When Dr. Tiffany Zachery first began seeing clients as a therapist in private practice in 2019, she already had many in her care.
First, there was her baby daughter, still in diapers. Then, there were the college students — “my babies,” Zachery still calls them — she counseled as an academic adviser at UL Lafayette. As excited as she was to begin her work, she was daunted by the unfamiliar business responsibilities and nervous about finding enough clients to stay afloat.
She voiced these worries to Casey Robinson, a fellow licensed clinical social worker who has run her own private therapy practice in Lafayette for several years. Robinson met her anxiety with a forceful push to continue. “Casey said, ‘We need you,’” Zachery recalls.
Across the country, there’s long been a lack of Black mental health professionals, and while rates of mental illness among Black Americans are similar to those of the rest of the population, they disproportionately receive poor care from white practitioners who aren’t culturally competent. The pandemic has only worsened these mental health vulnerabilities by exacerbating pre-existing racial inequities in healthcare, causing higher Covid death rates among communities of color.
Both Robinson and Zachery see clients of all races, but some clients find more ease and comfort with therapists of the same race. “Some people are coming to see me because I look like them,” Robinson says. “They don’t have to explain what being Black is. So there’s an instant comfort — like, you may not understand what I’m experiencing exactly, but you understand the basis of that experience. That, in itself, is therapeutic.” In a frightening and isolating time, Black women therapists like Robinson and Zachery help create an invisible network of support with their work, caring for the community one private video call at a time.
With Robinson’s guidance on the business end of things, Zachery began to see clients on weekends. In less than two weeks, her schedule was full. By February, she’d left her university job to pursue therapy work full-time. Almost two years later, Zachery sees about 50 active clients — 20 or so every week, four or five every day she’s in session.
“Every client is different,” she says, describing her operation as a one-woman show. “My 9 o’clock might be live, and then at 10 I got somebody who’s real monotone. That high-low, high-low — it wears you out!”
This year, Zachery’s hard work garnered her recognition as one of Lafayette’s 20 under 40, an annual award for young professionals. If the award has gone to her head, it doesn’t show; she answers my Zoom call in her office off Pinhook in a zip-up sweatshirt and a pair of silver hoops. She’s warm, effusive, down-to-earth and quick to laugh.
Before the pandemic forced therapy online, Zachery did her best to make her office into a comfortable space: a diffuser in the corner wafting lemon leaf and lavender, two plush armchairs, warm light from multiple lamps. Since Covid, clients haven’t had that experience, settling instead for talking over video calls with kids yelling in the background or pets walking in front of the computer screen.
Despite the technological inconvenience, Zachery’s schedule is completely full until March 2021. “A lot of people are transitioning,” she says. “Forced to think about retirement, to rethink their career paths, to look in the mirror because they’re home all day.”
These jarring shifts in lifestyle, alongside other stressors like social isolation, police violence and the loss of loved ones to Covid, have taken a heavy toll on the psyche of the nation as a whole and communities of color in particular. Around 25% of Lafayette Parish residents are Black. But Black people make up 38% of Covid deaths in the area and 31% of Covid cases.
A similar disparity has played out in mental health for years. A quick scroll through the first four pages of results on Psychology Today’s online database of therapists in the area returns few Black therapists. Nationwide, the mental health field is dominated by white practitioners, who comprise 86% of the clinical psychology workforce and 60% of all social workers. This lack of Black professionals has real consequences when it comes to the quality of care Black clients receive, and thus the outcomes they can expect from therapy.
“You can go to any dentist and get a root canal,” says Zachery. “You don’t need to have a personal vibe — just make sure they do it right. But for your therapist? If you don’t like them, you’re not going to open up to them.” And when clients don’t open up, they can struggle to heal.
A host of studies indicates the importance of the client-therapist relationship in achieving positive outcomes in a therapeutic setting. Given how crucial the quality of this connection is, it’s not difficult to imagine how much racial biases may damage white practitioners’ relationships with clients of color. Such biases can result in misdiagnosis, and ultimately prevent clients from feeling comfortable enough to really benefit from treatment.
Zachery notes that sharing the same race as your therapist is certainly not a guarantee for quality of care and experience. As a self-described “spunky millennial,” she recommends folks to, above all else, “find a therapist that fits your personality. My white clients? They got funky personalities, too! They’re no sticks in the mud.” She says the most gratifying part of her work is getting people to a place where they can leave therapy with a new set of skills to take on the world.
Robinson agrees that seeing these positive outcomes is by far the best part of her job. She notes that it’s been especially powerful to help people explore their privilege and oppression in new ways lately.
“There’s been so much division,” Robinson says. “Not just with racial issues, but politics. And it’s all clumped up together!”
Robinson, a few years Zachery’s senior and more circumspect in nature, is currently balancing her full-time practice with homeschooling her young son. She hopes her practice, in its own way, contributes to Lafayette’s growth into a city that will be more accepting of differences in the future.
“I know I’m not this big change maker out in the community, standing beside people in the protests,” she says. “But the work I’m doing individually with people is helping them to heal within themselves, which is eventually going to pour out into the greater community.”
Neither Robinson nor Zachery are currently able to take new clients, and are referring out to other practitioners. Directories on Psychology Today or Therapy for Black Girls, a website and podcast by licensed psychologist Dr. Joy Harden Bradford, are both great places to start looking for support.
Zachery says she used to feel pressured to take on more clients, simply due to the demand, but as she’s matured into her practice, she’s getting better at finding a balance. “I practice what I preach,” she says, because she’s seen first hand how deadly stress can be.
In 2014, her father died unexpectedly of a heart attack. “My dad didn’t have heart issues,” she says. “It was stress.”
Her father had been a huge supporter of her graduate studies; to honor him, she does her best to not overextend herself, especially for the sake of her 3-year-old daughter.
With so much need for mental health professionals in the area, especially those of color, it’s hard not to wonder who’s out there helping the helpers. It turns out, somewhat unsurprisingly, that the answer is: other helpers. Robinson credits the support of her peers and colleagues with helping her through all the different pressures the past year has brought into her life. Zachery, in turn, is grateful for Robinson’s help getting her practice off the ground two years ago.“Casey’s the G.O.A.T.,” says Zachery, laughing. Instead of charging her for the assistance she offered in the early days of her business, Robinson only asked that Zachery pay it forward. “And that’s what I’ve been doing,” Zachery says. “Anytime somebody hits me up, if they want to start a practice, I take the time and try to do the same thing.” She pauses. “Because you gotta think: For every one of us, there’s probably 50 people who need us.”