How Microaggressions Are Harmful

This chapter discusses the research regarding microaggressions and negative mental health outcomes. Microaggressions are associated with increased stress, increased physical ailments such as hypertension and impaired immune responses, increased depression and depressive symptoms, lower self-esteem and self-efficacy, increased alcohol abuse and binge drinking, substance use disorders, increased post-traumatic stress disorder symptoms, higher levels of suicidal ideation, increased anxiety, increased somatic symptoms and negative affect, and increased obsessive–compulsive disorder symptoms. Overall, those who experience everyday discrimination have higher odds of any lifetime mental health issue. This is illustrated using a case example of a student who developed depression and anxiety from experiencing microaggressions in school, leading to a negative impact on mental health. The chapter presents an example interaction between a client and a therapist illustrating that microaggressions can be harmful to White people as well in indirect ways. Furthermore, to address mental health disparities and treatment barriers as a result of various pathways including microaggressions, clinicians need to address their own possible implicit biases that can lead to perpetuating these problems.

Preventing Microaggressions in Therapy (and Life in General)

This chapter outlines ways in which clinicians can prevent committing microaggressions and grow in cultural competence. Critical self-examination, which means bringing hidden racism to light, is essential before one can make a change. As such, it is important that all clinicians take stock of their biases through a fearless moral inventory. Challenging personal stereotypes, clinicians must be willing to examine and correct any stereotypical beliefs because they are not immune from the cultural forces that produce these difficulties as normative processes. The chapter describes ways to cultivate a multicultural perspective through the use of thoughtfully planned exercises aimed at confronting differences, which will reduce anxiety, increase confidence, and reduce the propensity to microaggress. This includes discussion of connecting with others who are different. Learning to acknowledge, address, and navigate power, privilege, and racism in cross-racial friendships may be similar to doing the same within a therapeutic relationship, and these non-professional relationships may inform a therapist’s personal and professional development. Allies are people who recognize the unearned privilege they receive from society’s patterns of injustice and take responsibility for changing these patterns. Through an example of a couple’s session, allyship and providing therapy for microaggressions experienced by one of the clients are outlined. Finally, supportive racial statements including positive statements about a person’s culture can be an important means of helping them feel understood, appreciated, and supported.

Assessing the Impact of Microaggressions

This chapter outlines classification systems for microaggressions and validated psychological measures of microaggressions and related constructs. Self-report measures for microaggressions vary in their applicability across specific racial and ethnic groups. Measures reviewed include the Racial Microaggressions Scale, Racial and Ethnic Microaggressions Scale, Ethnic Microaggressions Scale, LBGT People of Color Microaggressions Scale, Inventory of Microaggressions Against Black Individuals, Gendered Racial Microaggressions Scale for Asian American Women, Multiracial Microaggression Scale, and Racial Microaggressions in Counseling Scale. Another method of assessing microaggressions as well as racial trauma is through use of the UConn Racial/Ethnic Stress and Trauma Survey, which assesses for racial stress and trauma to guide clinicians in asking clients difficult questions about their experiences surrounding racism. The American Psychiatric Association’s Cultural Formulation Interview in the DSM-5 gathers information on the cultural definition of the problem, cultural perceptions of the cause of difficulties, context and available support, and cultural factors affecting coping and help seeking. There are other self-report measures of related cultural constructs, including the Trauma Symptoms of Discrimination Scale, Multigroup Ethnic Identity Measure, General Ethnic and Racial Discrimination Scale, Schedule of Racist Events, Everyday Discrimination Scale, Major Experiences of Discrimination Scale, Cross-Cultural Counseling Inventory–Revised, and Racial Microaggressions in Counseling Scale. Also described is a demographic form that can sensitively collect important information about a client’s diverse identities.

Microaggressions in Therapy

Common therapist microaggressions toward clients, microaggressions toward therapists, and ways to address both issues are discussed in this chapter. It is important for therapists to be conscientious about their presence in terms of providing a welcoming website, an office free of potential microaggressive or unwelcoming content, and basic interactions that are culturally sensitive and nondiscriminatory. There are many ways that a clinician may engage in microaggressive actions, including minimizing cultural experiences, pathologizing cultural values and collectivism, overidentification, trying too hard to be culturally sensitive, engaging in insensitive remarks, and withholding answers from clients of color. Two examples of microaggressions in therapist–client interactions are outlined in which racism is dismissed by a therapist and a client is called a “strong Black woman.” It is important for clinicians to know how to repair the therapeutic alliance if they have engaged in microaggressive behavior either by realizing it later or if a client brings it up. Clients also may engage in microaggressions, and therapists should address these behaviors in session to help increase understanding, awareness, and empathy in clients. Microaggressions against therapists of color from clients and from supervisors are challenging and may not be easy to navigate; some ways of addressing these are outlined.

