The psychotherapist's confidence in his own empathy.

Richard A. Friedman casts doubt on those patients who want psychotherapists who share their traits. The gay patient wants a gay therapist. The old patient wants a therapist who is at least not too young. The feminist wants a feminist.

What is critical to understanding someone is not necessarily having had his or her experience; it is being able to imagine what it would be like to have it. Thus, I do not have to be black to empathize with the toxic effects of racial prejudice, or be a woman to know how I would feel about being denied promotion on the basis of sex.

Even if we believe this feat of imagination is possible, how is the patient supposed to know that a therapist is sufficiently imaginative to do this well? You may think you have a great imagination. A lot of people do! But that doesn't mean that what you are imagining is accurate. I've known some individuals who have devoted an astounding amount of mental energy to thinking about what other people are thinking and coming up with plenty of material -- that imagination is grinding away like mad -- but it's all quite wrong.

There's a different level to the problem. Quite aside from whether or not the patient is right about who will empathize, there's the question of whether is morally wrong for the patient to discriminate based on the characteristics of the therapist.

Sometimes... patients should get exactly what they ask for in a therapist. One of my residents once saw a young woman from Africa who had survived hideous torture and rape and said that she didn’t think she could see a male therapist.

That struck me as entirely appropriate. Given her trauma, she simply could not have put her trust in a male therapist, no matter how empathic he might actually be.

What about patients whose demand for a particular therapist springs from nothing more than everyday prejudice? I remember a patient who once stormed into my office and demanded a white therapist to replace his therapist, who was black.

That’s a request I turned down, even knowing that this patient’s biased beliefs were an appropriate target for treatment. To do otherwise would have vindicated his prejudice and fundamentally compromised the therapy from the start.

Note that Friedman doesn't say that race discrimination is so morally wrong that he cannot be a party to it. He justifies his refusal on therapeutic grounds.

ADDED: Neo-Neocon responds.