When Silence Enters the Therapy Room

Part II of “Silence Has Consequences”: Race, Cultural Humility, and the Clinical Cost of Avoidance

By Tracey Taldon, LICSW

When I wrote Silence Has Consequences: An Open Letter to Our Allies on Mental Health, Race, and the Cost of Complacency, I was speaking to our communities.

I was speaking to the friends, neighbors, colleagues, and family members who believe in fairness and human dignity but may remain quiet because they feel uncertain, unprepared, or afraid of saying the wrong thing.

I was asking them to consider what silence communicates when prejudice, misinformation, or discrimination goes unchallenged.

I was asking them to understand that allyship is not simply something we believe in private.

It is reflected in the choices we make when another person’s dignity is at stake.

But the question did not end there.

It followed me back into the therapy room.

What happens when silence enters the clinical relationship?

What happens when a client describes an experience of racism and the clinician says nothing?

What happens when a client wonders aloud whether race influenced how they were treated, and the therapist quickly offers another explanation?

What happens when a client is carrying racial stress, cultural grief, immigration-related fear, or the exhaustion of repeatedly having to prove that their experiences are real—but begins to sense that these subjects are too uncomfortable to bring into treatment?

As mental health clinicians, we understand that silence can be powerful.

Silence can slow a moment down.

Silence can give a client room to feel.

To reflect.

To breathe.

To find words for something that has not yet been spoken.

Silence can communicate patience.

Silence can communicate presence.

Silence can communicate, I am not going to rush you.

But silence is not automatically therapeutic.

Sometimes silence creates space for the client.

Sometimes silence protects the clinician from discomfort.

The difference matters.

Not All Silence Is the Same

Most clinicians do not consciously decide to dismiss a client’s experience of racism.

More often, avoidance appears in subtler ways.

We become anxious about saying the wrong thing.

We worry that naming race will appear presumptuous.

We believe that being neutral means waiting for the client to direct every conversation involving identity.

We convince ourselves that focusing on race is outside the scope of the presenting problem.

We move quickly toward coping skills, cognitive reframing, or problem-solving because those interventions feel more familiar.

More structured.

More clinically manageable.

These responses are not always motivated by hostility.

Sometimes they are motivated by fear.

Sometimes they reflect gaps in our training.

Sometimes they are attempts to remain professional, objective, or client-centered.

But good intentions do not automatically prevent harm.

A clinically important question is not simply:

Did I mean well?

It is also:

What did my response communicate to the client?

And perhaps the most difficult question:

Whose needs was my silence serving?

The Therapy Room Is Not Neutral

Clients do not leave their racial and cultural identities outside the office door.

They do not remove their language, immigration history, faith, gender, family traditions, community experiences, socioeconomic realities, or encounters with discrimination before sitting on our couches.

And clinicians do not enter the room without identities of our own.

Every therapeutic relationship includes two people who have been shaped by families, cultures, institutions, opportunities, losses, privileges, and experiences of marginalization.

Those experiences do not disappear simply because the door closes and the session begins.

This does not mean that every clinical concern should be reduced to race.

It does mean that race cannot automatically be excluded from the clinical formulation because discussing it makes us uncomfortable.

Many of us were trained to value neutrality.

We were taught not to impose our values.

Not to make assumptions.

Not to tell clients how they should interpret their experiences.

Those principles remain important.

But clinical neutrality does not require cultural blindness.

It does not require us to pretend that discrimination, power, and social context have no influence on psychological well-being.

It does not require silence when the client has already brought race into the room.

This is not about imposing a political position on a client.

It is not about assuming that we understand an experience because we attended a training or read a book.

It is not about telling clients that race must be the explanation for everything they have experienced.

It is about developing the clinical capacity to remain present when race is already part of the story.

How Avoidance Can Hide Inside Good Intentions

Clinical avoidance does not always look like outright dismissal.

It can sound thoughtful.

It can sound logical.

It can even sound therapeutic.

