Professional Psychology: Research and Practice © 2014 American Psychological Association

2014, Vol. 45, No. 4, 283–290 0735-7028/14/$12.00 http://dx.doi.org/10.1037/a0037420

Addressing Racial and Ethnic Microaggressions in Therapy

Jesse Owen Karen W. Tao and Zac E. Imel

University of Louisville University of Utah

Bruce E. Wampold Emil Rodolfa

University of Wisconsin, Madison and Research Institute, Alliant International University
Modum Bad Psychiatric Center, Vikersund, Norway
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Racial and ethnic microaggressions in everyday life can negatively impact the well-being of racial
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and ethnic minorities (REM). When microaggressions are perceived in therapy they can interfere
with therapeutic progress. However, little is known about whether microaggressions are addressed
in therapy and if so, does addressing them impact the therapeutic relationship. REM clients from a
university counseling center (n ⫽ 120) reported on their therapy experience. Approximately 53% of
clients reported experiencing a microaggression from their therapist. Clients’ perceptions of micro-
aggressions were negatively related to the working alliance, even after controlling for their current
psychological well-being, number of sessions, and therapist racial and ethnic status. Of those clients
who reported a microaggression, nearly 76% reported that the microaggression was not discussed.
For those clients who experienced a microaggression and did not discuss it, alliance ratings were
lower as compared with clients who did not experience a microaggression or who experienced a
microaggression but discussed it.

Keywords: alliance, cultural competence, microaggression, psychotherapy, rupture

Overt forms of racism and prejudice have a long history in
the United States and they still occur today. However, less overt
forms of racism and prejudice are more ubiquitous (Sue et al.,
2007). Pierce et al. (1978) identified an insidious form of
cultural bias—racial microaggressions, which include the ex-
perience of a variety of direct and indirect (conscious and
JESSE OWEN received his PhD in counseling psychology from the Uni-
versity of Denver. He is currently an associate professor and training
director at the University of Denver. His research interest includes multi-
cultural processes in psychotherapy and psychotherapy outcomes and
processes.
KAREN W. TAO received her PhD in counseling psychology from Uni-
versity of Wisconsin, Madison in Counseling Psychology. She is currently
an assistant professor at the University of Utah. Her research interest
includes cultural processes, psychotherapy outcomes, and processes.
ZAC E. IMEL received his PhD in counseling psychology from University
of Wisconsin, Madison. He is an assistant professor at the University of
Utah. His research interest includes psychotherapy outcome and processes.
BRUCE E. WAMPOLD received his PhD in counseling psychology from
University of California, Santa Barbara. He is currently a professor at the
University of Wisconsin, Madison and Modum Bad Psychiatric Center. His
research interest includes psychotherapy outcomes and processes.
EMIL RODOLFA received his PhD in counseling psychology from Texas
A&M University. He is currently a professor at the Alliant International
University. His research interests include supervision, training, ethics, and
boundaries.
CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Jesse
Owen, Psychology Department, College of Education, University of Lou-
isville, Louisville, KY 40292. E-mail: jesse.owen@louisville.edu
unconscious) insults, slights, and discriminatory messages. Sue
et al. (2007) explicated three specific types of microaggres-
sions: microinvalidations (e.g., denying that racism exists),
microassualts (e.g., more direct racism, but conducted in private
or safe environments), and microinsults (e.g., believing the
cultural norms of a group are pathological). A core character-
istic of a microaggression is that it is ambiguous or subtle in
nature, which is in contrast to an overt racial slur Microaggres-
sions can target individuals’ cultural identities (e.g., gender,
sexual orientation; Owen, Tao, & Rodolfa, 2010; Shelton &
Delgado-Romero, 2011) and generally when they target indi-
viduals’ race and ethnicity (e.g., subtle discriminatory mes-
sages), as they are biased comments referring to nationality,
values, cultural customs, and language and can also be based on
physical appearance (Pollard & O’Hare, 1999). Ethnicity typi-
cally refers to group membership related to a common cultural
heritage, values, attitudes, and behaviors; whereas race is typ-
ically defined by physical attributes (e.g., skin color) that is
shared by a group of people (Cokley, 2007; Quintana, 2007). A
hybrid definition that integrates both race and ethnicity can be
useful in some cases (Cokley, 2007) and in particular for
therapy studies as therapists are reacting to both the clients’
race and ethnicity during therapy.
