Samuel Knapp, Ed.D., ABPP
Director of Professional Affairs
Conventional words for ethnic groups vary over time, and what is acceptable for a group in one period of time would be viewed as offensive in another time or context. However, at times patients will use words or comments directed at others because of their race, gender, or sexual orientation that clearly offend standards of decency. How should psychologists respond in such situations? Should they ignore the comment or directly confront the patient about the terms that were used?
Discretion is needed to determine when a word is intended as offensive or not. For example, Hawaiians refer to European American residents of Hawaii as haole (pronounced “howlee”). At times it is delivered as a factual statement, “He is a haole” (a white person who lives in Hawaii), and European American residents of Hawaii commonly refer to themselves as haole. However, it could be used as an insult if it were combined with certain adjectives, voice intonations, or hand gestures (Rare storm, 2011).
The conduct of psychologists in addressing hurtful speech, as in other aspects of professional behavior, should be guided by adherence to overarching ethical standards. So, when a patient makes an ethnic slur, the response of the psychologist should be guided by the principles of beneficence (acting to promote the well-being of the patient), nonmaleficence (acting to avoid harming the patient), general beneficence (acting to promote the welfare of the public in general), or other ethical principles.
The context of the comment may be relevant. It is important to know if the comment is related to the patient’s presenting problem, or activated as a function of the perceived characteristics of the therapist (Bartoli & Pyati, 2009). However, I am aware of a few situations where patients have made such intense hate-filled and vitriolic comments (addressed towards groups represented by the psychologist) that a decision was made to refer the patient elsewhere.
In some situations the principle of beneficence (welfare of the patient) may be operative. For example, a young person may use an ethnic term in a manner that an adult considers offensive. Here it is most likely appropriate for correction or feedback because the person might not understand the implications or ways in which the words come across. An educational or non-judgmental exchange could help the young person understand the implications of this speech and how it might impair their social relationships in the future.
The overarching ethical principle of general beneficence holds that psychologists should act to protect the public in general. Consequently, it would seem that, according to this principle, psychologists should address hate-filled comments. However, this ethical principle should be balanced with concerns about beneficence or the welfare of the patient. One patient of mine made a derogatory comment about an ethnic group which I corrected, with as much tact as I could manage. The patient was embarrassed, apologized, and corrected himself. However, if the comment were made in the context of a psychotic episode, disclosure of suicidal intent, or other indication of serious emotional crisis, I probably would have ignored the comment altogether and focused entirely on the patient’s well-being. If the patient had made the comment in response to a particularly upsetting or stressful event, I might have deferred addressing the issue to a time when the patient could get more perspective on the situation.
It is often best to avoid assuming that there will always be a false dichotomy between general beneficence and beneficence. Except in extreme circumstances when patient welfare is at stake or when the hateful comments represent extreme social deviance, psychologists can often find a way to address the issue without harming the therapeutic relationship. Anger and judgmental attitudes should be avoided. Patients are more likely to respond positively to comments made in a calm and direct manner (e.g., “let’s use another word, it makes you come across as prejudiced”).
Bartoli, E., & Pyati, A. (2009). Addressing clients’ racism and racial prejudice in individual psychotherapy: Therapeutic considerations. Psychotherapy: Theory, Research, Practice, Training, 46, 145-157.
Rare storm over races ruffles a mixed society. (2011). New York Times. Retrieved from here.