Racism has many definitions, some of which identify frank prejudice and verbal or physical hostility towards people with a different racial appearance. Some definitions emphasise the presence of negative and disadvantaging behaviours and attitudes towards the racial other, even among those considering themselves liberal and taking an anti-racist stance (Bhui, 2002; Primm, 2006). It is well established that, as a scientific construct, race does not determine how likely a person is to get a mental illness, and it does not really predict social, cultural or ethnic characteristics. Its importance lies mainly in the propensity for human populations to make use of a shorthand to describe and attempt to classify each other (often incorrectly) on the basis of appearance. It is also important because power, income and status appear to be patterned by race.

Given that in therapeutic settings, patient and therapist have many expectations of each other, race becomes one of numerous characteristics that both make use of in their initial encounter. Then it is taken up in the life of the consultation, assessment and treatment cycle, or it remains very silent, as if nothing to do with either person. This observation has been repeatedly made by clinicians and therapists for many decades. It has become known as the ‘silence of race’, carrying with it a quality of the repression or disavowal of an experience or set of historical group relations that would otherwise be troublesome (Young-Bruehl, 1998; Qureshi, 2007). When race does arise in a more explicit manner, it is difficult for therapist and patient to know how to take it up, given that it might lead to very different and deep-seated responses from either. When it is mentioned, it can be lightly touched upon and then overlooked or laughed off, perhaps disguising contempt or disgust, or shame or guilt, or some of those automatic thoughts and feelings that emerge in relationships. Fantasies of miscegenation, for example, are common (Calvo, 2008) in cross-racial encounters, and are often found at times of war and conflict, when inter-group (race, tribe, nation) relationships are attacked.