Racial and ethnic microaggressions have been associated with
psychological distress, such as anger, anxiety, confusion, and
contempt (e.g., Blume, Lovato, Thyken, & Denny, 2012; Mercer,
Zeigler-Hill, Hayes, & Wallace, 2011; Schoulte, Schultz, & Alt-
maier, 2011; Wang, Leu, & Shoda, 2011). Many racial and ethnic
minority (REM) individuals experience microaggressions in ev-
eryday life, and unfortunately they also can be experienced during

283
 284 OWEN, TAO, IMEL, WAMPOLD, AND RODOLFA
therapy. For instance, clients are likely to perceive microinvalida-
tions and microinsults1 from their therapists in the form of dismis-
sive or negating messages about their cultural heritage or culturally
inappropriate interventions (Burkard & Knox, 2004; Neville, Lilly,
Duran, Lee & Browne, 2000; Salvatore & Shelton, 2007; Solór-
zano, Ceja, & Yosso, 2000; Thompson & Jenal, 1994). Concep-
tually, microaggressions could be experienced by REM clients
(either tacitly or explicitly) as a recapitulation of previous cultural
injustices, which when not properly handled could impede the
therapy process. For example, a microinsult to an Asian American
client (e.g., “I don’t know why you just don’t speak up for yourself
and tell your parents how you feel”) potentially pathologizes the
client’s cultural ways of relating to elders. In doing so, the thera-
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pist possibly jeopardizes the working alliance, as the client and
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therapist will likely disagree on standing up to the client’s parents
as an appropriate method to alleviate the client’s distress with his
family. Thus, therapists may need to be aware of the cultural
dynamics in the therapy process and be able to successfully nav-
igate these conversations (Cardemil & Battle, 2003; Maxie, Ar-
nold, & Stephenson, 2006).
To date, there are only three known studies that have examined
racial and ethnic microaggressions in therapy with two samples of
African American clients (n ⫽ 40, Constantine, 2007; n ⫽ 19,
Morton, 2011) and one sample was more diverse including ap-
proximately 20% Asian American clients, 16% multiracial/ethnic
clients, 9% Hispanic clients, 1% African American, and 50% Euro
American clients (n ⫽ 232, Owen et al., 2011). Moreover, there
are only two other known studies examining microaggressions
against women and LGBQ clients in therapy (Owen et al., 2010;
Shelton & Delgado-Romero, 2011). Despite the paucity of therapy
studies, one emerging trend is becoming clear: the experience of
microaggressions can lead to feelings of invalidation and/or dis-
respect, thus resulting in a rupture wherein the emotional bond
with a therapist is disrupted. For instance, in several analogue
studies, therapists’ endorsement of a specific type of microaggres-
sion— colorblind attitudes (Neville et al., 2000)— has been shown
to impact aspects of the working alliance, such as their empathy
toward an African American client (Burkard & Knox, 2004; also
see Gushue, 2004; Neville et al., 2006). In actual therapy sessions,
clients’ perceptions of racial and ethnic microaggressions were
negatively associated with the quality of the working alliance
(Constantine, 2007; Morton, 2011; Owen et al., 2011) as well as
satisfaction with services and therapy outcomes (Constantine,
2007; Owen et al., 2011).
The negative association between microaggressions and the
working alliance is of particular importance. First, the alliance— or
the agreement between the client and therapist on the goals for
therapy and the methods to reach those goals as well as the
relational bond between the client and therapist (Bordin, 1979)—is
one of the most robust predictors of therapy outcomes, accounting
for approximately 7% to 14% of the variance (Crits-Christoph et
al., 2011; Horvath et al., 2011). Accordingly, it is of utmost
importance for therapists to attend to microaggressions that impact
the ability to form or maintain a therapeutic working alliance.
Second, the alliance has been shown to be a mediator for the
association between microaggression and therapy outcomes, sug-
gesting those client–therapist dyads who are able to maintain high
quality alliances are able to work through the rupture in a way that
does not impede clients’ clinical goals (Constantine, 2007; Owen
et al., 2011; Owen & Imel, 2010).
Given the deleterious effects of clients’ perceptions of micro-
aggressions on therapy processes, it is important to ascertain
whether therapists and clients are discussing these potentially
negative experiences. Therapists may not be fully aware of the
specific statement or action that the client perceived as a micro-
aggression, because microaggressions can be indirect, uncon-
scious, and unintentional. Generally, therapists are not good pre-
dictors of treatment process and outcome. For example, therapists
tend to underestimate the number of clients who deteriorate during
therapy (Chapman et al., 2012; Hannan et al., 2005). Moreover,
therapists have been shown to be reluctant and uncomfortable
when addressing issues of race and ethnicity (Knox, Burkard,
Johnson, Suzuki, & Ponterotto, 2003). Nonetheless, therapists
should strive to be aware of how the client reacts to what they say
and any potential changes in the therapeutic relationship (Safran &
Murran, 2000). Ideally, therapists who are aware of potential
problems can directly process the specific microaggression, seek to
understand why it occurred, clarify misunderstandings, and work
to realign with the client (Nadal, 2009; Safran & Murran, 2000). In
doing so, therapists should be able to repair the therapeutic rela-
tionship. Currently, we are not aware of any data establishing
whether therapists attempt to mend the therapeutic relationship
with clients after the presence of microaggressions.
