Lesbians and the Parable of the Late Client

In social work classes (and also in my undergraduate clinical psychology/counseling psychology classes) there is the Parable of The Late Client.* It looks something like this:

There’s a therapist whose client is always late. Not five minutes late, but fifteen or twenty minutes late to the majority of sessions. The therapist finds this disrespectful and resistant, and in the grand tradition of Freud, decides to address with the client what this means about how the client views the therapist-client relationship. What is the client’s relationship to authority? What things do they believe about the therapeutic process? Does the client need to push away everyone who tries to help her? What does that mean? So the next time the client walks in late, the therapist brings it up.

And….

…the bus is late. The client cannot afford to travel except by public transportation, and the bus is often late. She could catch the much earlier bus, but that would mean leaving work early each day she had therapy, and she can’t afford that either.

The first point of the parable is to pay attention to environmental factors** and to be extraordinarily careful in attributing fault to the client. Client appears to be ‘resistant’ to medication? Can they afford them? Client is late—do they have control over their ability to arrive?

The second point is about—at least, in the tellings I’ve heard—making sure to look around at what’s leading to the client’s concern…and what risks and strengths could shape the future of the client’s life. So, I spend a lot of time looking at case studies And it seems like there are two kinds of risk factors: the Intrinsically Risky and the Societally Risky.

Take lead.

Lead exposure is bad. It’s near impossible to bend and twist ‘has lead exposure’ into anything but a risk factor for future health. Exposure to toxic metals is not good for you, and will probably measurably impact your life. Also bad: domestic violence, iodine shortages, not being able to afford food, really, poverty of all kinds, and a bunch of other things. These are not putting you at risk purely because society thinks they’re bad and then treats you poorly, they are things that will harm you no matter how people feel you experiencing them.

Okay, but take being a lesbian.***

In theory, being a cis lesbian should be….probably a protective factor. Lesbians are less likely to contract HIV/AIDS, significantly less likely to have an unintentional pregnancy, less likely to be killed by a partner.

But right now, lesbians are more likely to be suicidal, more likely to self harm, and experience a lack of social support than their heterosexual counterparts, and all of that makes the reaction to ‘in case study, client is a lesbian’ be ‘risk factor’

Just taking a wild, speculative, swing at things, I’m going to guess this is not a feature of ‘wanting to sleep with women’ and possibly more a feature of discrimination, lack of acceptance, and ambiguous attribution issues. (In fact, this study, linked to previously, suggests that lesbian and bisexual women had slightly lower levels of depressive symptomatology than their heterosexual counterparts.)

And I’m sure there are other qualities that are like that: risks only because we make them out to be. I’d love to arrive a place where orientation isn’t one of those—it feels likely that that will happen within my lifetime. And then we’ll move on to the next Societally Risky, but not Intrinsically Risky feature.


*I don’t know if it’s been named as such, but it’s appeared in a variety of textbooks and classes across more than one university.
**the social work version of this told it as “psychotherapists don’t pay attention to environmental factors, but we do.
*** For the purposes of this discussion, we’re talking cis-lesbians. I know this is frustrating, but the research only looks at cis lesbians, and paragraphs got unwieldy when I did anything else.

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3 thoughts on “Lesbians and the Parable of the Late Client

  1. Don’t African Americans have lower suicide, self harm and depressive symptomatology rates than whites? By your reckoning it should be the opposite. It seems like a real injustice, to your patients, to just blame society. Personal behavior and ideology must have something to do with psych problems,don’t ya think?

    1. I mean, it’s not as if I just go “client has depression, MUST be societal”

      The general point of the parable is that people tend to round off in the direction of assigning culpability entirely to others (see also: fundamental attribution error) and that you can mess up if you don’t also look at related factors.

      Relatedly, while I haven’t gone looking to confirm or deny your initial premise, I also know that African Americans have strong cultural prohibitions around admitting depression, and we tend to suck for controlling for those (Willow Weep For Me explores this via a long case study). This seems like a societal factor worth factoring it in, though obviously if a person were to be African American and not be depressed, or say they had symptomatology of depression, it would be ridiculous if I said “eh, that’s *only* because you’re Black!”

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