Therapists of Color Strategies for Handling in-Session Microaggressions from Clients: A Qualitative Survey

Background: This study examined the strategies of Therapists of Color in handling microaggressions against them from clients during sessions. Past studies of racism and microaggressions illuminate the negative impacts on the BIPOC population in general (Harrell, 2000; Pieterse & Carter, 2007). While quite a bit of work has been done on microaggressions in therapy, the majority has been aimed at helping therapists avoid perpetrating microaggressions against clients (Owen et al., 2014, Mazzula & Nadal, 2015; Microtraining, 2018). This study looks at the relationship going the opposite direction by exploring practitioner’s perceptions of how racial microaggressions impact their own health and the therapist-client interactions. It explores both in-session strategies for handling microaggressions and perceptions of what is helpful and detrimental.

Methods: Data were collected using an online survey that included both closed- and open-ended questions. Additionally, respondents could opt-in to participate in a follow-up interview. The survey sample was collected by posting invitations to message boards for Black, Latinx, Asian, or general BIPOC therapist organization sites. Follow-up participants were chosen using purposeful sampling to include even representation from each of the following racial or ethnic groups: Black, Latinx, Asian, and other. The survey and interviews also included prompts about perceptions of how intersecting identities played into client interactions and therapists’ strategies for handling microaggressions in sessions.

The analytic process used methods of grounded theory. The interviews were digitally recorded and then transcribed. NVivo software was used to analyze the open-ended questions and interviews in an iterative process of coding, writing memos, and analysis.

Results: The analysis revealed that BIPOC therapists considered multiple factors in deciding how to respond to a microaggression in therapy. Results show a tension between remaining client-centered and the need for self-preservation. Therapists also considered the clients’ age, development level and/or mental health diagnosis, and level of distress in the moment in deciding how to respond. In addition, therapists’ own current emotional states and exhaustion from racial trauma played a part in their decisions of how to respond. Strategies for handling microaggressions included stating direct observations, asking clarifying questions, ignoring, boundary-setting, and/or deciding to bring up the issue later (in session or in subsequent sessions). Findings show patterns regarding which strategies were perceived to be most helpful or harmful to the therapist-client relationship as well as to the therapists’ own emotional well-being. Patterns arose around racial ethnic identity and type of therapist license.

Implications:

Results of this study are important for several reasons. First, commonly used textbooks in social work advocate for the social worker to bring up therapist-client racial differences as a means of strengthening the relationship. However, newer research shows that when the therapist is a Person of Color, this strategy often backfires (Branco & Bayne, 2020). Second, there is a dearth of research on BIPOC therapists’ strategies for handling microaggressions, meaning that students of Color often do not get trained in this area. Finally, research into these strategies will help inform best practices for both the therapist-client relationship and the overall health of the therapist.