Predictors of Therapy Trainees' Pathologizing and Invalidating Microaggressions With Sexual and Racial Minority Therapy Clients

Public Significance Statement This study found that therapists-in-training who had strong negative emotional reactions to racially and sexually diverse clients and who endorsed a colorblind ideology were more likely to overpathologize their clients' symptoms and to disbelieve their clients' self-reported experiences with microaggressions and cultural mistreatment. Training models should provide support for therapy trainees to better manage strongly negative reactions to clients and avoid colorblindness so that they can provide culturally respectful and high-quality care to clients who are racial and sexual minorities. Providing culturally affirmative clinical care entails taking care not to engage in therapy microaggressions nor invalidate the client's own experiences of microaggressions. The present study aimed to understand if therapy trainees enact microaggressions of overpathologization and invalidation toward racial and/or sexual orientation minority clients and to understand whether factors such as countertransference, perceived multicultural competence, empathy, heterosexism, and colorblindness contributed to the likelihood of enacting those microaggressions. One hundred and ten participants were randomly assigned to read one of four clinical vignettes of a client who reported experiencing discrimination because of her identity. Conditions differed by client race (White or African American) and sexual orientation (heterosexual or lesbian). Participants did not overpathologize racial and sexual minority clients. However, participants who reported greater overwhelmed/disorganized countertransference and greater colorblindness were more likely to overpathologize their clients. Participants invalidated the microaggression experiences of the White heterosexual client the most when compared to the other conditions. Additionally, participants who reported experiencing overwhelmed/disorganized countertransference reactions and more colorblindness were less likely to believe the client's experiences of microaggressions, whereas having greater helpless/inadequate countertransference and positive countertransference was associated with being more likely to believe the client. Results suggest that therapy training programs might facilitate therapy trainees' engagement in self-reflection around countertransference reactions and help students minimize colorblindness so that trainees will better acknowledge and sensitively address clients' experiences with microaggressions.