We predicted that REM clients’ perceptions of microaggres-
sions would be negatively associated with their ratings of the
alliance (Hypothesis 1), after controlling for current psychological
well-being, number of sessions, and therapist race and ethnic
status. The use of current psychological well-being as a control
variable should help reduce the likelihood that some of the vari-
ance in the alliance are due to positive mental health or gains in
therapy (cf. Barber, 2009). Additionally, we predicted that client–
therapist dyads that addressed the microaggression (and were able
to come to resolution) would (a) demonstrate similar levels of
working alliance to clients who never perceived a microaggression
(Hypothesis 2) and (b) have higher levels of alliance than clients
whose therapist never discussed the microaggression or were un-
able to resolve the issue (Hypothesis 3).
Method
Participants
Clients included 88 females and 32 males with a median age of
22 years old (range ⫽ 18 to 51). Thirty-one percent (24.2%) of the
clients were graduate students, 28.3% were seniors, 20.8% were
juniors, 11.7% were sophomores, 13.3% were freshman, and 1.7%
were nonstudents. Clients were asked to self-identify their race/
ethnicity; 1.7% of clients identified as African American, 42.5%
identified as Asian American, 24.2% identified as Hispanic, 30.8%
identified as multiethnic, and less than 1% did not identify their
race or ethnicity. The small number of clients did not allow us to
test for differences between racial and ethnic demographic groups.
1
Therapists are less likely to use microassualts in session with clients
because this subtype of microaggression is more conscious and resembles
overt racism.
 RACIAL AND ETHNIC MICROAGGRESSIONS IN THERAPY
These figures are consistent with the overall university’s race and
ethnic composition, wherein Asian Americans represent 41% of
the student body, Hispanic/Latino(a) students represent 16%, and
African American students represent 3% (note the university does
not include multiethnic/racial as a category).
Thirty-three therapists treated the 120 clients. The average num-
ber of clients reporting for each therapist was 3.64 (range ⫽ 1 to
9). Ten of the therapists self-identified as REM and 23 self-
identified as White. Therapists were not directly assessed in this
study and subsequently further demographic or other therapeutic
information was not gathered. In general, the therapists were
predoctoral interns, postdoctoral fellows, staff psychologists, and
staff therapists. There is no prescribed therapeutic approach for
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therapists. In prior assessments at this counseling center, where
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therapists were asked to indicate their theoretical orientation in an
open-ended format, all therapists indicated that they practiced
some form of integrative therapy (e.g., psychodynamic/cognitive–
behavioral, relational/systems/cultural; see Owen et al., 2011).
This counseling center generally provides brief therapy (6 – 10
sessions; the median number of sessions for this sample was four).
It is common practice at this counseling center for the therapist
who conducts the intake to continue to see the client for therapy.
Measures
Racial Microaggressions in Counseling Scale (RMCS; Con-
stantine, 2007). The RMCS was used to assess clients’ per-
ceptions of racial microaggressions during the course of ther-
apy. It is a 10-item scale with items that assesses a client’s
perception of counseling situations related to race or ethnicity.
Example items include the following: My counselor minimized
the importance of cultural issues in our session(s), and My
counselor sometimes was insensitive about my cultural group
when trying to understand or treat my concerns or issues. We
retained the wording for the items; however we altered the
instructions and the rating scales. The original rating scale was
a 0 (this never happened to me), 1 (this happened, but it did not
bother me), and 2 (this happened and I was bothered by it). The
existing rating scale can be characterized as a categorical rating
system, reflecting two dimensions: (a) if the microaggression
happened or not, and (b) if the microaggression bothered the
client or not. Moreover, there might be reactions that could be
delineated between the ratings of it did not bother me and I was
bothered by it, (e.g., I was slightly bothered by it) that are
conceptually meaningful. Statistically, rating scales with few
response options can also impact the reliability of the measure,
with rating scales that have 5 to 7 response options generally
demonstrating better reliability estimates (Nunnally, 1978). As
such, to assess frequency and impact of microaggressions,
clients were instructed to First rate how often each situation
occurred, then rate how the situation affected you. The rating
scale to assess frequency ranged from 1 (Never) to 5 (Always).
Next, clients were asked, in a separate question for each item,
If this occurred, how much did it bother you? to assess the
impact of microaggression, which was rated on a 5-point scale
ranging from 1 (Not at all) to 5 (Very much).
The distribution of the scores was restricted for both sub-
scales. The mean for the frequency ratings were M ⫽ 1.22
(SD ⫽ 0.35) and for the impact ratings were M ⫽ 1.20 (SD ⫽
285
0.48). As such, we created two scores for the RMCS: (a)
whether microaggression occurred at all (Yes ⫽ 64 [53.3%];
No ⫽ 56 [46.7%]), and (b) a total microaggression score. For
the latter score, we included all clients including those who did
not report any microaggressions. To do so, we treated ‘no
reported microaggressions’ responses as the anchor point on the
scale (i.e., 1) and then continued with the other rating points on
the impact scale. For example, a client who experienced a
microaggression but reported that it did not bother then at all
would have a score of 2 on the impact of microaggression score.