It may look like:

• Moving immediately to “what you can control” before fully understanding what happened

• Searching for an alternative explanation before exploring the client’s interpretation

• Treating racial stress as generic anxiety without assessing its context

• Redirecting the conversation toward coping skills when the client first needs acknowledgment

• Remaining expressionless or silent while the client watches closely for a response

• Asking the client to educate the clinician about racism, culture, or oppression

• Overintellectualizing the conversation rather than attending to grief, anger, fear, or exhaustion

• Avoiding questions about racial or cultural differences between the clinician and the client

• Referring a client elsewhere primarily because the clinician feels uncomfortable rather than because the client requires specialized care

Any one of these responses could be appropriate in a particular clinical context.

The concern is not the intervention alone.

The concern is the reflex.

Did we choose the intervention because it met the client’s needs?

Or did we choose it because it helped us escape an uncomfortable moment?

What the Client May Hear

A clinician’s silence may be intended to communicate openness.

The client may experience it very differently.

They may hear:

I do not believe you.

You may be exaggerating.

Race is not something we discuss here.

Your experience is making me uncomfortable.

Please make this easier for me to hear.

You will have to prove that racism occurred before I take its impact seriously.

This room is safe for some parts of you, but not all of you.

Clients may not use the term therapeutic rupture.

They may simply stop bringing certain experiences into the room.

They may become agreeable.

They may change the subject.

They may tell us that everything is fine.

They may continue attending therapy while quietly deciding that we are not someone with whom they can be fully known.

That is why the absence of conflict should not automatically be interpreted as the presence of safety.

A Composite Clinical Example

The following vignette is a composite created for educational purposes. It does not represent an identifiable client.

A Black professional tells her therapist that she has repeatedly been described as “aggressive” when advocating for herself at work.

She has noticed that White colleagues who communicate similarly are described as confident, direct, or leadership-oriented.

After being passed over for another opportunity, she says:

“I know I cannot prove it, but I think race is part of what is happening.”

The clinician responds:

“We cannot know what your supervisor intended. It might be more helpful to focus on what you can control.”

The clinician may be attempting to reduce helplessness.

They may be trying to support cognitive flexibility.

They may believe they are helping the client avoid making an assumption.

But the timing of the intervention matters.

The client has not yet been asked what patterns she has observed.

She has not been asked how these experiences have affected her confidence.

Her sleep.

Her mood.

Her body.

Her professional identity.

Her sense of safety.

The clinician has moved toward uncertainty about the supervisor’s intentions before acknowledging the client’s lived experience.

A more culturally responsive response might sound like this:

“We may not be able to know every person’s intention, but I do not want to remove race from the conversation before understanding what you have experienced. What patterns have you noticed? What happens internally when you receive that feedback? And what feels most important for us to attend to today?”

This response does not instruct the client to conclude that every interaction was racially motivated.

It does not claim certainty where certainty is impossible.

It communicates something more clinically important:

I am willing to explore this with you.

You do not have to erase race to make this conversation acceptable.

Your interpretation deserves thoughtful attention.

From there, the clinician can assess the psychological impact.

Anxiety.

Disrupted sleep.

Depressive symptoms.

Hypervigilance.

Somatic stress.

Avoidance.

Changes in occupational functioning.

Cumulative exposure.

The clinician can also explore the client’s existing sources of protection.

Community.

Family.

Faith.

Cultural identity.

Boundaries.

Advocacy.

Rest.

Joy.

Healing is not limited to reducing symptoms.

It may also involve helping the client reconnect with dignity, agency, belonging, and trust in their own perception.

What Culturally Responsive Presence Can Look Like

Cultural responsiveness does not require perfect language.

It requires enough humility to remain curious.

Enough self-awareness to recognize our reactions.

Enough clinical skill to keep the client at the center.

1. Notice Your Internal Response

Before responding, notice what is happening inside you.

Are you becoming anxious?

Defensive?

Embarrassed?

Are you eager to prove that you are one of the “good” providers?

