Racial Microaggressions in Therapy & BIPOC mental health
By Peggy Loo, PhD
The importance of multicultural therapy
Experiencing validation in a relationship is powerful. When someone validates you, you feel seen, understood, and cared for. You’re not crazy, you’re not too much, you’re not alone, and I’m in your corner - these are things we all need to hear, probably more often than we do. Someone who can validate what you’ve been through is someone you feel connected to.
Now say that person can validate not only your experiences, but also affirm who you are - all the identities that make you, you. Now this can be transformative, life changing, even. What an incredible thing, when we are fully seen in all of who we are, and feel safe and supported.
So what happens when you are invalidated, and by the very person you hoped would “get you”? Like a therapist?
BIPOC mental health & BIPOC therapy
I am a second generation Asian American licensed psychologist. I’ve lost count how many times a new patient of color has reached out to me about therapy and one of the reasons they did was “my last therapist didn’t get me” or “I want a therapist who can understand race or culture”.
That makes me sad for three reasons. Because this conversation has happened enough times that I lost count, because there’s still a low supply-high demand for multiculturally trained clinicians, and because after some gentle prodding, I realize that this person stayed with this therapist longer than they wanted to.
The BIPOC community underutilizes therapy
It’s common knowledge that persons of color pursue therapy at lower numbers than their White counterparts. (More often than not, Asians still make up the smallest sliver of the already small persons-of-color-in-therapy pie slice.) There is a large body of scholarly research that draws attention to various racial, cultural, linguistic, gendered, structural (and many other) barriers that discourage BIPOCs from seeking (and staying) in therapy. I am for equitable access to therapy for anyone and reducing micro and macro-level barriers in the way. This post is not about that.
Multiculturally trained therapists are still the minority
This post is about what happens if therapists are part of the problem - they are barriers. Hear me out - I don’t think every therapist is part of the problem - and I am proud to know many colleagues who are part of the solution! But getting into a therapist’s office is not the same as staying. And the sad truth is that most psychology graduate programs lack robust multicultural training. Which means that while your therapist may be well trained in anxiety or depression, they may lack the knowledge or experience to tailor to address how diversity or identity factors play into mental health too. This post is to validate anyone who has experienced racial invalidation in therapy, which made them question if therapy was for them. It is.
Racial microaggressions and mental health
Racial microaggressions research took off over a decade ago (even though the term itself has been around since the 1970s). It supplied much needed language to describe implicit racism, especially after explicit racism was pummeled into politically correct submission. Racial microaggressions are brief, everyday comments, non-verbals, or behaviors that convey negative or diminishing views towards people of color.
What are racial microinvalidations?
Within the umbrella term of microaggressions are three types: microassaults, microinsults, and microinvalidations (Sue et al., 2007). This post focuses on the latter type. Racial microinvalidations are comments or actions that “exclude, negate, or nullify the psychological thoughts, feelings, or experiential reality of a person of color” (Sue et al., 2007, p.274). It’s important to know that microaggressions are not limited to racial ones, but are often experienced from anyone who occupies a marginalized space in society (e.g., non-binary people, Muslims, etc).
Three common racial (and cultural) microinvalidations in therapy
A colorblind approach to therapy
Comments like “I don’t see race when I see you”, conversational pivots towards shared or universal human experiences when race is brought up, or complete silence or neglect in exploring your racial identity and its effect on your mental health can all feel dismissive and result in a censored way of relating.
If I kept getting the subtle message that my thoughts on being Asian were less relevant or interesting to my therapist than my thoughts on my relationship with my parents, I’d probably stop talking about being Asian. If therapists were “blind” to the effect of age, neurodiversity, gender, sexuality, class, religion - they would not really know what it’s like to be you in the world. If no topic is off limits in therapy, that includes race. You do not need to check your racial identity at the door.
2. Dismissing the psychological impact of racism
Ever have a moment where you are telling a story or giving an update to your therapist that includes a racist moment? What happened? Now I am a CBT psychologist - which means I love using Socratic questioning with patients to challenge unhelpful thinking patterns. This often looks like asking open ended questions to encourage reflection on the conclusions you draw about a situation, exploring connections, and considering alternative points of view. This is a common technique therapists use that takes clinical skill to execute and wisdom to know when and how to use it.
Starting off with questions like “Is there an alternative explanation for what happened?” to challenge one’s experience of racism is an abuse of what is meant to be an empowering, collaborative technique. Other responses like encouraging someone to not ruminate, to “not take personally”, or to not “catastrophize” a racialized moment to lessen its emotional effect can also be very hurtful and dismissive. Softening racism by focusing on a possible lack of ill intent (as is common when name-based microaggressions are presumed benign) or shifting to another troubling aspect of an experience other than racism are examples that delegitimize the real psychological impact of race-based stress.
3. Assuming a White (and Western) point of view
I work with many second-generation adult children of immigrants, biracial adults, and adults in interracial relationships where traversing “two worlds” is simply a part of life and relating. We can forget that a lot of original psychological theories were based on a White, European, masculine, individualistic, heteronormative, upper middle class, secular worldview…which means that often the epitome of mental health and a “good” therapy session will reflect those values. For example, emotional health (and maturity) are associated with visible emotional expression, independent decision-making, direct communication, boundary setting, and self-focused care as primary objectives. And they can be!
