Why Intersectionality Isn't Optional in Mental Health Care
Can we truly understand someone's mental health if we only understand the individual?
For much of psychology's history, we've attempted to answer that question with diagnoses, symptom checklists, personality traits, and treatment protocols. While those things have value and provide us with language, structure, and direction, they are rarely enough for sustainable outcomes. Especially if goals include progress beyond crisis management or baseline ‘functioning.’
Every person who walks into therapy arrives carrying far more than their own thoughts, behaviors, or biology. They bring families, cultures, communities, histories, identities, opportunities, losses, privileges, barriers, expectations, and systems with them. They bring generations before them and hopes for generations after them. They bring relationships that have shaped how safe the world feels, whether vulnerability is possible, and what survival has required of them.
In other words: they bring context. And context can both inform and change everything.
What is intersectionality?
Intersectionality is often misunderstood as simply "having multiple identities."
Coined in 1989 by American legal scholar & civil rights advocate, Kimberlé Crenshaw, intersectionality is a framework that shows how different parts of a person's identity (such as race, gender, class, and ability) overlap and combine. Intersectionality explains how these overlapping traits create unique forms of discrimination or privilege, rather than looking at each part of identity by itself.
Within the context of therapy & mental health treatment, intersectionality is crucial. As much as some may wish it didn’t, the identities & intersectionalities of both the therapist and the clients matter. Especially when it comes to rapport, conceptualization, diagnosis, perspective, treatment, ‘progress,’ and outcomes.
No one experiences being LGBTQ+, a veteran, disabled, neurodivergent, a woman, a parent, Black, Indigenous, an immigrant, wealthy, impoverished, religious, or any other identity in isolation. Those experiences continually influence one another.
A queer veteran's experience is not simply "queer" plus "veteran."
A Black autistic woman does not experience racism, ableism, and sexism separately before combining them.
These identities overlap, shape one another, and create experiences that cannot be understood by examining each piece independently.
As therapists, when we miss this, we often misunderstand not only who someone is but how and why they have adapted the way they have based on how they experience the world & how the world experiences them.
Mental health doesn't happen in a vacuum.
Our brains are constantly asking one fundamental question: Am I safe? It’s an evolutionary trait, an involuntary one. “Survival of the fittest” ringing any bells?
The answer isn't determined solely by our judgement or even our nervous systems. It's largely informed & determined by our environments.
If someone has repeatedly experienced discrimination, marginalization, family rejection, chronic financial instability, military trauma, inaccessible healthcare, racism, transphobia, sexism, or community violence, those experiences don't simply become "background information."
They become part of the nervous system's evidence. When we only focus on internal symptoms without acknowledging external realities, we risk unintentionally communicating that the problem exists entirely within the person.
For example: sometimes anxiety is anxiety. Sure. But sometimes hypervigilance is a remarkably intelligent response to environments that have repeatedly proven unpredictable. Sometimes exhaustion isn't depression. Instead, it's the cumulative cost of navigating systems that require someone to work twice as hard simply to receive equal care, safety, or opportunity.
Context doesn't eliminate diagnoses, it helps us understand them more accurately.
Trauma is relational.
I've written before that I believe we've over-individualized trauma. Trauma rarely develops in isolation from relationships, communities, or systems. Therefore, healing rarely does either.
Our nervous systems are shaped through connection. Attachment develops through connection. Identity develops through connection. Safety develops through connection.
Which means healing also happens through connection.
This is one reason intersectionality matters so deeply. If we ignore the cultural, historical, relational, or systemic realities that have contributed to someone's pain, we unintentionally ask them to heal without acknowledging the very conditions that wounded them.
That's a heavy burden for anyone to carry, and simultaneously over-allocates control & responsibility on the individual while also underemphasizes the impact from social ‘norms,’ policy, and systemic impacts that directly & indirectly influence potential ‘progress.’
The goal isn't to become an expert in every culture.
One misconception I hear frequently is that therapists need to memorize every identity, every cultural tradition, or every marginalized experience before discussing intersectionality.
Thankfully, that's not the goal. Humility is far more important than expertise.
Intersectionality isn't about assuming we know. It's about recognizing all the ways we don't. It's remaining curious instead of certain. It's understanding that two clients who appear similar on paper may experience the world in profoundly different ways. It's asking better questions:
"What has shaped your relationship with this?"
"What messages did you receive growing up?"
"What has it been like navigating the world with these parts of your identity?"
"Where have you felt safest?"
"What has made safety difficult?"
Those questions often tell us far more than symptom checklists ever could.
Therapy should expand the story, not shrink it.
One of the greatest gifts therapy can offer is helping people recognize that many of the beliefs they've carried about themselves didn't originate with them.
"I'm too much."
"I'm weak."
"I'm difficult."
"I don't belong."
"I'm failing."
Often those beliefs were learned within relationships or reinforced by systems, not discovered as objective truths. When we understand someone's story through an intersectional lens, we stop asking:
"What's wrong with you?"
and begin asking: "Given everything you've experienced and everything you've had to navigate... how does this make sense?"
That question doesn't remove responsibility, but it often removes shame. And shame is rarely fertile ground for healing.
Moving beyond "trauma-informed."
Being trauma-informed is an important beginning. But if our understanding of trauma never extends to the social, cultural, historical, and systemic conditions that shape those experiences, we risk halting progress to the point in which the individual no longer has ‘control.’
To be truly person-centered requires being context-centered.
To be culturally affirming requires remaining teachable.
To be relational requires acknowledging that relationships extend beyond the therapy room and into families, institutions, communities, and society itself.
Our clients are not simply individuals. They are people living within ecosystems. The more fully we understand those ecosystems, the more accurately we can understand the person sitting in front of us. And I think that understanding is one of the most compassionate things we can offer.
