Maximizing a client's chances for success

I appreciate this opportunity to set the record straight regarding statements attributed to me in the February Monitor article "Deal with clients you don't like." The reporter quoted me as saying I have a "personal bias against people who are highly introverted." This is most definitely untrue and is not reflected in either my professional practice or personal life. In response to the reporter's questions, I reluctantly said that I found it difficult to work with extremely withdrawn, introverted clients who could not express their feelings and were not motivated to do so. I also said that, in general, I found that people who can name and express their feelings, and even be assertive, were certainly more likely to be enjoyable to work with. The way the reporter used my response made it sound like I was more interested in being entertained than in doing therapy.

What is more important to the story and should have been emphasized are the good clinical reasons for therapists not treating people they do not like. I talked about the importance of emotional engagement and how research has shown that a strong therapeutic alliance is critical to therapeutic success. Strong relationships, in turn, require a consistent high degree of empathy. Affect research confirms that our degree of empathy for another human being correlates closely with our positive feelings for that person. Therefore I believe that therapists who attempt to treat clients to whom they have an immediate aversive reaction are actually shortchanging them. Guilt over not liking a potential client may lead to denial of these feelings and a misguided attempt to conduct therapy anyway. Matching up therapist and client is highly idiosyncratic and, just as in personal relationships, there is someone for everyone. From my point of view, it is better to maximize the client's chances for success by gently referring him or her to a colleague rather than attempting to transcend a true feeling of dislike.

Karen Maroda, PhD

Can they take us seriously?

I enjoyed the February "Judicial Notebook" article about a legal double standard in regard to mental pain. I agree that psychological issues are often not taken seriously. However, I thought it ironic that in the same issue, the "In Brief" column reported that "nearly half of young adults meet the diagnostic criteria for mental illness and substance abuse."

When we're so ready to diagnose such a large part of the population, how can we expect a court of law to take us seriously?

Yitzhak Berger, PhD
Queens, N.Y.

Perpetuating 'us vs. them'

As I read the quotations attributed to Derald Wing Sue, PhD, in the February article "Unmasking racial microaggressions," I found myself feeling frustrated and objectified. As a white male, I felt I was the recipient myself of racial microaggression, as I read the quotes about "white people" this and "white people" that.

I believe the concept of racial mircoaggression is probably accurate and very powerful, but its application, at least via the tone of this article, appears overly simplistic, wedge-creating and very objectifying. Certainly, white citizens send messages to others in which mircoaggression is present (and as a white, liberal psychologist in the Bay Area, I assume I am as guilty of this as the next person), but surely such behavior is not found in just one racial or ethnic group.

Hopefully, researchers in the field of microaggression do not seriously believe that microaggression emanates just from within one racial group. Such a belief would go counter to the tenets of human nature, which I believe assert that all people are vulnerable to processing and expressing prejudiced aggression in subtle and devaluing forms. Without such a belief grounding the work on microaggression, the field is serving to perpetuate an "us vs. them" mentality across our racial groups.

Steven Flannes, PhD
Oakland, Calif.

Repsonse from Dr. Sue: Dr. Flannes raises an important point about the recent article on our racial microaggression research. I have learned from nearly 40 years of work in the field that topics of race and racism push strong and powerful emotional buttons in people. When topics of racism are addressed, many of my white brothers and sisters react with defensiveness, guilt, anxiety or anger. In other words, they feel blamed.

Nowhere in the article or in my microaggression research, however, do I claim that any one group has a corner on prejudice, bias, bigotry or discrimination. In fact, much of my work indicates that no individual or group is immune from inheriting the racial biases of our forebears or institutions (including me).

However, it is not uncommon for some well-intentioned white people, in the face of discussing racism, to make statements like the following: "So what, we whites are oppressed, too!" "Excuse me, sir, but prejudice and racism were and are part of every society in the world ad infinitum, not just the U.S." While these statements are true, the impact is to dilute, diminish or negate the detrimental impact of racism and to hinder an honest dialogue by covering up the real one (owning up to our racism and taking responsibility for our roles in the oppression of others).

I do not deny that whites can be victims of discrimination and prejudice, but it is clear that marginalized groups in the United States suffer the most. That is one of the reasons why our research has progressively turned to gender, sexual orientation, class and religious microaggressions. Making the "invisible visible" is the first step to change.

I am heartened by the fact that Dr. Flannes has started an important dialogue, and that he does take responsibility for being guilty of microaggressions. I hope others are equally courageous in their own self-exploration.

Derald Wing Sue, PhD
New York, N.Y.

Religious freedom

I was terribly dismayed to read that APA supported rescinding rules allowing health providers to decline to provide some health services based on religious belief (February, "On Your Behalf") Rescinding those rules would effectively destroy the First Amendment right to religious freedom. The practice of religion is not merely attending religious services or observing religious "customs;" the practice of religion is living one's life in accordance with one's religious beliefs. An individual's right to practice his or her religion is as important as anyone's "right" to a particular health service. The rules do not keep a woman from having an abortion but only assure that someone is not forced to engage in an act that he or she deems to be immoral. If I had to leave the practice of psychology in order to live a moral life, I would do so. There is nothing more important.

Philip J. Lanzisera, PhD
Troy, Mich.

The key role of school psychologists

In "Schools Expand Mental Health Care," the Monitor (January 2009) highlights the need for school-based mental health services and the potential for school-based health centers to play a role in their delivery. We support your effort to highlight the importance of school-based services. Lacking in the article, however, was a context for understanding how the various kinds of programs should fit into the continuum of mental health services typically delivered in schools, as well as a recognition of mental health services provided by professionals already working in schools.

Every school district in the country employs mental health professionals such as school psychologists, school social workers and school counselors. In fact, schools currently are the primary providers of mental health services for children in this country. For example, school psychologists provide mental health services in prevention, assessment, diagnosis, parent and teacher consultation, intervention, health promotion, school safety, crisis response, behavior management, individual and group therapy, and program development and evaluation. They work with the entire school community and are specifically trained to link interventions and services to education's mission and purpose: learning.

The article states that "the debate continues over whether these [health centers] are the best way to serve students." Clearly, school health centers, particularly in communities with high need, can be a critical resource. However, if they are to be effective and embraced by the educational community, mental health services must be integrated into the fabric of schools and help promote the overall development of the child, including improving academic competence. To do otherwise is to risk increasing fragmentation of services in schools and missing opportunities to use resources in the most efficacious manner.

Addressing these issues within the full context of school-based services is critical to advancing an accurate and meaningful dialogue on this important area of service to children and youth.

Ray W. Christner, PsyD
Hanover, Pa.

John E. Desrochers, PhD
Southport, Conn.

Thomas J. Power, PhD

Please send letters to Sara Martin, Monitor editor, at the APA address. Letters should be no more than 250 words and may be edited for clarity or space.