On Racial Microaggressions in Therapy

Research has shown high prevalence rates of microaggressions in individual therapy, and conversely demonstrated the importance of addressing such microaggressions in therapy (Kivlighan & Chapman, 2018). Shockingly, most clients experience at least one microaggression within any given counselling relationship (Kivlighan et al., 2020), while a large number of therapists remain unable to accurately identify the presence of a microaggression (McSorley, 2020). Such microaggressions might involve stereotyping, misgendering, or denying experiences of oppression (McSorley, 2020).
 
One problem here is that the industry remains overwhelmingly White. Back in 2012 only 3% of marriage and family therapists and only 6% of all psychologists in North America were racialized practitioners. Even if we account for potential increases in these numbers over the previous decade it still means that the likelihood of a racialized individual receiving services from a White practitioner is very high – even if their presenting issue is related to racism (Henderson-Daniel et al., 2004; Hall & Sandberg, 2012).
 
The issue here is that studies have shown that if the therapist is at all uncomfortable with the issue of race, it is highly unlikely that they will be able to help their clients work through these difficulties (Stevens & Abernethy, 2018). Studies have also shown that most White therapists do report discomfort with broaching the topic of race in therapy, whether directly or indirectly, due to their own cultural and racial socialization (Knox et al., 2003; Chang & Yoon, 2011)​. Some even report allowing clients to focus on universalities rather than cross-racial differences because of this discomfort (Zaharopoulos & Chen, 2018)​, while others can resort to strategies such as color blindness and assumed racial superiority to avoid engaging in explicit conversations about race (Kivlighan et al., 2019). Such defensive reactions have been shown to adversely impact communication and the ability to collaborate effectively across racial lines (Chang & Yoon, 2011)​ and may also result in racialized clients feeling burdened to take care of their therapists by monitoring their disclosures in order to protect the therapist's feelings (Henderson-Daniel et al., 2004).
 
Experiences of racism can often be traumatic, and as clients share their personal experiences with such they may experience in session all the feelings these bring up, such as grief, and anger. These feelings and experiences may well in turn activate varied and challenging feelings within a White therapist, who in an effort to cope may react in any number of defensive ways, such as by withdrawing, asserting their lack of racial bias, or dismissing their clients' experiences as anecdotal or as ‘reading too much into things’. These defensive responses can be potentially traumatizing for the client (Nagai, 2009; Stevens & Abernethy, 2018). It is therefore critically important that racialized folks not encounter such responses when in need and actively seeking care and support.
 
Chang, D. F. & Yoon, P. (2011). Ethnic minority clients’ perceptions of the significance of race in cross-racial therapy relationships. Psychotherapy Research, 21 (5), pp. 567-582. DOI: 10.1080/10503307.2011.592549 
 
Hall, C. A. & Sandberg, J. G. (2012). “We Shall Overcome”: A Qualitative Exploratory Study of the Experiences of African Americans Who Overcame Barriers to Engage in Family Therapy. The American Journal of Family Therapy, 40:445–458. DOI: 10.1080/01926187.2011.637486
 
Henderson-Daniel, J., Roysircar, G., Abeles, N. & Boyd, C. (2004). Individual and Cultural-Diversity Competency: Focus on the Therapist. Journal of Clinical Psychology, 60 (7), pp. 755-770. DOI: 10.1002/jclp.20014 
 
Kivlighan, D. M. & Chapman, N. A. (2018). Extending the Multicultural Orientation (MCO) Framework to Group Psychotherapy: A Clinical Illustration. Psychotherapy, 55 (1), 39–44. http://dx.doi.org/10.1037/pst0000142   
 
Kivlighan, D. M., Drinane, J. M., Tao, K. W., Owen, J. & Liu, W. M. (2019). Detrimental Effect of Fragile Groups: Examining the Role of Cultural Comfort for Group Therapy Members of Color. Journal of Counseling Psychology, 66 (6), 763–770. http://dx.doi.org/10.1037/cou0000352
 
Kivlighan, D. M., Swancy, A. G., Smith, E., & Brennaman, C. (2020). Examining Racial Microaggressions in Group Therapy and the Buffering Role of Members’ Perceptions of Their Group’s Multicultural Orientation. Journal of Counseling Psychology. Advance online publication. http://dx.doi.org/10.1037/cou0000531  
 
Knox, S. Burkard, A. W., Johnson, A. J., Suzuki, L. A. & Ponterotto, J. G. (2003). African American and European American Therapists’ Experiences of Addressing Race in Cross-Racial Psychotherapy Dyads. Journal of Counseling Psychology, Vol. 50, No. 4, 466–481. DOI: 10.1037/0022-0167.50.4.466
 
McSorley, K. (2020). Sexism and cisgenderism in music therapy spaces: An exploration of gender microaggressions experienced by music therapists. The Arts in Psychotherapy, 71, pp. 1-9. https://doi.org/10.1016/j.aip.2020.101707    
 
Nagai, C. (2009). Ethno-cultural and linguistic transference and countertransference: from Asian perspectives. American Journal of Psychotherapy, 63 (1), pp. 13 – 23.
 
Stevens, F. L. & Abernethy, A. D. (2018). Neuroscience and Racism: The Power of Groups for Overcoming Implicit Bias. International Journal of Group Psychotherapy, 68:4, 561-584, DOI: 10.1080/00207284.2017.1315583
 
Zaharopoulos, M.  & Chen, E. C. (2018). Racial-Cultural Events in Group Therapy as Perceived by Group Therapists. International Journal of Group Psychotherapy, 68:4, 629-653, DOI: 10.1080/00207284.2018.1470899.