a Black woman. I had given myself permission to fail in order to protect myself from the feeling that Black women are not “supposed to” become analysts. A Black analyst is contrary to the world order. (p. 220)

As a beginning clinician and as an immigrant, cis-female therapist, I found Adam’s aggression particularly challenging to tolerate and experienced minimal support in how to navigate these interactions in supervision. Holmes (1992) encourages therapists to address countertransference reactions in supervision; however, when I did voice concerns, I did not feel heard and seldom felt my supervisor or faculty understood the extent of the aggression I was experiencing (regardless of being shown the session transcripts). It was difficult to address the racial dynamics in supervision and further explore how my interactions with Adam intersected with the microaggressions I experienced in my personal life, especially surrounding the political climate of 2016 while living in Washington, DC. It was difficult to communicate to my supervisor that my experience was not just of a therapist in training, but more so a multiple minority therapist in training and that aspects of my identity seemed to be being used as a weapon against me in the therapy with Adam. I diligently presented transcribed sessions or recorded sessions to my White-American supervisors who did not acknowledge, address, or aid in my challenges with Adam. In fact, I was continuously given the feedback to ignore my countertransference, attend every session “without memory or desire,” and empathize with his feelings of vulnerability and fear of rejection.

Discussion

As Holmes (1992) emphasizes, race will always be present in the therapeutic dyad, potentially creating an opening for racial differences to be used as a defense against closeness, representations of the self (Hamer, 2002, 2006; Holmes, 1992), a means to gain control (Hamer, 2002, 2006), a defense in the paranoid-schizoid position, or as a displacement for resistance in treatment (Tan, 2006). “Unconscious racism exists especially when therapist and patient are from different racial backgrounds … [and] it is imperative that racist feelings are interpreted in the transference” (Tan, 2006, p. 122) to avoid use of these differences as receptacles for projection (Tan, 2006). As outlined in this paper, a particular example is the splitting between idealized and undesirable aspects of oneself and projecting these devalued features onto the racialized therapist (Hamer, 2006). Adam used race in our work together to defend against dependency and closeness, as a representation of his “evil” self that he projected onto my racial identity, and to obtain control when feeling vulnerable. However, when issues of race become present in the dyad, anxiety is manifested in both participants (Hamer, 2006) and counter-resistance in the countertransference can be created, causing difficulty in the interpretation of the racial transference (Holmes, 2016).

Adam introduced topics of competence, race, gender and sexuality, trauma, and power and privilege into our interactions explicitly and implicitly. Through this exploration of our interactions, I hope to show how powerful dynamics involving race and trauma can be in the therapeutic process, at times creating sadomasochistic enactments of otherness and recreations of trauma. It was difficult to balance being used in the therapy, maintain my ability to communicate in English, and preserve my self-esteem and thought as Adam tried to work through his own difficulties and experiences of trauma. The absence of language in our work led to the recreation of multiple enactments. Ferenczi helps orient to the enactment of trauma in therapy that is split-off to preserve safety in childhood (Gutiérrez-Peláez, 2012/2018); due to the absence of language available to process this trauma, there is no avenue for remembrance other than recreation. Waska (2013) and Chused (2003) encourage interpreting the countertransference and the patient’s use of projective identification to be able to cease communication through projective identification and to prevent acting out in the dyad.

My experience may help to provide some insight on the importance of addressing race and trauma in the dyad when it emerges—both in therapy and supervision. As Holmes (2016) advocates, more discourse and training needs to be implemented in professional programs to address multicultural issues both within psychology programs as well as the therapeutic dyad. Many minority therapists may experience instances of introjecting sadistic attacks due to their repeated experiences of aggression in society and may continue to be unaware of how to address this if these conversations are not pervasively implemented in training programs (Holmes, 1992). Discussions should occur on how to address issues of race individually, and how to use and feel empowered in the therapy room to work through the emergence of race in the dyad, and what racism in sessions may be signaling in the therapeutic process but also in societal context, without expectation that the marginalized therapist should be devoid of feelings and reactions. Special consideration should be given to the fact that these are additional emotional energy and triggers that minority therapists face in their training, and that there is retraumatization that occurs in the absence of this discourse, training, and support. Supports should exist in doctoral programs, with representation of students across faculty and supervisors that can understand the experience of being a therapist of marginalized identity and prevent isolation from peers.

Teaching therapists how to engage in these conversations has historically been hindered by archaic and traditional psychoanalytic attitudes and the field’s history of being composed of predominantly White, privileged men (Leary, 2012). Supervisors should ideally be more receptive to engaging in conversations about race and other oppressed identities with beginning therapists as a way to model these conversations, and so supervision can be used to its fullest extent in addressing these issues as they arise in therapy. Beginning with the first supervision meeting, supervisors should be encouraged to approach talking through identity and cultural factors, how these load onto conversations in supervision and in sessions with patients, and how these identity and cultural factors impact the experience of the therapist’s internal world. I also urge doctoral programs to be aware and speak to the imbalances that occur within their structures as they may be carried into the therapeutic room by their trainees and may lead to trainees questioning their abilities and belonging—in higher education and in the field—even more than is warranted for a therapist in training. Understanding that nascent clinicians learn through modeling from their supervisors and professors (Hill et al., 2007), it is imperative to model and integrate these conversations into all aspects of current training programs. Supervision and academic coursework that does not emphasize the importance of marginalized identities in this field is oppressive, harmful, and silencing within itself, and in this way, unethical.