Psychotherapy clients often hold multiple and varied cultural identities, and it is important for therapists to attend to the intersectionality of clients' cultural identities, as well as the saliency of these identities. However, to date, few studies have considered the saliency of clients' multiple identities and how this may impact clients' perceptions of cultural processes in therapy. Therefore, this study utilized polynomial regression and response surface analysis to operationalize and examine congruent and discrepant effects between the saliency of clients' multiple identities and their perceptions of their therapists' cultural humility and cultural missed opportunities. Data for this study consisted of 87 clients who received individual counseling services at either a university counseling center or training clinic at two large universities in the United States. As hypothesized, results indicated significant discrepant effects between the saliency of clients' first and second most important cultural identities and perceptions of their therapists' cultural humility and cultural missed opportunities. Specifically, clients' ratings of their therapist's cultural missed opportunities were lowest when they reported either a) high saliency of cultural identity one and low saliency of cultural identity two, or b) low saliency of cultural identity one and high saliency of cultural identity two. Similarly, clients' ratings of their therapist's cultural humility were highest when they reported either a) high saliency of cultural identity one and low saliency of cultural identity two, or b) low saliency of cultural identity one and high saliency of cultural identity two. Public Significance StatementThis study found that when the salience of clients' two most important cultural identities was discrepant (i.e., high-low or low-high), they perceived their therapist to be high in culturally humility and low in cultural missed opportunities. Therapists should acknowledge that clients often hold multiple cultural identities and that the saliency of these identities may differ in meaningful ways. Therapists should attend to this complexity from a multicultural framework to engage in culturally responsive care.
Objective: Because therapy groups represent social microcosms, social dynamics from outside of the group play out in the context of the group, including those related to power, privilege, and oppression, like microaggressions. Left unaddressed, microaggressions have negative impacts on the health and well-being of the targets, perpetuate systemic inequity, and present a particularly destructive form in rupture to the group. The objective of this practice review is to help prepare group therapists to address the cultural ruptures known as microaggressions. Method: We first briefly review the literature on microaggressions, including those that occur in individual and group psychotherapy, to highlight the importance of addressing microaggressions when they occur. Next, we review the literature related to multicultural competence, multicultural orientation, difficult dialogues, and bystander intervention to suggest practice recommendations for addressing microaggressions in group therapy at the therapist and group levels. We also present a case example to illustrate these recommendations in practice. Results: Our practice recommendations highlight actionable ways for group therapists to proactively prepare to address microaggressions both before and outside of the group and in the here-and-now. Conclusions: Microaggressions are likely to occur in the social microcosm of the group and addressing microaggressions in groups is essential. Group leaders can proactively prepare themselves and the group to address microaggressions as they occur to minimize harm to the targets and the group-as-a-whole. Highlights and Implications• Microaggressions, or subtle discriminatory slights that perpetuate inequality, are likely to emerge in the context of the social microcosm of group therapy, as they have been found to in individual therapy.• At the group level, the group can also set norms that encourage and support difficult cultural dialogues, develop a group MCO (i.e., their cultural humility, and willingness and comfort in addressing cultural issues, like those presented by microaggressions), develop capacities for bystander intervention, and create corrective emotional experiences in response to cultural ruptures.• Additional empirical research is needed on microaggressions in group therapy, as well as the preparation of the therapist and group to successfully negotiate these cultural ruptures as they occur.
A growing body of research has demonstrated the importance of therapists’ multicultural orientation (MCO), namely, their cultural humility (CH), cultural comfort, and cultural missed opportunities, on treatment processes and outcomes (Davis et al., 2018). However, to date, few research has attempted to identify client factors that may moderate the relationship between therapists’ MCO and therapeutic processes and outcomes. Informed by Yakushko et al.’s (2009) identity salience model, this study seeks to advance the MCO literature by examining the saliency of clients’ cultural identities, therapists’ MCO, and improvement in therapy. Data for this study consisted of 193 individuals who had received at least five sessions of psychotherapy in the last 6 months and responded to an online survey about their experience in therapy. Moderated polynomial regression and response surface analysis was used to examine if the relationship between therapists’ MCO and clients’ perceived improvement in psychotherapy differed as a function of the salience of clients’ first and second most important cultural identities. The results indicated that when clients report only one highly salient cultural identity and perceive their therapist high in cultural humility, they report high levels of improvement. In contrast, when clients reported two highly salient identities, cultural humility and improvement in therapy were not significantly related.
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