Oct 21, 2026
Therapy does not happen in a social vacuum.
Every client enters the therapy room with a history, relationships, identities, communities and experiences of the world that have shaped how they understand themselves. Therapists enter with these things too, and while psychotherapy often focuses on what is happening internally (our thoughts, emotions, behaviours, relationships and nervous systems) people are also profoundly affected by the environments and systems in which they live.
An intersectional approach asks therapists to understand psychological distress within the context of the whole person, including the ways race, gender, sexuality, disability, neurodivergence, socioeconomic status, culture, religion, immigration, age and other aspects of identity may interact with experiences of power, privilege, marginalization and belonging.
It also asks something more difficult:
How might these dynamics be entering the therapy room itself?
The term intersectionality was introduced by legal scholar Kimberlé Crenshaw to describe how overlapping identities and systems of power can create experiences that cannot always be understood by examining each identity separately. In therapy, this means moving beyond the idea that a person simply possesses a collection of separate identities.
A client's experience is shaped by how those identities interact with one another and with the environments they move through.
Race may interact with gender, disability may interact with socioeconomic status, sexuality may interact with religion, neurodivergence may interact with cultural expectations, employment or education.
A person can also experience privilege in some contexts and marginalization in others.
Intersectionality is therefore not about creating a hierarchy of who is more or less oppressed. Clinically, it encourages a more sophisticated question:
How has this particular person learned to understand themselves, other people, safety, belonging and power within the environments they have had to navigate?
Intersectionality is present in therapy whether it is explicitly discussed or not. Consider a client who tells their therapist:
“Whenever my manager questions me, I immediately start explaining myself. I know I need to stop being so defensive.”
A therapist might reasonably explore anxiety, self-esteem, sensitivity to criticism or previous relational experiences. An intersectional formulation does not discard those possibilities, but it expands the inquiry.
What has happened when this person has challenged authority before? How are they perceived within their workplace? Are cultural, racialized or gendered expectations relevant? Does disability or neurodivergence affect their communication? Are there financial circumstances that make conflict with an employer particularly risky?
The client's response may still be something they want to change. But what appears 'maladaptive' when removed from context may make considerably more sense when understood within it.
Psychotherapy traditionally spends considerable time asking: What is happening within this person?
Intersectional practice adds another essential question: What has happened, and what is still happening, around this person?
Without that context, therapists risk individualizing problems that are partly relational, cultural or structural.
A client experiencing racism in the workplace could be conceptualized primarily as hypervigilant.
A disabled person repeatedly encountering inaccessible environments could be encouraged to challenge their “negative thinking.”
A queer client carefully considering whether disclosure is safe could be understood as avoidant.
A parent carrying a disproportionate amount of unpaid caregiving could receive strategies for managing stress without anyone examining why their workload has become unsustainable.
This does not mean assuming that every difficulty is caused by oppression or discrimination; doing so would simply replace one reductive formulation with another. Instead, intersectional therapy keeps both the internal and external world available for examination.
Intersectionality can also help therapists distinguish between psychological symptoms and strategies that developed in response to a person's environment.
Hypervigilance may be associated with trauma, but vigilance can also have an adaptive function when threat or discrimination remains present.
People-pleasing may reflect attachment experiences, while also having developed in environments where disagreement carried meaningful consequences.
Code-switching may be psychologically exhausting without being pathological.
Distrust of institutions may be informed by personal, historical or intergenerational experiences.
The goal is not to romanticize coping strategies or suggest they should never change (a strategy can once have been adaptive and still become costly). The difference is in the formulation.
Rather than asking only, “How do we stop this behaviour?” therapy can also ask:
“What did this behaviour help you survive, manage or navigate, and does it still serve you now?”
Intersectionality also matters because therapeutic rapport requires more than warmth and empathy. Clients are continually learning whether their therapist can understand the complexity of their world.
When a client describes an experience involving racism, disability, sexuality, religion, poverty, culture or another aspect of identity and the therapist minimizes it, immediately reframes it, becomes defensive or moves too quickly toward coping strategies, something important can happen: the client may begin editing themselves.
