Cultural ruptures in short-term therapy: Working alliance as a mediator between clients' perceptions of microaggressions and therapy outcomes

Abstract

Aim: To determine whether or not clients' perceptions of microaggressions varied based on their own and the therapist's race/ethnicity and whether or not they would be negatively related to the effectiveness of therapy and if the working alliance would mediate this effect. Method: The study utilised a cross-sectional, retrospective, methodology. Clients were recruited from a large university counselling centre in the United States (N=232 clients and 29 therapists). Results: Neither clients' race/ethnicity, therapists’ race/ethnicity, nor client-therapist ethnic matching predicted perceptions of microaggressions. Clients' ratings of microaggressions were negatively associated with their psychological wellbeing; however, this effect was mediated by clients' ratings of the working alliance. Implications: Therapists should take into account the cultural messages they may be conveying to both white and racial/ethnic minority clients. Therapists should develop strategies that are consistent with a general therapeutic approach that promotes discussions about culture with their clients and, most importantly, should attend to the therapeutic relationship.

Keywords:

• process
• cultural competence
• therapy outcome
• working alliance

Acknowledgements

We would like to thank the clients in this study for participating and sharing their experiences and the therapists who work valiantly to assist their clients.

Notes

1. Ethnicity typically refers to a group of people who share a common cultural heritage, values, attitudes, and behaviours; whereas race is typically defined by physical attributes (e.g. skin colour) that is shared by a group of people (Quintana, 2007). Some theorists have utilised a hybrid definition that integrates both race and ethnicity, which appears to be most consistent with clients' experience of microaggressions as therapists are reacting to both the clients' race and ethnicity during therapy.

2. In recognition the unique experience of R/EM clients in racist society, it may be more appropriate to use the term microaggressions for acts against R/EM clients and refer to other cultural transgressions against White clients as cultural insensitivities. This discernment is similar to prior literature on prejudice and racism; that is, racism is similar to prejudice but also denotes a lack of institutional power, thus only applying to R/EM individuals (Sue, 2003). For consistency, we will use the term microaggression.