Religious microaggressions in psychotherapy: A mixed methods examination of client perspectives.

Abstract

Ethical guidelines state that psychologists should consider clients' religion in their practice. However, some clients have reported negative experiences regarding clinicians' treatment of religion in psychotherapy. These experiences may constitute microaggressions, which have been negatively associated with the working alliance and treatment outcomes among clients with various identities (e.g., those of marginalized racial groups or sexual orientations). The present study used mixed methods to examine religious microaggressions among current and former psychotherapy clients identifying as religious (N = 396). Approximately 39% of participants indicated that at least one religious microaggression occurred during treatment; the most common was minimization or avoidance of religious issues. Religious microaggressions were negatively associated with the working alliance and outcomes. Additionally, the working alliance fully mediated the association between religious microaggressions and poorer outcomes. Thematic analysis of qualitative descriptions of religious microaggressions yielded seven themes: minimization/avoidance of religious issues, assumptions of religious homogeneity, pathologizing religion, unhelpful/inappropriate interventions, pressure to embrace religion, prioritization of therapist's religious beliefs, and lack of expertise. Limitations include a retrospective, cross-sectional design and a majority White, female, and Christian sample. These results provide initial evidence that a substantial minority of religious clients may experience religious microaggressions in psychotherapy, which could impede treatment progress via negative effects on the working alliance. As such, clinicians may be able to enhance client outcomes by increasing awareness of religious microaggressions in their work and addressing microaggression-related alliance ruptures openly when they do occur. Implications for training are also discussed. Clinical Impact StatementQuestion: What is the prevalence and nature of religious microaggressions in psychotherapy, and what effects do religious microaggressions have on the working alliance and treatment outcomes? Findings: Slightly over one third of religious clients reported experiencing religious microaggressions in treatment (e.g., minimization of the importance of religious issues), and these were negatively associated with treatment outcomes via the working alliance. Meaning: Religious microaggressions may weaken the working alliance, which could result in poorer treatment outcomes for a substantial minority of religious clients. Next Steps: Longitudinal research with diverse client samples is needed to further clarify the effects of religious microaggressions and to test effective ways to repair microaggression-related alliance ruptures.

Client factors.

“…As reported earlier, when it comes to cultural and religious identity, a large percentage of clients report experiencing microaggressions from their therapists (e.g., 50%-75% of clients; Constantine, 2007;Hook et al, 2016;Owen et al, 2010Owen et al, , 2014Shelton & Delgado-Romero, 2013;Trusty et al, 2022). To be sure, it is unlikely the majority of offenders intend to interact with certain clients in a hostile manner.…”

“…In fact, most welcome questions and want to discuss their beliefs, viewing them as an integral part of their treatment experience (Dimmick et al, 2021;Martinez et al, 2007;Rose et al, 2001;Rosmarin et al, 2015). Unfortunately, Trusty et al (2022) found that a sizeable number who consider themselves religious experience at least one microaggression-defined as subtle, denigrating comments or behaviors-during therapy, the most common being the minimization or avoidance of religious or spiritual issues.…”

Confronting religious and spiritual discrimination in clinical and professional practice.

“…Secular-minded mental health professionals may have little personal experience with various faith communities and religious traditions and thus have little nuanced information to go on other than what they may watch or read about through secular news outlets. Thus, it may be easy for them to fall into the trap of stereotyping various religious traditions and groups that receive negative and inflammatory press that might lead to prejudice and discrimination in their beliefs and practices (Plante, 2009;Trusty et al, 2022). We always must remember that mental health professionals are human too and are not immune to discrimination and prejudice among This document is copyrighted by the American Psychological Association or one of its allied publishers.…”

“…Unfortunately, many in the professional psychology and mental health community have embraced negative stereotypes about the Judeo-Christian traditions in particular (Hill, 2019; Plante, 2009; Rios & Roth, 2020; Trusty et al, 2022). As example, many have very negative views about Catholicism, Evangelical Christianity, The Church of Jesus Christ of Latter-day Saints, and Judaism most especially.…”

Enhancing the evidence base for spiritually integrated psychotherapies: Progressing the paradigm of practice-based evidence.

“…The next two articles present qualitative studies focusing on the key role of therapists , first in Buddhist-informed compassion training (Quaglia et al, 2021) and then in relation to therapist mindfulness (Konichezky et al, 2021). The next three articles focus on the process of therapy sessions, the first adopting a mixed-methods design to study therapist–client synchrony (Roesler & Reefschläger, 2021), the second also using a mixed-methods approach to analyze microagressions (Trusty et al, 2021), while the third article applies task analysis to video-recordings of therapy sessions (Kim & Chen, 2021). This is followed by two articles, the first addressing a specific patient population (i.e., inpatient, residential, and intensive treatments; Rosmarin et al, 2021) and the second focusing on a specific therapy modality (i.e., couple therapy; Ripley et al, 2021).…”