This scaling was done to include all clients. The total micro-
aggression scale was consistent to creating a composite score by
summing the frequency and impact subscales.
The reliability and validity of RMCS has been tested in three
separate samples (Constantine, 2007; Morton, 2011; Owen et
al., 2011). To establish concurrent validity, Constantine (2007)
found the clients’ scores on the RMCS were negatively corre-
lated with their ratings of cross-cultural competency of White
therapists. Furthermore, the RMCS was negatively related to
client rated working alliance and satisfaction with therapy,
suggesting that the measure captures meaningful aspects of the
psychotherapy process (Constantine, 2007; Morton, 2011;
Owen et al., 2011). Previous reliability estimates have ranged
from .66 to .79 for REM clients. In the current study, the
Cronbach’s alpha was .88.
Discussion of microaggressions. For clients who reported
that they experienced a microaggression, they were asked if the
microaggression(s) was discussed in therapy. Specifically, they
were asked the following: If any of the above occurred [microag-
gressions from the RMCS], did you and your counselor discuss the
issue(s)? and the response categories were Yes, and we were able
to work it out; Yes, and we were unable to work it out; and No, we
did not discuss the issue.
Working Alliance Inventory-Short Form (WAI-S, Tracey &
Kokotovic, 1989). The WAI-S is a client rated measure of
working alliance that consists of 12 items that assess goals and
tasks for therapy as well as the relational bond between the
client-therapist. These items were rated on a seven-point scale
ranging from 1 (Strongly disagree) to 7 (Strongly agree) with
higher scores indicating a better working alliance. The WAI-S
is a commonly used measure of working alliance and the
reliability and validity has been demonstrated in numerous
studies comparing the WAI-S to other working alliance scales
and therapy outcome (see Horvath et al., 2011). For the current
study, the total scale score was used and the Cronbach’s alpha
was .95.
Schwartz Outcome Scale-10 (SOS-10; Blais et al., 1999).
The SOS-10 is a 10-item scale designed to assess current psycho-
logical well-being over the past week, which is rated on a seven-
point scale ranging from 1 (Never) to 7 (All the time or nearly all
the time). The reference samples (n ⬎ 10,000) for the SOS-10
were drawn from various clinical populations (e.g., inpatient,
outpatient, college counseling centers) and nonclinical populations
(e.g., adults from the community, college students; Owen & Imel,
2010). Across studies, the SOS-10’s reliability was: test/retest, r ⫽
.88 and Cronbach’s alpha (␣) ⫽ .91. Furthermore, the SOS-10 has
strong convergent and divergent validity as it correlates in the
predicted direction with a variety of clinical and psychological
well-being scales and reliably discriminates between clinical and
 286 OWEN, TAO, IMEL, WAMPOLD, AND RODOLFA
nonclinical samples (see Owen & Imel, 2010 for review). The
Cronbach’s alpha coefficient for this study was .94.
Procedure
During intake at a large West Coast university counseling center
clients were asked, on their intake card, if they would be willing to
receive a survey about their therapy experience. Clients who
agreed were sent an email at the end of the academic quarter
directing them to an anonymous online survey. Three-hundred
fifty-seven individuals responded to the electronic survey (29%
response rate); however, we only included clients who identified as
an REM, participated in individual therapy, and identified their
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therapist. For purposes of the research, participants initially com-
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pleted an informed consent form and then were then asked to
identify their therapist. Next, clients completed a series of instru-
ment and other questions related to the functioning of the coun-
seling center (not analyzed here). Clients were directed to identify
and report on a specific therapist for the alliance and microaggres-
sion measures. If clients identified multiple individual therapists
they were excluded from the analyses. Furthermore, clients who
did not identify any therapist were also excluded from the analy-
ses. After completion of the study, clients were able to enter a
raffle for $100.00 dollars. All procedures were approved by the
university IRB.
Data Analysis Considerations
Psychotherapy data frequently violate a basic assumption of
statistical testing—independence of observations—as multiple cli-
ents are treated by the same therapist. Multilevel models can
correct for the biases that occur when this assumption is violated.
We conducted multilevel models with Bayesian estimation utiliz-
ing the statistical package Mplus 7.0 (Muthén, & Muthén, 1998 –
2012). Bayesian models are not based on normality assumptions or
asymptotic results and provide better estimations for unbalanced
and small sample sizes (Hamaker & Klugkist, 2011), which is well
suited for our study given that we had a moderately small number
of therapists and an unbalanced number of clients treated by each
therapist. In Bayesian models the results describe posterior distri-
bution, which is the range of uncertainty left in the model after
accounting data included in the model (Hamaker & Klugkist,
2011). Thus, larger posterior distributions mean that there is more
uncertainty in the results. Credible intervals (CI), similar to con-
fidence intervals, are utilized in Bayesian models to help describe
the range of the posterior distribution. For more detailed overview
of Bayesian analysis see Hamaker and Klugkist (2011).
