When I was a football fan in my youth, one of my favorite players was Christian Okoye, nicknamed the “Nigerian Nightmare.” The nickname derived from his birthplace as well as the fact that as a speedy running back and huge at 6’1, 260 pounds, he was a nightmare to tackle. Wade was my supervisee for 3 years. I would call him the Nigerian dream. Six foot 2 with a lean athletic build, Wade dressed well and had a warm smile. However, in trying to build a great team of psychotherapists, appearance did not matter too much in my book. In reality, Wade had a very rocky start working in my practice. I am a psychologist with several offices in the Los Angeles area and I had an opening for a therapist intern in the Manhattan Beach office. Manhattan Beach is a town composed predominantly of upper middle to upper-class white people. Wade is an African-American male 42 years old. He seemed to have a very difficult time retaining clients that I referred to him, most of whom were white. The reasons these clients were not sticking with him were not clear. When I listened to his recordings of sessions with clients as well as observing him in my supervision group, it helped me understand better. Wade tended to be quite careful and anxious. He was deferential and very respectful to me, but I often found him difficult to connect to because he was quite anxious, stiff, and guarded. It seemsed as though he did not allow himself to just be more his authentic self around me or his clients. After about the eighth client or so did not stick with him past a few sessions, I strongly questioned whether I should have hired him. Perhaps he was not adequately trained and prepared for private practice. Wade had previously interned solely in community mental health clinics which often utilize a different set of therapeutic skills than those needed in private practice.
I decided to be very direct with Wade. I said, “I have given you a bunch of referrals and none of these patients have stayed with you. I’m not comfortable giving you any more referrals for the time being. I’m not sure why they’re not sticking with you but it could be because of your anxiety. Perhaps you’re not allowing them to see your personality enough. It could even be because of your race with some of them.” Racism can be a very difficult thing to assess as one often does not know to what degree race is playing in the interaction/relationship. My last words in this conversation were, “Wade, you’re going to have to get your own referrals and build your own empire.”
Wade, a former top college athlete, impressively rose to the challenge. He networked and put himself out there in a way that no other interns that I have worked with over the years have done. He built up a solid caseload of patients who sought him out directly rather than being given patients who had initially requested me. He entered into his own twice a week psychoanalysis with a skilled therapist who helped him work through a lot of his issues including performance anxiety as a new therapist. Courageously, he was always the first to volunteer play his recordings of patient sessions in the group supervision that I led. He was hungry for my feedback about his therapeutic skills and mistakes. Basically, he put in the hard work to get better at his craft, expand his client base, and perhaps most importantly, to know himself better.
Wade was very close to achieving his doctorate degree. I noticed that he spoke clearly and was articulate. However, he had a couple words he used that were typically considered black. For example, instead of ‘ask’ he would say ‘ax’. Also, he pronounced heroin as if there was no ‘I’. I felt uncomfortable bringing this up with Wade as it seemed vaguely disrespectful or potentially even racist. After discussing the situation amongst some therapists with whom I often consulted, I determined I would be remiss not to bring it up. Wade had wanted to build a practice as a doctor working with a variety of people including educated whites. A percentage of this group could lose confidence in him based on a couple of his pronunciations. I decided Wade should at least be made aware of these pronunciations even if he then deemed it unnecessary to change anything. As is often the case when I am unsure about broaching a difficult subject with a supervisee, a patient, or someone in my personal life, I was so glad that I did bring it up! He opened up a side of him which I had not seen.
Not only did we discuss pronunciation, but how he had grown up in a Nigerian community with different pronunciations and dialects in Houston, Texas. He described going to a school where the American black children were quite cruel to him. They often bullied him and he was ridiculed for being Nigerian and African. He reported the whites were nicer to him, although he did not feel he quite fit in with them either. Furthermore, Nigerians often excluded him for being American. “I didn’t fit in anywhere!” He also told me about a psychotherapy client who said his last name with a lot of sarcasm and said, “What kind of name is that?!” This particular comment from the client caused Wade to shut down and in that moment he struggled to maintain his curiosity about the client. I explained to him that as he gets more comfortable with his identity, he can explore this type of client comment and the client’s feelings behind it more readily. I empathized with the discomfort he experienced and I let him know that.
Wade was working with a diverse client base that he had built up over a year or so. He had a nagging feeling that he was a fraud, and felt as though he had to hide from his black clients that he was not a typical American black with American born parents. Wade feared if they discovered he had grown up with a much different experience as a black in America, they would not trust him or would attack him like when he was a child. We discussed ways he could actually use their feelings about his name or his heritage to help the client with their own internalized racism and feelings about race. Wade became excited when I pointed out he could use his personal life and disclose some of it when it was indicated/useful to the patient. He realized he had the opportunity to uniquely understand clients with racial identity issues.
One of Wade’s most challenging cases was working with a 12 year black male named Eddie. Eddie had been transferred to a rougher school because he was expelled from his previous school. He complained of being bullied and physically threatened at the new school. At home he was required to do many chores as his mother was working as an uber driver all day and a second job at night. The only thing that kept Eddie going was his passion for basketball. This was similar to Wade who found basketball to be one his few positive experiences from childhood. When I told Wade that they could take a session and play basketball together Wade began crying. I had opened up an important pathway of connection and he was moved that I allowed it.
I disclosed to Wade some of my own conflicts with identity. Although my parents were Jewish, my father and his older brother changed their name to a non-Jewish sounding name when he was applying to medical school in the early 1940s. This was a way to improve their chances for admission as there were quotas limiting the number of Jews accepted into US medical schools. I also inherited more of my mother’s features and I have been told (as she has) that I do not look Jewish. When I was a young boy my mother told me it was a compliment when someone said I did not look Jewish. This was confusing to me as a child : “I am supposed to be proud of being Jewish but it’s better if I don’t look Jewish?” I better understand these mixed messages now. There was an understandable family desire to assimilate into mainstream America especially as her parents had narrowly escaped Nazi Germany. I could also relate to not fitting into a certain group or culture. With Jewish groups I felt some disconnection as I was very rarely practicing the religion/customs. With some other groups I was the only Jew in the group and felt some distance culturally and there were even a few blatant anti-semitic comments. I shared with Wade how I used humor in part probably to cope with my discomfort. My mother said to me when I was in college, “Michael you should go to Hillel and connect with other Jewish students. You know you are Jewish.” I would respond, “What! I am Jewish? Why didn’t anyone tell me?” She would then appear very distraught and sigh which I found very funny! I came up with this joke in part because I saw Richard Pryor use a variant of it. In a movie he plays a blind man and his friend tells him he is Black. He acts as if this this shocking news to him!
Sharing some of this information about my history and using some humor seemed to strengthen the bond between Wade and I. He appeared markedly more relaxed. I was also modeling to him how a therapist can disclose certain things about themselves if they believe it will be helpful to the client (or in this case the supervisee). Wade then shared with me that he would not be attending individual supervision the following week because he was going to his graduation ceremony – receiving his doctorate. Although usually poker faced, he really beamed when I said, “Congratulations Dr. Ugo.” I asked him who would be attending his graduation. He told me his girlfriend, mother, and a couple cousins would be there. Many years ago his father was deported to Nigeria, and he never had much of a relationship with him. I have never attended an intern’s graduation ceremony. Sadly, I did not even attend my own doctoral graduation ceremony. There are a number of doctors in my family so that I (and my family) did not appreciate and value the accomplishment enough at the time. The question occurred me whether I would attend Wade’s graduation ceremony. The answer: Yes, what a privilege!