In Consultation


In Consultation

When to Speak Up: Handling Microagressions in Therapy

By Anatasia Kim

September/October 2019


Q: Last week, my client said something racially insensitive that really bothered me. Should I bring it up? If so, how do I mention it without harming our relationship?

A: As therapists, we’ve been trained to hold a safe space for difficult conversations. Suicidality, trauma, addiction, sexual abuse—these are no easy matters to address. But when a client says something we perceive as racist, sexist, or heterosexist, however unintentional it might be, it can still be hard to know what to do. Do we keep our reactions to ourselves, brushing off a disturbing comment as just another microaggression in a world that’s brimming with them? Do we open a dialogue about it in hopes of enlightening our clients and cultivating a more socially conscious world in some small way? Do we stick to the traditional script of therapy and assume that these types of dialogues would only disrupt the “real” work of tending to our clients?

As much as we want to protect the therapeutic relationship, we can’t pretend that we therapists aren’t shaped by our own cultural identities, just like our clients are, and that this doesn’t affect what happens in the therapy room. After all, if we uttered something our clients perceived as offensive, wouldn’t we want them to speak up? In today’s sociopolitical climate, it’s hard to avoid these discussions in any relationship. So how do we approach them in therapy, especially with clients we genuinely like and who aren’t trying to offend us?

As a person of color, I’ve asked myself this question a lot throughout the years. What I’ve come to realize is that opening constructive dialogues around these perceived transgressions—rather than automatically reacting to them or even stewing about them quietly to ourselves—requires looking closely at our motivations for doing so. Does it benefit the client? Maybe not directly, or even at all at first. But even when we discern that it’s simply about speaking the truth of our experiences in the world, some therapists might be surprised to find that, if approached mindfully, these conversations can strengthen the therapeutic relationship. Is it a risk? Can it go wrong? Sure. But it’s something many of us will have to wrestle with at some point.

The Personal Impact

In my practice, I mainly work with teens and young adults. A large part of why I love working with them is their brutal honesty, but that often means they have no compunction about expressing overt stereotypes and unchecked biases.

A few years ago, I had a 17-year-old client, Rebecca, who’d come to me for help with anxiety issues. She was a white teen attending an affluent private high school, and the academic competition among her peers was intense. One day, she came to my office over-the-top stressed out about her college applications. As soon as I opened my office door, she threw herself on my couch and unleashed a breathless diatribe about her growing annoyance with the highest-achieving kids in her school.

“Why should I even bother applying?” she moaned. “I won’t get in. I don’t have a chance against kids like Sophia. She was in the junior Olympics! She got a perfect quantitative score! And she’s black, which means she’ll definitely get in! You know she’s gonna milk that for sure. It’s so annoying and unfair!”

Rebecca continued to rant for some time, but my attention started to waver. I was sympathetic to her frustration—college admissions can be a grueling and demoralizing process—and glad she felt comfortable enough to release her stress. But sitting across from her, as I had many times before, I began to sense the gnawing unease I’ve often experienced throughout my life when someone I genuinely like commits a microaggression.

Damn, I thought to myself. I know she’s super stressed, but really? Accusing Sophia of playing the race card? I knew she wasn’t trying to be hurtful, but the implication she made about her friend, and all people of color for that matter, felt wrong. Clearly, as a junior Olympic athlete and someone who received perfect ACT scores, Sophia was a remarkably competitive college applicant. So the suggestion that she’d exploit her racial identity and that this would be unfair to Rebecca didn’t sit right with me.

My own identity and experiences were involuntarily thrust into the foreground. I was reminded of the controversial arguments on affirmative action that defined my generation, the pervasive and blatant disregard for racial inequality in our educational system that persists today. I thought of how unearned privileges have been historically and systematically granted to some at the expense of others, and how policies like affirmative action have been but a small attempt to level the unfathomably unequal playing field—not to afford undue advantages to racial minorities, as Rebecca seemed to be implying.

The Deliberation

So what to do, if anything? With Rebecca ranting away in front of me, I debated with myself:

“Do I say something?”

“Yes, definitely. She just committed a microaggression!”

“But was it really a microaggression? She didn’t mean any harm. She’s just stressed out. Isn’t that what you should focus on?”

“Sure, she’s worried about getting into college, and you need to address that. But she’s also suggesting that her black friend will exploit the system!”

“But isn’t this more your issue than hers? After all, this is her therapy.”

“So racism is untouchable in therapy? Anything goes? Doesn’t matter if my client says something offensive, even unknowingly? Therapists aren’t supposed to have feelings?”

“Yes, you can have feelings, but don’t the client’s feelings matter more? It’s your job to manage your feelings, not the other way around!”

“But therapy is about being in a relationship, and I’m a real person too! Is it fair to me, or even Rebecca, to pretend I didn’t hear something hurtful?”