Results
Preliminary Analyses
Initially, we examined the degree to which therapists varied in
their clients’ ratings of alliance and microaggressions. Therapists
accounted for approximately 9.8% of the variance in their clients’
ratings of alliance (client level variance ⫽ 1.19, p ⬍ .001, 95%
CI ⫽ 0.94, 1.61; therapist level variance ⫽ 0.13, p ⬍ .001, 95%
CI ⫽ 0.004, 0.61) and they accounted for approximately 6% of the
variance in their clients’ perceptions of microaggressions (client
level variance ⫽ 0.15, p ⬍ .001, 95% CI ⫽ 0.12, 0.20; therapist
level variance ⫽ 0.01, p ⬍ .001, 95% CI ⫽ 0.001, 0.03). These
results suggest that therapists vary in their clients’ average ratings
of the alliance and microaggressions. However, some caution
should be taken with these results as the ratio of clients per
therapist was small.
Next, we screened for differences in clients’ ratings of mi-
croaggressions based on therapists’ racial/ethnic status. The
results were not statistically significant, b2 ⫽ ⫺0.04, SD ⫽ .08,
p ⫽ .64, 95% CI ⫽ ⫺0.18, 0.12, suggesting that REM clients
did not significantly differ in their report of microaggressions
when their therapist was White or REM. Similarly, when we
tested whether therapists’ racial/ethnic status would be associ-
ated with clients’ perception of microaggressions occurring at
all (yes/no), the results were not statistically significant, b ⫽
0.57, SD ⫽ .30, p ⫽ .086, 95% CI ⫽ ⫺0.11, 1.12. In total,
53.3% (n ⫽ 64) of REM clients reported experiencing a micro-
aggression (68.4% of REM clients who were treated by REM
therapists and 46.3% of REM clients who were treated by White
therapists)3. The descriptive statistics and bivariate correlations
for the variables in the study are presented in Table 1 and
Table 2.
Primary Analyses
We tested whether clients’ perceptions of microaggressions
would be negatively associated with their ratings of the working
alliance (Hypothesis 1). To do so, we predicted alliance scores by
clients’ perceptions of microaggressions (total score), and we
controlled for number of sessions (level 1-grand mean centered),
current well-being (level 1-grand mean centered), and therapists’
race and ethnicity (level 2-REM ⫽ 1, White ⫽ 0). The results
supported our hypothesis, insofar as clients who reported stronger
alliances reported fewer microaggressions, after controlling for the
variability among therapists and the variance in the other control
variables (see Table 3). Of the control variables, only clients’
current psychological well-being (SOS-10) was positively associ-
ated with alliance scores.
Of the 64 clients who reported experiencing a microaggression,
76% (n ⫽ 42) reported that the microaggression experience was
not discussed, 24% (n ⫽ 13) reported the microaggression was
discussed. Of these 13 clients, only one client reported that the
discussion was not successful. REM therapists were less likely to
discuss the microaggression experience as compared with White
therapists (90.5% vs. 67.6%); however, after controlling for ther-
apist effects, these differences were not statistically significant
(b ⫽ 0.78, SD ⫽ 0.37, p ⫽ .06, 95% CI ⫺0.04, 1.54). The lack of
statistical significance is likely a result of the small sample size as
there were only 10 REM therapists and 23 White therapists cou-
pled with the fact that discussion of the microaggression experi-
ence was a low base rate event.
2
For simplicity we will just report the b value here, but it reflects the
median of the posterior distribution.
3
We also tested whether client reports of microaggressions differed
among client racial/ethnic groups (e.g., African American, Asian Ameri-
can, Hispanic, Multi-Racial/Ethnic). The results were not statistically sig-
nificant (p ⬎ .05). However, our sample size per group was relatively
small. Further, information about these differences can be requested from
the first author.