Are you searching for a less racially charged explanation because uncertainty feels easier than acknowledgment?

Are you preparing your response instead of listening?

Our internal reactions are not proof that we are bad clinicians.

They are information.

The responsibility is to recognize them before they begin directing the session.

2. Invite Without Assuming

We do not have to impose meaning in order to make room for it.

We can say:

“Would it feel helpful to explore whether race or culture is part of what made this experience so painful?”

“You mentioned wondering whether race influenced what happened. Can you tell me more about what led you there?”

“How are you making sense of the role identity or power may have played?”

“Are there parts of your identity that feel especially important for me to understand in this situation?”

An invitation gives the client room to decide what is relevant.

It opens the door without pushing the client through it.

3. Validate the Impact Without Claiming Certainty

Validation does not require certainty about another person’s motives.

We can validate that an experience was painful, frightening, demeaning, confusing, or destabilizing without claiming to know everything that occurred.

We can say:

“That sounds exhausting.”

“It makes sense that repeated experiences like this would affect your sense of safety.”

“You should not have to convince me that this had an impact on you.”

“I can hear how much energy you have spent trying to determine whether you can trust your own perception.”

Validation does not end clinical inquiry.

It makes honest clinical inquiry possible.

4. Place the Symptoms in Context

We must ask how the client’s symptoms relate to the environment in which they are occurring.

Is anxiety happening only within the individual?

Or is the client responding to an environment that has repeatedly required vigilance?

Is the client struggling with distorted thinking?

Or are they also making realistic calculations about safety, employment, healthcare, education, immigration, policing, or the well-being of their children?

Both internal and environmental factors may be present.

A culturally responsive formulation makes room for both.

It does not pathologize a client for responding to circumstances that would place pressure on anyone’s nervous system.

5. Collaborate on What the Client Needs

Not every client wants the same response.

One client may want space to grieve.

Another may want help regulating physiological stress.

Another may need workplace problem-solving.

Boundary development.

Documentation strategies.

Community support.

Advocacy resources.

Another may simply need to tell the truth without having that truth debated.

We can ask:

“What would feel most supportive from me right now?”

“Would you like us to stay with the emotional impact, think through possible next steps, or do some of both?”

“What would help you leave today feeling more grounded or less alone?”

The goal is not to perform cultural responsiveness.

The goal is to practice it collaboratively.

6. Repair When You Miss Something

We will make mistakes.

We will misunderstand.

We will miss cues.

We will sometimes respond too quickly, become too quiet, or rely on an intervention that does not fit the moment.

Cultural humility is not the promise that we will never make a mistake.

It is the willingness to recognize the impact.

To take responsibility.

To return.

To repair.

A repair might sound like this:

“I have been thinking about how I responded when you brought up race. I moved too quickly toward another explanation, and I may have minimized something important. I am sorry. What was that moment like for you?”

Or:

“I noticed that I became quiet after you shared that experience. I am concerned that my silence may have left you feeling alone with it. I would like to return to that moment, if you are willing.”

Repair is not a lengthy confession.

It is not asking the client to reassure us that we are a good person.

It is not centering our guilt.

It is taking responsibility while returning attention to the client.

Questions for Clinical Reflection and Supervision

Cultural humility cannot exist only as a value we endorse.

It must become a practice we examine.

Clinicians may find it useful to ask:

1. What happens in my body when a client names racism, discrimination, or oppression?

2. Do I become more focused on determining whether an event was “really” racist than on understanding its psychological impact?

3. Do I move toward coping skills before the client feels heard?

4. Which identities do I treat as culturally specific, and which identities do I unconsciously treat as the default?

5. Do my clinical formulations include social, historical, institutional, and community context—or primarily individual pathology?

6. Am I able to acknowledge racial or cultural differences between myself and a client without becoming defensive, performative, or avoidant?

7. When I make a cultural misstep, do I invite feedback and repair, or do I quietly hope the moment will pass?

8. Do I regularly bring issues involving race, identity, power, privilege, and countertransference into supervision or consultation?

