Counseling the Culturally Diverse. Laura Smith L.

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Clients of color tend to prematurely terminate counseling and therapy at a rate much higher than their White counterparts. We submit that racial microaggressions may lie at the core of the problem. For example, one study found that more than half of racial‐ and ethnic‐minority clients at a college counseling center reported experiencing a microaggression from their therapist (Owen, Tao, Imel, Wampold, & Rodolfa, 2014), and other studies report between 43% and 81% of clients experiencing at least one microaggression in therapy (Hook et al., 2016; Owen et al., 2012, 2015). The most commonly experienced microaggressions involved therapists’ subtle expression of cultural stereotypes and avoidance of or minimization of cultural issues (Hook et al., 2016). A similar study of LGBTQ clients revealed, “clients were left feeling doubtful about the effectiveness of therapy, the therapists’ abilities, and the therapists’ investment in the therapeutic process when therapists minimized their sexual reality” (Shelton & Delgado‐Romero, 2011, p. 217).

      There is growing evidence to suggest that racial, gender, and sexual orientation microaggressions have a detrimental effect on the therapeutic alliance for clients of color (Owen et al., 2014), women (Owen, Tao, & Rodolfa, 2010), and LGBTQ individuals (Shelton & Delgado‐Romero, 2011, 2013). Specifically, “microaggressions can be thought of as a special case of ruptures in therapy, wherein experiences of discrimination and oppression from the larger society are recapitulated, which places the therapeutic relationship under duress and strain” (Owen et al., 2014, p. 287). Qualitative work with LGBTQ clients supports this finding, where the therapeutic alliance has been diminished by the presence of sexual orientation microaggressions: “affective consequences of sexual orientation microaggressions included clients feeling uncomfortable, confused, powerless, invisible, rejected, and forced or manipulated to comply with treatment” (Shelton & Delgado‐Romero, 2013, p. 66).

      One study found that microaggressions that went unaddressed by therapists were associated with a weaker working alliance compared to situations with (a) no microaggression or (b) a resolved microaggression (Owen et al., 2015). Although studies on microaggressions in therapy suggest that they are frequent and harmful, evidence also shows that when microaggressions are acknowledged and addressed, the therapeutic alliance can be restored with positive clinical outcomes (Owen et al., 2014; Owen, Tao, & Drinane, 2019). Therefore, it is paramount that helping professionals examine their own biases and beliefs and remain aware of how they may unintentionally communicate these when working with clients who are culturally diverse.

Although therapy provides an ideal opportunity for exploring microaggressions both within the therapeutic dyad and in presenting concerns, many therapists are unsure how to approach such conversations. The multicultural orientation (MCO) framework (Owen, 2013) can be used to help therapists engage in a discourse on race, culture, racism, and microaggressions. This framework includes three pillars: (a) cultural humility, (b) cultural opportunities, and (c) cultural comfort. These pillars involve therapists being (a) aware of their own cultural values and those of others, (b) curious about others’ cultural identities and values, and (c) at ease and comfortable with discussions that involve race, racism, and culture. Studies suggest that these variables are associated with more positive therapeutic outcomes. Specifically, counselors who score higher on cultural humility (a) are less likely to microaggress and (b) have more positive therapy outcomes (Hook et al., 2016; Owen et al., 2014, 2017). Table 4.2 provides several more therapy‐specific examples of microaggressions, using the same organizing themes presented in Table 4.1. We ask that you study these themes and ask if you have ever engaged in these or similar actions. If so, how can you prevent your own personal microaggressions from impairing the therapy process?

       Table 4.2 Examples of Microaggressions in Therapeutic Practice

      Adapted from Sue, Bucceri et al. (2007).