Multiple Microaggressions and Therapy Outcomes: The Indirect Effects of Cultural Humility and Working Alliance With Black, Indigenous, Women of Color Clients

• Published in: Professional psychology, research and practice research and practice, 2023-04, Vol.54 (2), p.115-124
• Main Authors: DeBlaere, Cirleen, Zelaya, David G., Dean, Jhodi-Ann B., Chadwick, Caleb N., Davis, Don E., Hook, Joshua N., Owen, Jesse
• Format: Article
• Language: English
• Subjects: Black People; Client Characteristics; Clients; Cultural Attitudes; Ethnicity; Female; Human; Human Females; Humility; Indigenous peoples; Indigenous Populations; Indirect effects; Microaggression; Microaggressions; Minority & ethnic groups; Native peoples; People of Color; Psychotherapy; Race; Therapeutic Alliance; Therapeutic alliances; Treatment Outcomes; Women
• ISSN: 0735-7028; 1939-1323
• DOI: 10.1037/pro0000497

We investigated the association between racial microaggressions and microaggressions against women in therapy and positive therapy outcomes. We also tested the potential intervening roles of cultural humility and working alliance in these associations. Participants were a sample of Black, Indigenous, Women of Color (BIWOC; N = 288) who had been in therapy. The sample indicated initial symptom severity and completed the Racial Microaggressions in Counseling Scale, Microaggressions against Women Scale, Cultural Humility Scale, Working Alliance Inventory-Short Form, and the 10-item Schwartz Outcome Scale-10. Bivariate correlations indicated that both forms of microaggressions were negatively related to cultural humility, working alliance, and positive therapy outcomes. Additionally, both forms of microaggressions were negatively related to positive therapy outcomes through cultural humility and working alliance. Exploratory analyses found that (a) BIWOC clients reported higher levels of racial microaggressions from White, compared to Black, Indigenous, People of Color (BIPOC), therapists and (b) the links between both forms of microaggressions and cultural humility were moderated by the race/ethnicity and gender of the therapist, respectively. Cultural humility and working alliance may be important points of intervention in disrupting the impact of microaggressions on therapy outcomes. Public Significance Statement This study found that racial and gender microaggressions in counseling are negatively associated to positive therapy outcomes through their links to cultural humility and working alliance for Black, Indigenous, Women of Color clients. These finding suggest that cultural humility and the therapeutic relationship may be important points of intervention in addressing the negative impact of microaggressions in therapy.