Microaggressions and the Therapeutic Space
Last week I made an instagram post that seemed to resonate with more people than usual. I know this, because I got text messages about it from people who I did not even know used social media. While I think my post was pretty clear, I thought I would keep the conversation going, because it is a topic that requires more words than instagram will allow.
The idea of “not being enough” is repeated in my office multiple times everyday. It comes from all people of all backgrounds, genders, religions, ethnicities, ideologies, sexualities, and income levels. I would also argue that it can be one of the most damning mental health struggles of the human experience.
My original post was about the idea of not being “black enough”. In my personal experience I could also identify with the idea of not being woman enough, old enough, good enough, Christian enough, worthy enough, valuable enough, innocent enough, sexy enough, pretty enough, healthy enough, whole enough, and so on.
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There is no end to this list. Imagine carrying all of these around at any given time of your life, whether child, adolescent or adult. Imagine, or perhaps you already know, what this can do to one’s self-esteem, one’s confidence, one’s idea of their value. Yet, we often impose this idea of not being enough on not only ourselves, but each other.
NPR’s Andrew Limbong defines microaggressions is a “thinly veiled, everyday instances of racism, homophobia, sexism (and more) that you see in the world. Sometimes it's an insult, other times it's an errant comment or gesture.” Let me be clear, there is nothing “micro” about the effect of microaggressions, they have major impacts on society, policy, and people. They also reinforce this idea that something is innately wrong with who we are and how we choose to engage with life. No one would read an article that listed every microaggression, it would not end. Also, I doubt anyone has the entire list. I am going to go over a few for the point of education - and because I think we need to know just how not micro the issue is.
There are countless studies on the false beliefs medical professionals hold regarding “biological differences'“ between black and white people and how to treat (and believe) pain. I would argue that this would also be the reality of many brown people. Legally, I cannot tell you the stories I have heard from clients related to this. Just know they are horrifying.
Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Kelly M. Hoffman, Sophie Trawalter, Jordan R. Axt, and M. Norman Oliver
If the medical doctor minimizes your pain, and says it is not legitimate, what does this teach a human being? It could make people less likely to seek medical care, therefore less likely to catch potentially fatal conditions early on. It could lead people to question their own mental health because the doctor says nothing is wrong. It could also have people labeled if they decide that doctor is wrong. Should you continue to seek medical care elsewhere - what is written in that file often travels with you. Bias in the medical system teaches people that they are not worth the time it takes to provide adequate treatment
Our education system is filled with gender bias, race bias, IQ bias, language bias, teacher bias, name bias, and more. Yet what are we doing to address it? Vanderbilt University has a great definition for unconscious bias, “(or implicit bias) is often defined as prejudice or unsupported judgments in favor of or against one thing, person, or group as compared to another, in a way that is usually considered unfair”. \I mentioned name bias, if you are unfamiliar with what this is you are probably named something to the effect of Matthew, Mark, Luke, John, Mary, or Sarah. Those are all beautiful names, but you have probably never had anyone refuse to learn how to properly pronounce your name. You remember the kids in class who the teacher would mispronounce on the first day, or sometimes say with an attitude? Or the kids who would give a “USA friendly” name, or just go by whatever the first letter of their name was? Name bias is when we make assumptions about a person because their name is unfamiliar to us, or we simply refuse to learn the correct way to say it. Yet somehow this country has little problem with “Schwarzenegger”. Name bias is when a resume is passed over because the first name is Lupita instead of Karen. Name bias teaches children that they are not worth the time it takes to learn their name.
Even our language is designed to slant our view of human beings. Illegal immigrants - referring to the existence of a human being as innately illegal. Whatever your political stance or view on immigration, a human life in and of itself is not a violation of law. Autistic people, disabled people, depressed people, crazy people, those people, you people - the list goes on. One of the primary concepts learned in therapy training is the idea of a “person centered approach”. The person comes first, the behavior or condition is only a part of the whole person. A person with cancer, not a cancer person. A child with autism, not an autistic child. A child or person who probably has a hundred other different qualities, yet those often are not highlighted the same. Then there are some terms that are offensive and should not be used - like crazy, or referencing “you people” or “those people”. There are several other terms/labels that should never be used, but that would be an entirely different post. Placing the adjective, the descriptor, the label before the person communicates that you are first and foremost the label society has given you.
