By Rev. Sheila P. Johnson

I was born in 1950, at Freedmen’s Hospital in Washington, D.C. — a hospital below the Mason-Dixon Line that was founded for formerly enslaved people. I weighed just 2 lbs at birth. My mother, suffering from preeclampsia and near death herself, had nowhere else to go. At the time, neonatology didn’t exist, and in most hospitals, Black women weren’t given access, dignity, or quality care. But Freedmen’s Hospital, staffed by both Black and white doctors and nurses, made survival possible for us.

That story is bigger than me or my mother. It’s about what happens when care reflects the community it serves. Representation mattered. It meant my mother and I had a chance when other doors were closed. Care was rooted not only in skill, but in understanding and respect — when so many Black lives were dismissed as unworthy of saving.

The same truth carries into mental health today. At a time when more people are seeking a path through depression, anxiety, and other mental illnesses, representation matters. When your therapist looks like you —, or at least has the framework to understand your lived realities, the work changes. Healing feels possible. You don’t waste energy translating or defending your experience. You don’t hold your breath wondering whether your truth will be minimized or doubted. Instead, you can exhale. You can trust that what you carry — the weight of racism, of inequities, of expectations born from culture — is real, and that it will be received with recognition, not dismissal.

Unfortunately, fewer than 6% of therapists were Black in 2023, and fewer than 8% were Hispanic, according to the American Psychological Association.

Representation can shift how treatment is perceived. For instance, a Black woman describing her exhaustion after yet another workplace microaggression doesn’t want to hear, “Are you sure you’re not being too sensitive?” A Latina immigrant who works two jobs while sending money home doesn’t need her therapist to reframe her sense of responsibility as “unhealthy codependency.” A Muslim teenager fasting during Ramadan shouldn’t have to use therapy time teaching what Ramadan even is. A queer client describing the stress of a family gathering doesn’t want subtle judgment disguised as neutrality.

These moments are not small. They define whether therapy harms or heals. Without context, bias seeps in. Anger gets pathologized instead of understood as survival. Silence is misread as resistance, when it may actually reflect cultural respect for authority. Parenting practices anchored in tradition can be labeled “rigid” by therapists who don’t realize they’re interpreting through their own cultural lens. These distortions don’t just affect individuals — they reverberate across families and communities.

Now, imagine the reverse. That same Black woman names her exhaustion and is met with validation: Yes, racism is corrosive to the body and spirit. That immigrant daughter speaks of sacrifice and is honored for her strength, not told to “just set boundaries.” That queer client opens up about family tensions and receives affirmation that their survival strategies make sense. The Muslim teen explores identity struggles with someone who doesn’t stumble at the first word of their religious practice. This is what context makes possible. The therapist doesn’t have to live the same life, but they honor the reality behind the words. When that happens, therapy becomes a place where healing is not only imaginable, but sustainable.

The truth is, assessment and treatment are never value-neutral. Every clinician brings something into the room: their history, their biases, their blind spots — and the makeup of the therapy profession tells its own story. In 2019, white therapists still made up the majority of the workforce. That number matters. It reveals the barriers people of color face in becoming providers, and it explains why so many clients of color still struggle to find therapists who truly “get it.” 

Some lawmakers have proposed federal legislation that would promote researching racial and ethnic disparities in mental health to develop a plan to increase culturally sensitive services. However, the ongoing attacks on diversity, equity, and inclusion at the national level mean that states may have to invest in workforce development that reflects their communities. 

Context isn’t optional — it is the soil that therapy grows from. Technique without context is fragile. But therapy grounded in context, in representation, in respect, can become a lifeline. Just as Freedmen’s Hospital gave my mother and me the chance to live, representation in mental health gives people the chance to be fully seen — not as problems, but as whole human beings worthy of care.

Rev. Sheila Poynter Johnson, LP, MPS, is chair and president of Harlem Family Services, which is opening a new clinic in fall 2025. She is a licensed psychoanalyst, ordained minister, educator, author, and social justice advocate with more than 11 years of clinical experience and a strong background in nonprofit leadership.

This post appeared first on New York Amsterdam News.