“What’s the harm in letting it slide? She’s a good, socially conscious person, and you don’t want to offend her by implying something to the contrary.”

Back and forth I went, straddling the murky and now increasingly indiscernible intersection between my personal and professional worlds. I’d been working with Rebecca for some time and liked her very much. More likely than not, she was displacing her emotional overwhelm onto others. Sophia’s résumé was impeccable; Rebecca’s was good but far from perfect. Maybe focusing on Sophia’s race, something entirely beyond Rebecca’s control, provided some easy outlet to vent her frustration.

Rebecca’s fragility, fears of inadequacy, and anxiety about her future seemed at the core of her comment. Given this plausible explanation, I could’ve shifted the conversation to focus solely on the clinical issues at hand: the roots of her negative self-regard, and her underdeveloped coping skills. Maybe another therapist, even another therapist of color, would’ve done just that, but I couldn’t.

As with all my clients, what mattered most in my relationship with Rebecca was our willingness to be honest and truthful. For months, we’d worked hard to build a mutually respectful and intimate connection—a brave space. Together, we’d agreed to show up, to speak truth. I couldn’t afford to compromise that.

A Step-by-Step Approach

As the messy internal deliberation came to a close, I made my decision. I would respond, but I’d do so with the following in mind.

What is my goal in this conversation? I want to maintain a strong and honest alliance. I need to show up for Rebecca with my full heart and attention, not strained by what I perceived to be disrespect for people of color. I need to speak up. I owe this to her and our work together.

Are there barriers standing in my way? Yes. This could lead to a rupture. I might make her feel uncomfortable or even hurt her feelings. So the risk I’m taking must be deliberate and thoughtful. It must be in the service of enhancing our alliance and ultimately Rebecca’s progress.

How am I going to anchor myself during the conversation? There are a lot of unknowns, including how Rebecca might respond. I don’t want to be hijacked by my emotional reactions. I need to stay grounded in my professional and personal values: honesty, respect, compassion, courage.

Okay, so how do I bring it up? What do I say? First, reflect and affirm her experience and feelings: “Rebecca, it sounds like the pressures of college applications are so challenging. You’re trying your very best, but it’s still scary. There’s so much stress and uncertainty. For sure, none of this is easy.”

Now for the delicate cargo: “There’s something else you said that I wanted to check in about. It sounds like you’re quite annoyed with Sophia. It must be hard to feel like you’re competing with someone with her résumé. I was curious, however, about your comment that Sophia would ‘milk’ her black identity. I was wondering what you meant by that?”

Rebecca’s long legs suddenly swung around, nearly hitting the coffee table. She was now sitting straight up. Her voice struck with alarm, “OMG! Did I say something racist?!”

“Whoa, let’s slow down,” I said, for both of our sakes. “I was just confused by it, so I wanted to follow up. When you said that about Sophia, I did have an immediate ouch reaction.” I paused for a second, wanting to clearly communicate the impact of her comment. “I know you didn’t mean any harm,” I continued. “Most likely, I assumed, it was your stress talking. Because I respect you and care very much about our open and honest relationship, I wanted to let you know and check in.”

It was important that I give Rebecca the benefit of the doubt. Against the backdrop of today’s nasty Twitter storms and Facebook comments, it often seems there’s only room for knee-jerk reactions and judgments. Rather than feeling accusatory, I wanted my conversation with Rebecca to feel constructive.

Her eyes still wide, I could see Rebecca pushing the rewind button, trying to recount exactly what she’d said just minutes before. “You’re right. I did say that about Sophia milking being black. Why did I say that?” She sounded genuinely baffled. “It just came out. I wasn’t really thinking. I’ve heard about kids checking the Native American box on their college apps just so they have a better chance at getting in. Of course, I know that’s wrong.” I waited. She was diving deep. As she sank back into her internal world, as she often does in our sessions, I could see her anxiety giving way to curiosity.

“Sophia’s my friend, since fifth grade! She’s always been super smart. A total nerd, really. She’s also one of two black kids in my grade. I always felt bad about that. I know it bothered her.” She paused. “Maybe I’m jealous. Sometimes it seems like everything comes so easily to her. And it doesn’t to me, you know? I stay up all night stressing, and she’s always just so chill.” She was now looking right at me, inviting me back in.

“Yeah, I know,” I gently affirmed.

“I hope I didn’t offend you.” Her voice was tender and sheepish.

I released the breath I didn’t know I’d been holding. She was letting me know she sees me, and her vulnerability inspired me. “I’m not gonna lie: it did surprise me to hear you say that,” I told her. “But I know you. I know you didn’t have any bad intentions. Still, I felt it was important to let you know. I knew it wouldn’t be easy, but I was confident we could talk about it.”