9. Is my knowledge based primarily on clients teaching me, or am I taking responsibility for my own continuing education?

10. What might clients learn about belonging from my website, intake materials, office environment, policies, staff, and referral network before therapy even begins?

These are not questions we answer once.

They are part of an ongoing clinical practice.

The Responsibility Extends Beyond the Individual Session

Culturally responsive care cannot depend entirely on the skill or goodwill of one clinician.

Organizations also communicate who belongs.

They communicate through their intake forms.

Their hiring practices.

Their supervision practices.

Their language access.

Their fees.

Their cancellation policies.

Their referral networks.

The voices included in training.

The concerns leadership treats as urgent.

The concerns leadership quietly postpones.

A clinician can be compassionate in session while participating in a system that remains difficult to access, culturally unsafe, or structurally unresponsive.

Clinical reflection must therefore include both questions:

How am I showing up?

And:

What kind of environment am I helping to create?

Our Clients Should Not Have to Edit Themselves to Receive Care

In my first article, I asked allies to consider what their silence communicates outside the therapy room.

This time, I am asking us, as clinicians, to consider what our silence communicates within it.

Our clients may not remember every intervention we offered.

They may not remember every worksheet.

Every coping strategy.

Every clinical term.

But they may remember whether they had to edit themselves to remain acceptable to us.

They may remember whether we became distant when race entered the conversation.

They may remember whether they felt believed.

Whether we stayed curious.

Whether we recognized the larger context of their distress.

Whether we were willing to repair.

The therapy room is not separate from the world.

Neither the clinician nor the client enters it without history.

Without identity.

Without culture.

Without power.

Without loss.

Without fear.

Without hope.

Silence can hold a client.

Silence can also leave a client alone.

Our responsibility is not to speak in every moment.

It is to understand whose needs our silence is serving.

It is to recognize when neutrality has become avoidance.

It is to develop the courage, humility, and clinical skill to respond when silence is no longer therapeutic.

Related Article

Silence Has Consequences: An Open Letter to Our Allies on Mental Health, Race, and the Cost of Complacency. (Wellness for Our Future)

Clinical References and Further Reading

American Counseling Association. Multicultural and Social Justice Counseling Competencies. This framework addresses clinician self-awareness, the client’s worldview, the counseling relationship, power, privilege, oppression, and interventions at individual and systemic levels. (www.counseling.org)

American Psychological Association, Task Force on Race and Ethnicity Guidelines in Psychology. (2019). Race and Ethnicity Guidelines in Psychology: Promoting Responsiveness and Equity. (American Psychological Association)

National Association of Social Workers. (2021). Code of Ethics, Standard 1.05: Cultural Competence. The standard addresses culturally informed services, critical self-reflection, personal bias, cultural humility, lifelong learning, racism, oppression, and institutional accountability. (NASW)

Hook, J. N., Davis, D. E., Owen, J., Worthington, E. L., and Utsey, S. O. (2013). “Cultural Humility: Measuring Openness to Culturally Diverse Clients.” Journal of Counseling Psychology, 60(3), 353–366. (PubMed)

Hook, J. N., Farrell, J. E., Davis, D. E., DeBlaere, C., Van Tongeren, D. R., and Utsey, S. O. (2016). “Cultural Humility and Racial Microaggressions in Counseling.” Journal of Counseling Psychology, 63(3), 269–277. (PubMed)

Cénat, J. M. (2023). “Complex Racial Trauma: Evidence, Theory, Assessment, and Treatment.” Perspectives on Psychological Science, 18(3), 675–687. (PubMed Central (PMC))

Williams, M. T., Holmes, S. C., Zare, M., Haeny, A. M., and Faber, S. C. (2023). “An Evidence-Based Approach for Treating Stress and Trauma Due to Racism.” Cognitive and Behavioral Practice, 30(4), 565–588. (ScienceDirect)