 RACIAL AND ETHNIC MICROAGGRESSIONS IN THERAPY 287

Table 1 Table 3
Means and Standard Deviations for the Alliance, SOS-10, Summary of Multilevel Model Predicting Alliance by Clients’
and Microaggressions Perceptions of Microaggressions

REM clients REM clients Effect b (SD) p value 95% CI

with REM with White Scale
therapists therapists information Fixed effects
Intercept-alliance 4.88 (0.36) ⬍.001 4.29, 5.69
M (SD) M (SD) Range Total microaggression ⫺0.82 (0.21) ⬍.001 ⫺1.20, ⫺0.38
Number of sessions 0.04 (0.03) .11 ⫺0.01, 0.10
Alliance (WAI-S) 5.60 (1.17) 5.51 (1.09) 1–7 SOS-10 0.24 (0.06) ⬍.001 0.12, 0.37
Psych well-being (SOS-10) 4.98 (1.25) 5.16 (1.09) 1–7 Therapist ethnicity 0.16 (0.30) .68 ⫺0.41, 0.70
Microaggression (RMCS) 1.11 (0.25) 1.14 (0.43) 1–6 Random effects
Therapist variance 0.26 (0.19) ⬍.001 0.06, 0.75
n (%) n (%) Total N Client variance 0.89 (0.13) ⬍.001 0.65, 1.15
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Any Micro 26 (68.4%) 38 (46.3%) 38/82 Note. Ethnicity was coded 1 for REM and 0 for White. Coefficients are
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No discuss micro 19 (90.5%) 23 (67.6%) 21/34a unstandardized effects. CI ⫽ credible intervals.

Note. REM clients treated by REM therapists, n ⫽ 38; REM clients
treated by White therapists, n ⫽ 82. WAI-S ⫽ Working alliance Inventory-
Short Form; SOS-10 ⫽ Schwartz Outcome Scale-10; RMCS ⫽ Racial
Microaggression in Counseling Scale.
a
There were nine missing cases for the discussion of microaggression
item, thus the number of clients reporting a microaggression slightly
exceeds the number of clients reporting on whether a discussion of the
microaggression occurred.
To address our second and third hypothesis, we examined three
groups: (a) client and therapist dyads who successfully discussed
the microaggression experience, (b) client and therapist dyads who
did not discuss the microaggression, and (c) client and therapist
dyads where there were no reported microaggressions. There was
one client who discussed the microaggression experience but it
was unresolved, thus this client was excluded from comparisons.
Table 4 shows the means and standard deviations for the three
groups. The results demonstrated that alliance scores were signif-
icantly different among the three groups (b ⫽ ⫺0.27, SD ⫽ 0.08,
p ⬍ .001, 95% CI ⫺0.44, ⫺0.12). As seen in the table, client and
therapist dyads who successfully discussed the microaggression
experience had alliance scores comparable with clients who did
not perceive any microaggressions (p ⬎ .05, d ⫽ ⫺0.15, 95%
CI ⫺0.40, 0.10; supporting Hypothesis 2). Client and therapist
dyads who successfully discussed the microaggression experience
had higher alliance scores as compared with client and therapist
dyads who did not discuss the microaggression experience (p ⬍
.05, d ⫽ 0.42, 95% CI 0.73, 0.12; supporting Hypothesis 3). Client
and therapist dyads that did not discuss the microaggression ex-
perience had significantly lower alliance scores as compared with
Table 2
Bivariate Correlations Between Working Alliance, SOS-10,
and Microaggressions
Any micro Total micro Alliance SOS-10
Any micro —
Total micro .21ⴱ — No discussion
Alliance ⫺.21ⴱ ⫺.28ⴱⴱ — (n ⫽ 42)
SOS-10 ⫺.17 ⫺.27ⴱⴱ .41ⴱⴱⴱ —
Note. These correlations do not account for therapist effects. Any micro
was coded 1 ⫽ Yes, 0 ⫽ No.
ⴱ
p ⬍ .05. ⴱⴱ p ⬍ .01. ⴱⴱⴱ p ⬍ .001.
client and therapist dyads where there were no reported microag-
gressions (p ⬍ .05, d ⫽ ⫺0.56, 95% CI ⫺0.79, ⫺0.34).
Discussion
Many REM clients may have experienced microaggressions in
daily life (e.g., Sue et al., 2007), and our results suggest that these
societal experiences of discrimination do not stop at the therapy
door. Indeed, 53% of REM clients in the current study reported
that a microaggression occurred in their therapy (any score on any
item above the rating of Never). Moreover, clients’ perceptions of
microaggressions were related to lower quality alliances with their
therapists. Consequently, our findings add to the other three stud-
ies that have demonstrated that clients’ perceptions of racial and
ethnic microaggressions are negatively associated with the alli-
ance—a central element in the therapeutic process and significant
mediator between clients’ perceptions of microaggressions and
therapy outcomes (Owen et al., 2010).
Conceptually, 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. In the
current study, only 24% of client and therapist dyads discussed the
microaggression experience. Given that therapists are not gener-
ally proficient at identifying clients who are deteriorating in ther-
apy (Hannan et al., 2005), this finding might be a multicultural
variant of a similar phenomenon. Indeed, the very nature of mi-
croaggressions as subtle, unconscious, and indirect may prevent
well-meaning therapists from recognizing that their clients are
experiencing such offenses. Moreover, therapists have been shown
to be reluctant and uncomfortable when addressing issues of race
Table 4
Means and Standard Deviations for Alliance by No Discussion
of Microaggressions, Successful Discussion of
Microaggressions, and No Microaggressions
Successful discussion No micro
(n ⫽ 12) (n ⫽ 51)
Alliance 5.17 (1.21) 5.65 (0.91) 5.80 (1.06)
Note. One client reported that the discussion of microaggression was not
successfully resolved, but his/her/their scores are not reported here.
