Navigating Client Generated Prejudice


In recent years, we have seen an increase in hate crimes and overt derogatory comments towards many cultural groups (Hassan, 2019). It would be naïve of us to think that oppressive language and behaviors do not enter the therapy room, as well.

Therapists may hear derogatory statements about various groups that may or may not include the demographic group of the therapist. Clients may also state derogatory comments about the therapist in session, and therapists may intuitively have different responses to a client’s derogatory statements. Some therapists may want to terminate therapy. Others may want to deconstruct the prejudicial thinking and incorporate anti-[fill in the word]-ism training into the treatment plan. Some therapists may just ignore the comments.What is the responsibility of the therapist when the therapy room becomes a hostile place because of the client’s negative perceptions and oppressive language? How do therapists ethically navigate client-generated prejudice?

Client-generated prejudice

The field has made slow, yet concerted efforts to incorporate intentional consideration of cultural context into the training of marriage and family therapists, clinical research, and clinical practice (Awosan, Sandberg, & Hall 2011; Castro, Barrera, & Steiker, 2010; COAMFTE, 2017). Therapists understand the importance of discussing culture in building and maintaining the therapeutic relationship in an effort to engage clients in the therapeutic process (Owen, Tao, Leach, & Rodolfa, 2011). Therapists also understand how to incorporate culture into treatment without “othering” the client, and how negative perceptions of differences between the therapist and client can undermine the therapeutic work.

To maintain the therapeutic relationship, therapists may tolerate hostile language or behavior from a client due to client’s transference (van Leeuwen & Harte, 2017).  Therapists may rationalize the hostile behavior as client’s projection, that has little to do with the therapist as person. Rarely is “othering” discussed as something therapists may have to endure, especially as it relates to ethical treatment of clients. Acts of hostility by the client towards the therapist due to personal and/or cultural identities was termed as [client] generated prejudice by Mbroh, Najjab, & Gottlieb (2019). Similar to “othering,” this hostility generally has its origins in prejudiced belief systems and can be demonstrated in numerous ways.

Ethical considerations

When client-generated hostility is due to the therapist’s role as a mental health professional, the therapist should call on their clinical training. It is necessary to remember the circumstances which bring our clients into our offices. The client is most likely in a state of distress and struggling to cope with a significant mental/emotional difficulty. Unlike our clients, we have resources of supervision, peer consultation, and the AAMFT ethics hotline to help us in deciding the best course of action. Many of our clients confide solely in their therapist about the vulnerable parts of their life.

Rarely is “othering” discussed as something therapists may have to endure, especially as it relates to ethical treatment of clients.

Although there has been increased emphasis placed on multicultural competence, diversity, and equity (COAMFTE, 2017), there fails to be adequate guidance on how family therapists are expected to handle client-generated prejudice, especially as it relates to the AAMFT Code of Ethics (Steele, 2011). While the profession may agree that this type of hostility does exist and may be cognizant of this occurring with therapists who present with minority or marginalized identities, it is less clear what types of protections therapists may have in these situations.

As clinicians, we are trained to diffuse intense situations and to manage the emotionality of others. For even the most experienced clinician, it can be difficult to anticipate what may cause a client to direct anger and discontentment towards a therapist during a session. We have all had sessions that end very differently than they began, or had a client express unhappiness with a piece of feedback we provide. How, then, do we ethically handle open hostility when it is related to our personal/cultural factors?

Therapists may want to consider their person-of-the therapist (POTT) concerns, the client’s history and diagnoses, the therapeutic relationships, and professional responsibility/ethical codes. Being a clinician does not equate to being a punching bag, but it does mean that we have the greater responsibility to bear in managing the situation. We must be able to acknowledge our own emotions, appropriately respond to what is happening in the moment, and figure out our next steps.

Safety is always the priority. There is no situation in which a therapist should compromise physical safety. In case of any physical emergencies, 911 should be called immediately. The therapist should also observe and follow any local guidelines about when and how to properly breach confidentiality to report harm towards others. If there are no safety concerns, the therapist should consider whether the hostility is related to their racial/ethnic background or any other identity-related or psychosocial factor.

Whether the social location of the therapist is visible to the eye or not, the therapist has to assess if treating this particular client could potentially cause harm to either person.

We learn in our training programs about the importance of facilitating change in our client’s life and we are taught how to challenge them out of their comfortable cycles of chaos. While in the midst of the therapy process, we can often forget how difficult being asked to change can be. This is not to suggest that we are to blame for client-generated prejudice, yet rather to highlight that we should anticipate how a client attempting to manage their change process may present as misplaced anger. Addressing the hostility and allowing the client to openly speak to their mixed emotions can serve to strengthen the therapeutic relationship.

Appropriately managing client-generated prejudice is an important part of providing treatment in any clinical setting. The occurrence can be upsetting and traumatic, but it can also be transformative and create a new pathway to healing. Barring the use of derogatory language, a client expressing hostility may be a function of vulnerability. We can use this emotional transaction to address the client’s treatment goals and incorporate it into what needs to be worked on. Conversely, the outward discontentment can help facilitate a conversation about whether there is a goodness of fit between the therapist and client. In this case, providing appropriate referrals and discharging the client may be best for both parties.

