How Therapy Prejudice And Discrimination Affect Outcomes
Like anyone else, a therapist can harbor prejudicial beliefs—sometimes even without being aware of it. Prejudice can show up as ageism, false ideas about people of various cultural backgrounds, and other forms of discrimination. Keep reading to learn more about therapy prejudice and how it can affect the therapy process, as well as the importance of culturally competent care.
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Sometimes, a therapist’s comments may betray prejudicial attitudes. Today, a therapist’s education typically involves training in bias and cultural sensitivity, but it’s still possible for them to make assumptions about people from various groups.
Research in the field of social psychology indicates that everyone can be susceptible to bias, whether they are aware of it or not. Biases can show up in many forms and may affect the way that a therapist communicates with and advises a client, which can ultimately negatively affect the client.
Even if discrimination in therapy is unintentional, it can harm the therapeutic relationship, the well-being and emotional safety of the client, and the client’s longer-term health outcomes.
Race, ethnicity, and mental health care
Some people—including some therapists—may hold certain ideas about people of different races or ethnicities. Despite awareness that it can be unfair and harmful to generalize people of certain races, ethnicities, or other groups, a therapist may knowingly or unknowingly make certain decisions that reflect unfair assumptions on this basis.
Racial discrimination is well-known to occur in the healthcare space in general, particularly for those with intersecting identities. In addition to systemic barriers that often make it more difficult for BIPOC (Black, Indigenous, and People of Color) individuals to receive healthcare at all, discrimination can take place during or even before therapy sessions for those who can receive care. For example, consider a 2022 study that suggests that Black, middle-class callers were less likely to be offered an appointment with a new therapist than white, middle-class callers, even with the same insurance.
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Prejudice based on age
It’s also possible for a therapist to make assumptions about an individual based on their perceived age. For example, an older therapist may assume that a client who looks young has certain attributes that are considered common among Gen Z individuals. These assumptions could influence the therapeutic relationship and the guidance that the therapist offers.
Prejudice based on gender or sexual orientation
Another way that prejudice can negatively affect the therapeutic process is through preconceived judgments about those of various genders or sexual orientations. As open-minded as a therapist might strive to be with regard to sexual orientation, they may harbor harmful ideas about LGBTQ+ clients and their relationships. This can shape the guidance they provide to certain clients regarding interpersonal connections or life decisions. Sexual harassment is a form of gender-based prejudice and harm that could also occur in extreme cases.
What to do if you experience therapy prejudice and discrimination
If you experience stereotypes during therapy, you have a few different options for next steps.
- If you feel comfortable, you can talk to your therapist directly about them.
- You can also change therapists if needed until you find someone with whom you feel comfortable.
- Keep in mind, however, that you don’t have to confront your therapist directly or at all about their problematic views or behaviors if you don’t feel comfortable doing so. You can always change therapists without notifying them.
- You can report them to the appropriate agency or governing body to ensure they receive this important feedback.
The importance of culturally competent treatment
According to the Latino Behavioral Health Coalition, culturally competent care “encompasses understanding and respecting the client's cultural beliefs, values, and practices, and integrating this knowledge into the therapeutic process.” Therapists who receive extensive training on this topic with regular updates and refreshers may be better equipped not only to provide culturally competent care but to take accountability for the implicit biases that they, like all of us, hold and ensure that these are addressed so they do not harm the client.
Culturally competent care in the context of therapy is important because it can help the client feel safe, understood, and not judged. It can involve:
- Self-awareness
- Respectful communication
- Cultural humility
- Openness to feedback
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There's extensive research on the importance of a strong therapist-client relationship—namely, that it’s critical for productive sessions. Everyone deserves to receive the care they may need from an understanding therapist who does not reproduce any of the many forms of discrimination that exist in the world today. This can be especially critical for those who are seeking care to cope with past trauma related to this discrimination and/or who already experience it in their daily life.
Getting support from a culturally competent therapist
If you’ve experienced prejudice in some area of life, you might consider speaking with a licensed mental health professional about it. If you’ve had an experience with prejudice during therapy, know that there are culturally competent therapists available with experience across diverse backgrounds who may be equipped to provide more sensitive care.