Rebecca and I exchanged a few more reflections. Before long, we were back on the topic of college applications. Although it had only taken a few minutes, we’d weathered an unexpected storm together. Repair already felt underway.

In subsequent sessions, Rebecca and I covered a lot of ground: the unrealistic pressures on today’s teens; rising anxiety and depression among many of her friends, including Sophia; the constant and unforgiving comparisons on social media. We stood together at the crossroads between Rebecca’s unique experiences and the larger sociopolitical context. We didn’t agree on all things, but we trusted enough to explore the uncertain and sometimes conflicted grounds of a complicated and often unjust world. In the end, it further deepened our alliance, especially when she didn’t get into her first-choice school and Sophia did.

- - - -

Clearly there’s no uniform answer to the question of what to do with microaggressions in sessions, as black-and-white or gray as they might seem. Not all clients will be as open and receptive as Rebecca, and not all therapists will choose to speak up in every instance. But when we decide to say something—with goals, barriers, and anchors in mind—the possibility that it will enrich our relationships is boundless.

***

Anatasia Kim, PhD, is an associate professor at The Wright Institute in Berkeley, CA. She has a private practice and provides consultations and trainings to organizations on matters related to diversity, equity, and inclusions. She’s the coauthor, with Alicia del Prado, of It’s Time to Talk (and Listen): How to Have Constructive Conversations About Race, Class, Sexuality, Ability & Gender in a Polarized World.

***

Tell us what you think about this article by emailing letters@psychnetworker.org. Want to earn CE hours for reading it? Take the Networker CE Quiz.

Want to submit an In Consultation piece for an upcoming issue? Please see Submission Guidelines.

PHOTO © YURICAZAC/ISTOCK

Get the latest issue of Psychotherapy Networker

Subscribe for a full year of clinical insight and creative inspiration from the field’s innovators like Brené Brown, Bessel van der Kolk, Dan Siegel, Esther Perel, and many more. Plus, earn 2 CE hours every issue!



Previous: Clinician's Digest
Next: Case Study

Read 3756 times
Comments - (existing users please login first)
Your email address will not be published. Required fields are marked *

*
*
*
4 Comments

Monday, September 23, 2019 10:10:17 PM | posted by ellen fox
Dear Dr. Kim, Thank you so much for your tansparency in thinking about this clinical dilemma so carefully. Unfortunately I had a very shocking experience with my colleagues some years ago when I attempted to point out what I thought was racial stereotypoing. They were not happy and turned on me without looking at their own behaviors. I do confront racism, sexism and homophobia with my clients and do so in a spirit of inquiry without shaming. I feel that this is very much part of the fabric of psychotherapy and I cannot overlook these points of view. Today a female client talked about the "fragile male ego," and I rather vociferously disputed that narrative. Maybe I wasn't as skillful as you were but she was delighted with the questioning of that myth. This was in the service of empowering her to resist certain bullying behaviors of her spouse. So, thank you again for your nuanced article and sharing.

Sunday, September 22, 2019 7:36:02 AM | posted by Anne Marie
Wonderful article! Enlightening, informative,and very helpful. Thank you Ms.Kim for your insightful and respectful approach to a delicate topic.

Saturday, September 21, 2019 6:34:08 PM | posted by Lisa Love
Wow - elegant, beautiful way to address a potential rupture and raise awareness of negative bias so present in our American culture. Thank you for writing this and sharing your process. It takes such courage, diplomacy and honesty. I once had a 90-yr old male client boot me on my back side when I had to lean over to open my file drawer. He giggled and I was deeply offended. I went into emotional shock and had to wait until the next session to address it with him. I shared that it bothered me very much, felt disrespected and asked that he refrain from touching me other than a hand shake at the end of sessions. He was apologetic and unaware how much of a boundary violation that constituted and we were able to continue. I still felt there was more I could have done to explore where this impulse came from - anger, sexual aggression, humiliation, fear of his own vulnerability, etc. He was not able to really reflect very deeply on the origin of the action. But this would be a great topic for a continuing education workshop!

Saturday, September 21, 2019 12:22:12 AM | posted by Irit Felsen
I loved Anatasia Kim's "When to Speak Up: Handling Microagressions in Therapy" (September/October 2019). The topic of the personal and the professional and the way differences in ethnicity, religion and many other dimensions plays out in our work with patients is remarkably important. The article was beautifully written. I want to add that in the multi-cultural, multi-ethnic and politically polarized environment we live in, attention must be also paid to the fact that the same kind of microaggressions occur not only with patients, but with colleagues, where we are even much less prepared to address it. This is a very sensitive issue which we are not sufficiently addressing, as a profession, at a time in which both diversity and divisive forces are major facets of life in our society.