Learning to Notice: Everyday Discrimination in Psychotherapy. A Qualitative Analysis of the Experiences of Marginalized Patients in Psychotherapy

Background: Psychotherapy should provide safety and equitable care, but for marginalized patients, it not infrequently becomes a setting for subtle experiences of discrimination. Microaggressions perpetrated by therapists can jeopardize both the therapeutic alliance and the treatment outcome, especially when they go unrecognized. Objective: In what forms do typical microaggressions occur in German psychotherapy? Methods: We collected reports of N = 278 marginalized patients about their experiences with racism, sexism, heterosexism, and cis-sexism during psychotherapy in online surveys and evaluated them using content analysis. Results: We identified ten common types of psychotherapeutic microaggressions that occurred across diverse groups of individual patients and therapeutic approaches and reflect a structurally embedded pattern of subtle discrimination. Conclusions: The presented taxonomy provides a basis for improving awareness, self-reflection, and cultural humility in psychotherapeutic practice.