The topic of this article will be covered in a chapter by the authors in the upcoming AAMFT textbook on ethics.

Client-generated prejudice can be upsetting and traumatic, but it can also be transformative and create a new pathway to healing.

DeAnna Harris-McKoy is a licensed marriage and family therapist, an AAMFT Professional Member holding the Clinical Fellow and Approved Supervisor designations, professor, researcher, and social justice advocate. She has over 10 years of clinical experience with diverse populations and disorders in a variety of clinical settings. She is currently an associate professor and Specialization in Marriage and Family Therapy Program Director at Northern Illinois University. She has presented research at various local, national, and international conferences concerning Black mental health, adolescents, and social justice within the field of marriage and family therapy and received multiple awards for her community service, social justice work, and leadership.

Racine R. Henry, PhD, LMFT, has been practicing psychotherapy since 2008 and currently holds a license in Marriage and Family Therapy in New York. Dr. Henry holds a dual Bachelor of Arts degree in Psychology and Sociology/Social Psychology from Lehigh University, a Master of Science in Marriage and Family Therapy from Valdosta State University and a PhD in Couple and Family Therapy from Drexel University. Dr. Henry has done academic presentations at national and international conferences of several professional organizations along with publications in peer-reviewed journals, textbooks, and popular media literature. In addition to extensive work with couples, Dr. Henry is experienced in group therapy, family therapy, anger management training, and treating various mental health diagnoses including depression, infidelity, Post-Traumatic Stress Disorder, and adjustment issues. Currently, Dr. Henry is the founder of Sankofa Marriage & Family Therapy, PLLC and the creator of the “A Palate For Love”™️ series.

Taimyr Strachan-Louidor, PhD, is a licensed marriage and family therapist, and currently serves as a staff clinician at the University of West Georgia. She received a master’s degree in marriage and family therapy from Valdosta State University, and a doctorate in couple and family therapy from the University of Iowa. Strachan-Louidor is a former AAMFT Minority Fellow and her research agenda includes increasing the representation and engagement of minorities utilizing mental health services, increasing the representation of minorities as mental health service providers, and increasing cultural competence and awareness in training and clinical settings.


Awoson, C., Sandberg, J. G., & Hall, C. A. (2011). Understanding the experience of Black clients in marriage and family therapy. Journal of Marital and Family Therapy, 37(2), 153-68. doi:10.1111/j.1752-0606.2009.00166.x

Castro, F. G., Barrera, M., & Steiker, L. K. H. (2010).  Issues and challenges in the design of culturally adapted evidence-based interventions. Annual Review of Clinical Psychology, 6, 213-239. doi:10.1146/annurev-clinpsy-033109-132032

COAMFTE (2017). Accreditation standards: Graduate and post-graduate marriage and family therapy training programs. Retrieved from

Hassan, A. (2019, November 12). Hate-crime violence hits 16-year high, F.B.I. reports. The New York Times. Retrieved from

Mbroh, H. & Najjab, A., Knapp, S., Gottlieb, M. C. (2019). Prejudiced patients: Ethical considerations for addressing patients’ prejudicial comments in psychotherapy. Professional Psychology: Research and Practice.

Owen, J. J, Tao, K., Leach, M. M., & Rodolfa, E. (2011). Clients’ perceptions of their psychotherapists’ multicultural orientation. Psychotherapy, 48(3), 274-282. doi:10.1037/a0022065

Steele, K. (2011). When the patient is abusive to the therapist. ISSTD News, 29(4).

van Leeuwen, M. E. & Harte, M. J. (2017). Violence against mental health care professionals; prevalence, nature, and consequences. The Journal of Forensic Psychiatry & Psychology, 28(5), 581-598.

Other articles

Gray Divorce: Splitting Up Later in Life

Queer Therapists Practicing in Their Own Cultural Community: Proactive Ethical-Decision Making Suggestions

Discover some of the common ethical dilemmas that a therapist who works within their queer cultural identity may encounter and steps to take to be proactive and minimize any negative impact.
M. Evan Thomas, PhD and Mary R. Nedela, PhD

Meaning of Aging in a Time of Crisis

The Solid Ground of Integrated Ethical Practice

There is an expectation, a written and unwritten rule, a personal and professional imperative, that in order for couple and family therapists to practice from an ethical foundation, we stand on the solid ground of five principles.
Toni Zimmerman, PhD and Marj Castronova, PhD

Gray Divorce: Splitting Up Later in Life

Family Therapy Ethics with Service Members, Veterans, and Their Families

The U.S. Department of Defense is the largest employer in the world, thus it is highly likely that MFTs, whether intentional or not, will have the opportunity to work with service members, veterans, and their families (SMVF) throughout their career.
Meghan Lacks, PhD and Jessica Goodman, PhD