While one could argue (and many have tried) that most of these things are not innately, and perhaps not intentionally hostile, these microaggressions that pervade our society are also the foundations of systems that are directly related to the problems in our society. If society believes brown people cannot feel pain the same way, if society refuses to hire people with names they do not recognize, if society educates different kinds of students better than others - what kind of future does that lead to? It leads to a problematic one, filled with inequalities because people were treated without equity from the very beginning. I have only grazed the surface levels of the microggressions that exist. This idea that who we are deserves to be defined by something other than who we were designed to be. Now, this is a personal opinion, but I honestly believe that when we are born, we are born as wonderful, beautiful human beings. Then, life. Life interrupts, opinions come in, and from that moment on we are taught to question whether or not our hopes, dreams, feelings, sufferings, and interests are the ones we are supposed to have, are the ones others are supposed to have. Now I don’t disregard that guardians/parents/whatever community raises us, hopefully instill values of kindness, honesty, hard-work, confidence, etc. However, until we learn to encourage the strengths we come with, while modeling the values we need, we will do more harm than good.
How do microaggressions play into mental health? If you are struggling with the idea of not being enough - in any capacity - ask for help. If you can feel the effect of years of “micro” moments, ask for help. See a therapist, talk about it, process through it, and learn to see yourself as enough. You have every right to a whole life, where you know you are enough.
You also have the right to a therapist who has done the work to recognize their own implicit bias, is willing to address the elephant of different in the room, and/or apologize when they misstep. What does this mean? If you have not already noticed, I am black. I work with clients of all backgrounds. I have, and have had, many clients who come to me because I am black. I have others who come to me for my specialty (or both). I have others who called the front desk, were put on my calendar, and have no idea who I am until they walk in my office.
I am what I like to call a direct therapist. So, in the first session I identify myself as a black, female, therapist, trained in XYZ. (Please know that my identification is something I am willing to share with clients, your therapist is not required to share their personal life with you. Every therapist is different, but if it is important to you - seek a therapist that meets your needs.) Then I ask if they have any questions or concerns about my training or my identification, whether it is the same or different from their self-identification. No two experiences are the same. As the client, they have every right to the kind of therapist they feel most comfortable with. I sincerely do not care who that is. If they were brave enough to ask for support, I am not going to stand in their way now. So far, no one has ever identified my blackness or gender as a problem, at least not to my face. However, I also give them an out. I say “therapy is extremely relational. If at any time you feel as though I am not a good fit you don’t even have to tell me. You can call the front desk, ask for another therapist, and I won’t know the difference. I don’t work on Mondays, so you could even come on my off day!” On the one hand, this gives them the autonomy to make decisions on their own therapy process, but also lets them know that I want them to be comfortable. Usually, clients express relief that I have told them this directly. If your therapist did not tell you this, if your therapist did not give you an out, know my statement applies to you too. Unfortunately, there may be some cases where a different therapist is not possible - during some hospitalizations, certain mandated programs, etc. In many cases, you have the ability to move to a therapist that is most appropriate for you.
I also let clients know that if I feel I am not the best fit for them, or most clinically appropriate, I will be sure to have that conversation with them directly. Find a therapist that calls you by the name you prefer, not just the one that is easiest for them. There is no perfect therapist. Still, you deserve a therapist who will make the effort. Your therapist does not need to be the exact same as you, but they should recognize that they see you. Seeing you, means acknowledging the differences. Also, do not assume that because your therapist is brown/queer/tall/short/left-handed/whatever, that they are free of bias. This simply is not true. Maybe their bias does not look like yours, but maybe it does. Bias, microaggressions, and stereotypes, are not exclusive to race. Ask your therapist about what training they have done to learn about bias, acknowledge their own, learn about race, ethnicity, the LGBTQIA experience, the immigrant experience, etc. Ask the questions you need the answers to. If your therapist has not done the work, if your therapist is perpetuating some of the above microaggressions (or any not identified above), this will create barriers in your therapeutic process. In some cases, it leads to ending therapy for good.
If you (like we all are to some degree) perpetuate the idea of not being enough on others, recognize what is yours, and what is theirs. Read any or all of the links above. Being willing to make certain decisions because that is a preference, cannot be the expectation put on everyone else. If that decision is a critical value for you, choose people that support and nourish that value, yet it does not give you permission to degrade (intentional or not) those that choose otherwise. Just because you may not want to name your child the same thing as your neighbor, does not mean you should refuse to pronounce their name correctly when they are a student in your classroom/interview. While it is not any one member of a group’s responsibility to educate you on the history of a group - ask a a well intended question before making a potentially harmful conclusion. Stop assuming to know anything about who or what someone else is “supposed” to be based on sometimes hurtful, preconceived notions. Choose humility, educate yourself, and if still unsure after taking time to learn, ask before assuming. Not understanding or having knowledge of another culture/group/identity, is not an excuse to make assumptions and behave accordingly.