 288 OWEN, TAO, IMEL, WAMPOLD, AND RODOLFA
and ethnicity (Knox et al., 2003). Nonetheless, therapists are
responsible for the well-being of their clients.
Client and therapist dyads that were able to successfully
discuss the microaggression experience had higher quality al-
liances as compared with client and therapist dyads where the
microaggression experience was not discussed. In fact, client
and therapist dyads who successfully discussed the microag-
gression experience had similar alliances as those client and
therapist dyads where there was no perceived microaggression.
These results illuminate the power of addressing the missteps
that can occur in therapy (see Safran & Murran, 2000). More-
over, they are consistent with the positive effects of resolutions
to ruptures in nonmicroaggression studies (e.g., Muran et al.,
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
2009). At present and given the cross-sectional nature of our
This document is copyrighted by the American Psychological Association or one of its allied publishers.
study, it is unclear whether the initial alliance was stronger for
client and therapist dyads who successfully addressed the mi-
croaggression as compared with the dyads who did not address
the microaggression.
Limitations and Future Directions
The merits of our results should be interpreted within the scope
of the study’s methodological strengths and limitations. First, the
retrospective nature of this study coupled with the electronic
survey methodology raises several concerns: (a) inability to cap-
ture session by session process of alliance and microaggressions,
(b) our findings are correlational making the directionality of
microaggressions and alliance correlations potentially bidirec-
tional, and (c) the response rate (29%) was relatively low. All
known microaggression studies have utilized the same methodol-
ogy (Constantine, 2007; Morton, 2011; Owen et al., 2011), and in
our opinion the lack of research examining racial/ethnic microag-
gressions (only three studies) as well as therapists multicultural
competencies in actual therapy settings is particularly hampering
for the progress of our profession. There are many questions that
can be untangled by assessing microaggressions in a prospective
manner, including how the alliance changes after a microaggres-
sion and how client and therapists are able to address the experi-
ence. Potentially, therapists’ ability to establish a sound relational
foundation early in therapy may enhance therapy process by pro-
viding a safe environment, which may lend itself to having dis-
cussions about microaggressions. There may be advantage to as-
sess microaggressions via therapist rating to gauge the degree of
overlap in perceptions.
Second, we only assessed microaggressions related to clients’
racial and ethnic identity, whereas other types of cultural identities
(e.g., gender, sexual orientation) were not explored. Future studies
should continue to examine the potential intersection of gender and
ethnicity, for example, in relation to the experience of microag-
gressions. Moreover, between racial/ethnic group comparisons on
their perceptions of microaggressions was not statistically signif-
icant; however, we did not have sufficient sample size to fully test
these differences. Consistently, the limitations of restricting a
study to a single institution with disproportionality in racial and
ethnic demographics compelled us to combine racial and ethnic
minority clients into one group. We recognize this constrains
interpretation regarding differences between how specific groups
historically and currently experience racism or discrimination in
the United States or how specific groups on this campus may be
impacted by microaggressions based on the racial and ethnic
breakdown. We also acknowledge this decision to aggregate the
sample preferences nomothetic (e.g., Students of Color) over id-
iosyncratic (e.g., Vietnamese American compared with Mexican
American) information. Accordingly, our sample limited our abil-
ity to test potentially important distinctions within and between
racial/ethnic groups as well as differences for particular cross-
racial/ethnic therapist-client dyad pairings. Future research may
want to examine whether and how microaggressions are experi-
enced differentially among the various racial and ethnic groups.
Third, this study caries the typical strengths and limitations of
data sets obtained in naturalistic settings. As such, we sacrificed
more rigorous controls (e.g., prescreening, training therapists,
monitoring interventions) for a larger, more diverse sample, and
naturalistic treatments. Lastly, we adjusted rating scale for the
RMCS to provide separate ratings for frequency and impact of the
microaggression. The distinction between frequency and impact
may prove to be important in understanding how microaggressions
can influence the process of therapy. For instance, why are some
clients who perceive microaggressions not as impacted? Unfortu-
nately, our research design does not allow us to fully test these
hypotheses. Moreover, the scores on the RMCS were restricted,
suggesting that clients do not generally report that microaggres-
sions occur frequently throughout treatment and they do not report
that the microaggression experience bothered them a great
deal—at least based on scores on the ratings scale. These findings
parallel the frequency and impact of microaggressions in previous
psychotherapy studies (Constantine, 2007; Morton, 2011; Owen et
al., 2011). The restricted range on the measures does not neces-
sarily minimize the importance of microaggressions; rather, it
appears that even modest ratings of microaggressions can have a
deleterious effect on the process and outcome of psychotherapy.