The option of online therapy
For people who have experienced prejudice in therapy—or those who are concerned about experiencing prejudice—online therapy can serve as an alternative, as online therapy platforms tend to have a large selection of therapists from different backgrounds. For example, BetterHelp has a network of more than 25,000 licensed therapists, and individuals can be matched with someone based on their personal preferences in a therapist. Also, online therapy allows people to communicate with their therapist remotely in a way that’s comfortable for them, such as:
- Audio
- Video
- Live chat
- Or a combination of these methods
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In addition to offering a large pool of therapists and flexible communication options, research suggests that online therapy can often be effective for addressing a variety of mental health conditions. One review indicates that, in many cases, online cognitive behavioral therapy (CBT) can be effective for treating depression, generalized anxiety disorder, social anxiety disorder, and panic disorder, among other mental health diagnoses.
Takeaway
What are some ways that therapy prejudice can affect people living with disabilities?
Therapists or other mental health services providers might sometimes make assumptions about people based on their disability status. Misconceptions about certain disabilities may perpetuate harmful stereotypes and make a client feel unsafe and untrusting of their therapist. Without an accountable, aware, and compassionate provider, a client may experience negative emotions and not be able to receive the mental health support they may need.
What does social psychology say about bias?
Researchers and other psychologists have long studied something called “implicit bias.” The American Psychological Association defines implicit bias in the following way: “Implicit bias, also known as implicit prejudice or implicit attitude, is a negative attitude, of which one is not consciously aware, against a specific social group.” Research suggests that virtually everyone holds some forms of implicit bias due to the world in which we all live.
How can prejudice and discrimination affect treatment?
According to more than one study published on the topic, prejudice and discrimination can affect the way that a marriage and family therapist or other provider interacts with a client. They may make certain judgments in the therapy room about a client’s own experiences based on that client’s age, size, race, disability status, or another factor, which could negatively influence the quality of care they provide. It could also make the client feel unsafe and judged.
How does prejudice show up in family therapy?
Prejudice may affect family therapy if a therapist makes assumptions about a family based on factors like ethnicity, culture, or income. For instance, a therapist might assume that a family has certain cultural values or practices based on their background, even though families from any cultural group can have a diverse array of ideas and customs.
How can people fight therapy prejudice?
Fighting therapy prejudice can take different forms based on your role in the process, your social location, and your comfort level with various approaches. Therapists can engage in anti-bias, social justice, and cultural competency training. Clients may choose to report any therapist who provides biased and therefore potentially harmful care. People—from young people to college students to older adults—can also lead the charge to raise awareness of the existence of these forms of bias through social media by creating an open dialogue on the topic.
How can ageism affect mental health care?
Ageism can affect the way that a therapist approaches a treatment plan. For example, a therapist may make assumptions about a client’s life based on their age or perceived age and their preconceptions or past experiences with people of this age group. These ideas may have nothing to do with the individual client’s values and beliefs, and they can have a significant impact on therapy outcomes since they can damage the safe space that therapy is supposed to be.
What is prejudice in mental health?
Prejudice in a mental health setting can take many different forms. In general, however, it's when a mental health care provider engages with their client in a way that reveals underlying biases and discrimination, whether against race, age, sexuality, disability status, gender, and/or another identity. It can significantly negatively impact clients’ lives, self-esteem, and treatment outcomes due to the power dynamics, fear, and harm it can create, whether it’s a white person showing bias against a person of color or a neurotypical person showing bias against a neurodivergent person.
What is the difference between racism and prejudice?
The American Psychological Association defines prejudice as “a negative attitude toward another person or group formed in advance of any experience with that person or group.” Racism is a specific type of prejudice based on someone’s actual or presumed race.
Can you be prejudiced and not racist?
Prejudice can take many different forms. Racism is only one type, in addition to ageism, sexism, prejudice based on disability status, or body size, etc.
What is the emotional root of prejudice?
The emotional root of prejudice is often fear or insecurity. That said, it can be helpful for each individual to spend time reflecting on their own prejudices to recognize where they might stem from so they can be meaningfully addressed. Individuals might then work to cultivate more empathy so they don’t use marginalized individuals as a “punching bag” for their fears.
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