Addressing cultural ruptures in group therapy
Therapy groups are microcosms of society, reflecting the interpersonal dynamics of individual clients. Aspects of each client’s sociocultural identities (e.g., race, gender, sexual orientation) relate to broader cultural norms and experiences. Group leaders face challenges in navigating difficult cultural processes within group sessions. There is little in the literature on cultural ruptures in the form of microaggressions, leaving practitioners without guidance and clients without needed support.
In an article published in Group Dynamics: Theory, Research and Practiceopens in new window, Joseph Miles, Christopher Anders, Martin Kivlighan, and Aziza Belcher Platt recommend clinical practices for engaging in cultural group processes, including what to do when microaggressions rupture group alliance. Microaggressions—subtle acts of discrimination, such as racial slurs, assumptions based on perceived cultural characteristics, and pathologizing culture—can disrupt positive therapeutic processes and outcomes. Previous research has shown that microaggressions are associated with decreased self-esteem; feelings of shame, anger, and worthlessness; increased rates of distress and depression; and higher rates of substance use disorders. In individual therapy, microaggressions have resulted in early termination, low treatment use, weakening of the therapeutic alliance, and negative treatment outcomes.
Unfortunately, these are frequent occurrences within psychotherapy; a number of studies have demonstrated that between 53% and 81% of clients experience microaggressions while in therapy. Furthermore, microaggressions were rarely addressed within sessions or recognized by therapists. Though there is less research on microaggression in group settings, it is likely that they occur at a similar rate and have similar impacts for group members. Miles et al. argue that finding ways to identify and address microaggressions in therapy groups is crucial for group therapists to ensure well-being and benefit of therapy for clients.
Miles et al. offer useful suggestions for practitioners to address cultural ruptures when they occur and to cultivate group norms that encourage difficult cultural dialogues. They recommend that group leaders take action at both the therapist level and the group level. For example, therapists can develop multicultural competencies and multicultural orientation, understand how uncomfortable or painful emotions deter cultural dialogues, and formally or informally assess group members’ racial–cultural identity development. Group leaders may note cultural ruptures when they occur, check in and support the target of the microaggression and those with shared marginalized identities, educate the perpetrator, help to increase affective tolerance by managing shame and defensiveness, and seek to provide a correction emotional experience. Recommendations for clinical practice are presented, along with a vignette to illustrate how group leaders can enact culturally affirming care.
Note: This article is in the Clinical Psychology topic area. View more articles in the Clinical Psychology topic area.