Implications for Training and Practice
Given the complexity of microaggressions it is likely that all
therapists will have clients who experience them. The overwhelm-
ing aspect of microaggressions for many clinicians and trainees is
that they are often unconscious and unintentional. What we have
learned about the microaggression research, however, is that no
therapist is immune from unintentionally offending or invalidating
their clients. Therapists must realize that developing a strong
multicultural orientation requires a lifelong process of a willing-
ness to examine biases, attitudes, and beliefs— ultimately reflected
in a cultural humble stance with clients (Hook et al., 2013; Owen,
Tao, Leach, & Rodolfa, 2011; Owen, 2013). Accordingly, students
in counseling programs must be introduced to the concept and
impact of microaggressions early on in their training and beyond
the multicultural counseling class. Core courses such as counseling
skills, ethics and professional issues, and practicum should also
incorporate activities and readings that allow students to explore,
both didactically and experientially, the ways in which microag-
gressions manifest (e.g., implicit or unconscious biases) as well as
how they contrast to more explicit or overt forms of racism.
Moreover, the open endorsement of egalitarian or nonprejudiced
views is not a reliable indicator of an individual’s awareness about
their biases or stereotypes. In fact, evidence suggests those who
consider themselves politically liberal are often at greatest risk of
maintaining implicit bias or rationalizing their beliefs through
 RACIAL AND ETHNIC MICROAGGRESSIONS IN THERAPY
nuanced ways (e.g., microaggressions). To address these issues,
instructors and clinical supervisors are in a critical position to help
trainees process the phenomenon of microaggressions and other
forms of contemporary prejudice (e.g., aversive and modern rac-
ism) and recognize its cost to all (McConahay, 1986; Pearson,
Dovidio, & Gaertner, 2009; Sue, Lin, Torino, Capodilupo & Ri-
vera, 2009). In turn, students will then be able to develop a
‘language’ and ‘consciousness’ for talking about such interper-
sonal conflicts and engage in ‘difficult dialogues’ with their clients
about their racial/ethnic identities (Sue et al., 2009).
As practitioners, it is also extremely important to receive
ongoing education and in-service trainings that cultivate dis-
cussions around microaggressions and its potential to impact
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
client outcomes and/or perceptions of therapy (Sue et al., 2007).
This document is copyrighted by the American Psychological Association or one of its allied publishers.
Specifically, it is important to incorporate experiential trainings
that address the cognitive, affective and behavioral impact of
microaggressions. This includes confronting the uneasiness in
admitting that we may have offended our client or that we all
have unconscious biases based on our own racial and ethnic
identities and experiences. How best to educate therapists on
these subtle biases will likely be no easy feat and should be the
focus of further inquiry.
The presence of microaggressions in therapy may result in a
rupture, wherein clients experience an offense regarding their
racial/ethnic identity that may impact their trust in their thera-
pist, conveying the message that therapy is not emotionally
safe. Ways to recognize or prevent the macrolevel impact of a
microaggression in practice include developing a strong alli-
ance and continuous enhancement of reflexivity. The develop-
ment of the therapeutic alliance in the early stages of a coun-
seling relationship coupled with therapist who has a strong
multicultural orientation or general philosophy that places im-
portance on clients’ cultural heritage (Owen et al., 2011; Owen,
2013) can lay the foundation for sound therapeutic work. Tsang
and Bogo (1997) argued that trust between client and therapist
is demonstrated by openness to one another as well as a client’s
belief that the therapist has good intentions. Consequently,
therapists should develop strategies that are consistent with a
general therapeutic approach that promotes discussions about
their clients’ racial/ethnic heritage and, most importantly, at-
tend to the therapeutic relationship.
Reflexivity involves self-awareness and “agency within that
self-awareness (Rennie, 1992, p.183).” This concept goes be-
yond the notion of recognizing when things happen in therapy
(e.g., my client seemed to have a strong reaction to my state-
ment) and to realize the agency and perhaps ethical obligation
to act in response to critical interactions. This may take the
form of checking in with clients on their reactions in counseling
or to revisit the possibility of miscommunication based on
having different lived experiences and backgrounds. Regard-
less, therapists must engage in constant reflection on how their
presence, words, and actions have impact on clients as well be
willing to initiate discussions about potential microaggressions.
Therapists might be reluctant to explore potential ruptures
based on racial/ethnic microaggressions with clients, or may
simply be unaware that they have occurred. Yet, the costs of
ignoring microaggressions are even more detrimental than its
occurrence, impacting the therapeutic relationship and clients’
289
overall well-being (Constantine, 2007; Owen et al., 2011; Wang
et al., 2011).
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Received December 28, 2012
Revision received January 22, 2014
Accepted May 27, 2014 䡲