Using personal experience, historical analysis of scientific racism including the famous example of Samuel Cartwright's drapetomania a presumed disease of runaway slaves, and modern questionable practices in the UK health system as brought forward by the National Black and Minority Ethnic Network, the author analyses the complex dynamics of race and racial identity in the therapeutic relationship in a context of prejudice embedded in social structures. The author discusses the complexities of the Black therapist-Black client as well as the Black therapist-White client relationship, including the phenomenon of shadeism within the Black community, and calls for more explicit recognition and discussion of racial difference in the therapy relationship as a way to bring less Eurocentric approaches to Black experience.