Everyday Sexisms in Therapy: Microaggressions Towards Members of Sexual Minorities, Gender Minorities, and Women Within Psychotherapeutic Dyads

Microaggressions are a common phenomenon affecting minoritized individuals across a wide range of contexts. Their well-known cumulative detrimental effect on mental health raises questions not only in regard to etiological, but also health services research. Initial evidence suggests that microaggressions within psychotherapeutic contexts might harm both process and outcome variables within specific (e.g., racialized) samples. Still, it is unclear whether this is primarily a problem of specific patient groups or rather a generalizable pattern of structural oppression. The present work investigates parallels and differences in the experience and management of therapeutic microaggressions towards women, sexual, and gender minorities (N = 707). Across all three samples, a majority of participants reported microaggressions directed at them by their therapists. These experiences were associated with both a weaker working alliance and less perceived improvement from therapy. The effects were attenuated whenever microaggressions were subsequently addressed. Microaggressions should be understood as a structural phenomenon probably affecting most minoritized individuals, even within psychotherapies usually considered to be safer-spaces. To protect patients from their harmful effects, therapists should not only strive to minimize the occurrence of microaggressions, but also establish their collaborative management.