Causes of Microaggressions

This chapter analyzes the reasons why people commit microaggressions and how they are maintained. Microaggressions are conceptualized as learned behaviors, taught through observational learning and other social mechanisms from an early age. The impact of implicit bias is that Whites are implicitly taught they are a superior race, even though explicitly they may be instructed otherwise. As a result, their actions or inactions continue to promote racism in subtle, microaggressive ways. Aversive racism differs from blatant, old-fashioned racism, and it characterizes the racial attitudes of most well-educated and progressive White Americans. Aversive racists outwardly endorse fair and just treatment of all groups yet harbor feelings of discomfort toward people of color that may be unconscious. Microaggressions can also occur in the form of avoidance and inaction. Because biased socialization practices and interracial interactions put people at risk of committing microaggressions, some individuals find themselves avoiding people of color altogether and thus having little interaction with them. Microaggressions persist because the underlying cause of these behaviors (racism) reinforces social inequalities and hierarchies that are desirable to the in-group. Finally, people of color can and do commit microaggressions against each other; however, this occurs under an umbrella of White racial supremacy.

Issues and Controversies

Are microaggressions really just people being too sensitive? Not everyone agrees that microaggressions are a problem, and some view the increased social dialogue surrounding the harms of microaggressions as a sign of a threatening shift in cultural values. Are microaggressions truly aggressive? Microaggressions are believed to be often unintentional and harms are often small, so they may not automatically be considered a form of violence or aggression. However, there are many disciplines that consider all forms of racism to be violence and aggression. Should we just give offenders the benefit of the doubt? Some critics of microaggressions research have urged victims to simply choose not to be offended, but it is also important to consider the dangers of ignoring microaggressions. In this chapter, issues and controversies in the literature regarding microaggressions are reviewed. Reducing microaggressions on campuses and in the workplace is discussed including the Racial Harmony Workshop, a diversity workshop designed to be both educational and experiential, using the experiences and diversity of the participants to promote sharing and social connection. Future directions in the area of microaggressions include more funding opportunities for research to operationalize how to best help people who are experiencing distress resulting from microaggressions. Research is still needed to determine if and how certain responses can protect against the negative sequelae of experiencing a microaggression.

Helping Clients Manage Microaggressions

This chapter outlines what clinicians can do to help and support clients managing microaggressions. Ten steps are offered to help therapists respond effectively. Detailed examples of listening to a client of color who has experienced a microaggression, supporting a client of color who experienced a microaggression, and processing microaggressions experienced by a client of color are provided. Ongoing microaggressions can lead people of color to engage in maladaptive coping, such as remaining in denial, engaging in substance use, aggression, and self-blame; thus, it is important for therapists to recognize these and support clients to instead engage in adaptive and proactive coping strategies. A therapist can also support clients in how to respond effectively to microaggressions in their daily lives. It is not always possible or safe to respond to a microaggression, but clients should be encouraged to respond if they are able to do so safely. Strategies include making the microaggression more visible, disarming the microaggression, and educating the offender. Another way therapists can help is by encouraging and supporting clients in the exploration of their ethnoracial identities to help improve overall psychological well-being. However, therapists should pay careful attention if a client is unwilling to discuss microaggressions; rather than take it personally or pathologize the client, the therapist should openly acknowledge and validate the client’s mistrust. Microaggression discussion scenarios are outlined to help therapists; these scenarios include profiling by law enforcement, academic conflict, practicum student dress code conflict, and classroom confusion.

Understanding Racial Microaggressions

This chapter introduces the concept of microaggressions. It reviews stigmatized racial and ethnic identities and the importance of terminology. It outlines the meaning of Whiteness and White racial identity. It then describes and defines what microaggressions are specifically and the research surrounding this concept. Common stereotypes of ethnic and racial groups are outlined. Types of microaggressive behavior include categories termed not a true citizen; racial categorization and sameness; assumptions about intelligence, competence, and status; false color-blindness/invalidating racial or ethnic identity; criminality or dangerousness; denial of individual racism; myth of meritocracy/race is irrelevant for success; reverse racism hostility; pathologizing minority culture or appearance; second-class citizen/ignored; tokenism; attempting to connect using stereotypes; exoticization and eroticization; avoidance and distancing; environmental exclusion; and environmental attacks. Microaggressions in the media and their negative impact on society are described. Distinctions and commonalities between microaggressions and everyday racism as well as other related concepts are analyzed. Microaggressions overlap with some similar concepts, so one cannot study microaggressions without considering these other close constructs and the related literature base. Furthermore, microaggressions are context dependent: A statement that might be microaggressive in one situation may not be a microaggression in another case, and therefore it may be difficult to recognize.