They may continue attending therapy, appear engaged, or even have a pleasant relationship with their therapist. But there may now be parts of their experience they have learned not to bring into the room.
This is why apparent cooperation should not automatically be mistaken for therapeutic safety. A strong therapeutic alliance requires enough safety for the client to disagree, correct the therapist, name difference and introduce experiences the therapist may not fully understand.
Intersectional practice does not examine only the client's identity. Therapists also enter the room with social identities, values, assumptions, experiences and blind spots.
A therapist's race, gender, sexuality, age, disability, religion, socioeconomic background and other social locations may influence the therapeutic relationship. Sometimes the therapist occupies greater social privilege than the client, sometimes the client does. Often the dynamics are considerably more complicated.
There is also a power differential inherent in psychotherapy itself.
Therapists establish parts of the therapeutic frame; they document sensitive information, they make clinical judgments, their professional opinions may carry authority within healthcare, education, legal or other systems.
Recognizing this power does not undermine therapy, but failing to recognize it can.
Intersectional practice therefore requires cultural humility. Therapists should develop knowledge about communities, histories, discrimination and systemic inequities. But knowledge about a population is not the same as knowing the individual sitting across from you.
Two people who share the same race, religion, disability, sexuality or cultural background may understand those identities very differently. Good intersectional practice requires therapists to hold knowledge without allowing that knowledge to become assumption.
The position is closer to:
I should know enough that you do not have to teach me everything, while remaining humble enough not to presume that I already understand you.
One of the most important aspects of intersectional practice is the willingness to examine our own clinical interpretations. Therapists should be able to ask themselves:
What am I interpreting as resistance?
Whose definition of “healthy” am I applying?
Would I interpret this behaviour differently in a client with a different identity or social position?
Am I treating an adaptive response as pathology?
Am I assuming my experience of the world is more objective than my client's?
Is there something happening between this client and me that we need to name?
These questions are not evidence that the therapist has done something wrong, they are part of responsible clinical practice.
For social workers and psychotherapists, intersectionality is not simply a theoretical framework, it intersects directly with ethical practice.
Without attention to social context, clinicians can unintentionally impose culturally specific ideas about independence, family, communication, relationships or wellness. They may misunderstand barriers to treatment, pathologize adaptive responses or reproduce dynamics of power that clients encounter elsewhere.
At the same time, intersectionality itself must not become another way of making assumptions about people.
A therapist should not decide how important an identity is to a client, presume someone's political beliefs based on their social location, or assume that a particular experience must be understood through oppression simply because the client belongs to a marginalized group.
The client remains the authority on what their identities mean in their own life.
Intersectional psychotherapy holds several levels of understanding at once.
It considers what is happening individually in a client's thoughts, emotions, behaviours and nervous system.
It considers what is happening relationally in attachment, trust, conflict and belonging.
It considers what has happened developmentally across the client's life.
It considers the cultural and social meanings surrounding their experiences.
It considers the structural realities that may influence safety, opportunity, access and power.
And importantly, it considers what may be happening within the therapeutic relationship itself.
Who feels understood?
Who has to translate themselves?
Whose worldview is being treated as the default?
What can be disagreed with safely?
What happens when the therapist gets something wrong?
These questions are part of the work.
At VOX Mental Health, we believe meaningful psychotherapy requires understanding people within the context of their lives, not reducing complex experiences to symptoms or diagnoses.
Intersectional practice does not require a therapist and client to share the same identities or lived experiences. Nor does it require therapists to perfectly understand experiences they have never lived.
It requires something more clinically useful: curiosity, humility, awareness of power, willingness to examine assumptions, and the capacity to listen when a client's experience challenges our existing understanding.
Because sometimes therapy involves changing an internal pattern. Sometimes it involves recognizing that a person's distress makes sense within the environment they have been navigating.
Often, it requires both.
The goal is not to remove identity from the therapy room, it is to create enough space for the whole person to enter it. VOX Mental Health provides individual, couples, family and child and youth psychotherapy in Barrie, Ontario, with virtual therapy available across Ontario.
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