The term microaggression was coined by Dr. Chester Pierce to “…describe subtle pro-racist behaviors” in everyday life (Tam & Ochu). It is the subtly of microaggressions that can make these behaviors challenging and exhausting to routinely navigate. When you introduce these behaviors into the space of therapy, where the provider is managing numerous variables, it becomes exponentially harder. Several studies have likened exposure to microaggressions as a form of chronic stress and/or trauma due to a persistent awareness of and need to decipher threat from neutral stimuli (Pappas, 2021). Mental health providers who are Black, Indigenous, and People of Color (BIPOC) are not immune to this threat. Microaggressions sting. They hurt. They leave us confused.
Research is limited on best practices when addressing microaggressions from patients or clients. Much of the literature is from medicine, where the relationship is quite different than within mental health. Studies have found that the majority of BIPOC providers have reported an experience of bias and/or microaggression, up to sixty percent in some studies. Microaggressions can be perpetuated by peers, clients, or other staff members. These experiences can result in short- and long-term consequences to BIPOC providers. In the short-term, individuals may experience a variety of responses including shock over the event, doubt about the event, and embarrassment of their response. In the long-term, individuals may be more vulnerable to burnout, reduced work performance, and compromised problem solving (Sue, et al, 2019).
Considering the many ways in which microaggressions impact people and society, it is naïve, at best, to presume that these behaviors would not impact the therapeutic space. While the space of therapy is unique, many of the recommendations from other disciplines can be useful. Within this piece, I hope to provide a few suggestions for how to address microaggressions in therapy as a BIPOC therapist. Recent research by Dr. Derald Wing Sue has found that racial microaggressions are qualitatively more taxing to BIPOC individuals that other forms of interpersonal stressors due to the delegitimizing nature of the behaviors.
These recommendations start with the assumption of a client in a non-emergent situation and with decision-making capability. In addition, even similar experiences can have different contextual factors, which means that the necessary responses will vary. It can be helpful to pre-plan certain situations, considering that the goals of an effective response include naming the meta-communication and creating awareness. Sue, et al (2019) term the former making “the invisible, visible,” which can educate the perpetrator on the impact of their statement(s). Other factors to consider when addressing a microaggression include the emotional states of both parties, presence of an audience, or level of intentionality. Responding to a microaggression places both parties in vulnerable positions, which means that if the emotions are heightened then the reaction may not have the desired impact. Choosing to watch and wait can be a valid response, if it is in the aim of gathering more data or waiting for a more opportune time. This approach can also help a provider to validate themselves and to attend to their emotions, as the subtlety of these behaviors can leave BIPOC providers questioning the experience.
Once it is determined that a response is appropriate, Ackerman-Barger and colleagues (2021) provide a nice framework, using the acronym ACTION to organize ways in which a provider who is experiencing microaggressions can respond. The steps include:
A- Asking clarifying questions
C- Coming from a place of curiosity
T- Telling about what was observed
I- Impact exploration
O- Owning your thoughts and feelings
N- Next steps.
Regarding the next steps, other studies have encouraged BIPOC providers to ensure they include their wellness via means such as debriefing with trusted others, mindfulness practices, and social support.
In my own work, I often consider that the personal is political and what happens in therapy will impact the wider community. When we are able to encourage empathy and perspective-taking for the other, not only does that client benefit but so does their environment. With this in mind, when done thoughtfully and deliberately, addressing microaggressions can be empowering for the provider, beneficial for the therapeutic relationship, and illuminating for the client.
****To listen to the Resilience Lab July 2022 playlist built with this article’s theme in mind, click here.