However, if a therapist assumes that a universal point of view or values, anything different is vulnerable to misinterpretation, or worse, pathologized as underdeveloped, immature, or “areas of growth”. A common one I’ve seen as an Asian American psychologist is the automatic assumption that filial piety in adulthood signifies a failure to launch or poor boundaries with your family of origin.
There are many ways to be emotionally resilient and do healthy relationships that can incorporate multiple, seemingly incompatible cultural worldviews at the same time. The truth is, psychological wellbeing consists of paradoxes all the time. Compassionate self-acceptance of where you’re at and accepting personality responsibility to be a better human is an example. Discovering it’s empowering to be self-reliant and learning to depend on others as a good thing is another example. Because therapists are often viewed as the experts in the therapy relationship, it can be easy to defer to your therapist’s views. However, you should never feel as if you are sacrificing a personal value or assimilating ones that are valuable for others, but not for yourself.
How to respond to microaggresions in therapy
So what do you do if you’ve experienced (or are experiencing) microinvalidations in therapy? First of all, I’m so sorry. I really am. It’s not fair to open up to someone only to realize parts of you may not be safe or seen.
Here are some tips:
1. Practice affirmation and seek allies
A ton of research supports that microaggressions (even despite the name “micro”) cause real psychological pain. Seek and receive support from others. This also means not defending your therapist just to avoid rocking the boat. Understandably, this can be tough, especially if you don’t want a comment your therapist made to change your relationship. While it might be compassionate to think “it wasn’t intentional” - the effects are real. Remember that it has never been your job to take care of your therapist - don’t start now.
2. Consider microintervention or giving feedback
Responding (what has been coined a microintervention) may be a way to validate yourself and your own experience (Sue et al., 2019). This can range from a comment like “That’s not how I see it” in response to something your therapist said to revisiting a microaggressive comment in a later session.
The biggest factor here is recognizing that it is your choice, that there is no one “right” way to respond. Whatever prioritizes your mental health is what’s most important. You may have a very strong relationship with your therapist where bringing up feedback may be a way to kick off honest dialogue and restore honest communication or trust. Reflect on if you’d regret saying nothing. It’s important to be honest with yourself, knowing that bringing up a microinvalidation could lead to a number of outcomes, both ideal and not ideal.
Think about if you are in a place emotionally where bringing it up and staying healthy is possible. I’d definitely recommend already having support in place (see #1) before any conversation happens. Also know if you ultimately choose not to bring it up, it’s your choice, and prioritizing your decision-making power is always a good thing.
3. If you need to - break up with your therapist
Whether or not you choose to say anything, it’s okay to break up with your therapist (and this is coming from a therapist!) Don’t get sucked into the sunk cost myth (i.e.,“I don’t want to start over with someone else”). The truth is, it’s a waste of time (and money) to stay with a therapist that cannot provide what you need or you end up not being honest with. Of course it’s hard to end a relationship you’ve invested in. But think - what are the advantages of finding a new therapist at this point? A way to do this is to say something along the lines of: “I’ve appreciated X & Y in our work. I do think I’m looking for something different in my therapy experience and would like to talk about wrapping things up so that I can explore that.”
Questions to ask a therapist ally or BIPOC therapist
When looking for a therapist, ask questions about multicultural responsiveness. This does not mean that you have to or should work with a therapist who shares your racial identity - or that anyone who doesn’t will be a terrible therapist for you. In fact the close colleagues I’d trust any of my patients with are a racially diverse group of people. What they all have in common is that they prioritize multicultural responsiveness and open dialogue about it as a key part of therapy, not as a politically correct add-on. Three questions could be:
What experiences or training have you had working with diverse populations?
What does it mean to you to provide multiculturally responsive therapy?
How do you work with your patients about race, racial identity, or racism?
Don’t give up. Be picky. If you can, take your time. While therapists are ultimately responsible for changing and reshaping the field, we will get there faster if you don’t put up with anything less than what you deserve.
Our multiculturally trained therapists at Manhattan Therapy Collective provide a safe and supportive environment for individuals from all backgrounds. With sensitivity and awareness, our therapists honor and respect your unique racial identity while providing effective therapy tailored to your specific needs. Book a free consultation today.
About the Author: Dr. Loo is a licensed psychologist who has experienced all three microinvalidations before in her own therapy experiences. She is passionate about BIPOC mental health and empowering people not to accept less than what they need in therapy.
Examples of racial microaggressions
Citations:
Sue, D. W., Alsaidi, S., Awad, M. N., Glaeser, E., Calle, C. Z., & Mendez, N. (2019). Disarming racial microaggressions: Microintervention strategies for targets, White allies, and bystanders. American Psychologist, 74(1), 128.
Sue, D. W., Capodilupo, C. M., Torino, G. C., Bucceri, J. M., Holder, A., Nadal, K. L., & Esquilin, M. (2007). Racial microaggressions in everyday life: implications for clinical practice. American psychologist, 62(4), 271.