Addressing Unconscious Bias Or Implicit Bias As A Therapist

Addressing unconscious biases can be part of providing effective and equitable care. Navigating these blind spots can be crucial for creating a therapeutic environment where every client feels heard, understood, and respected. 

This article covers what unconscious bias is and why it is important to know as a therapist. We also delve into examples of unconscious bias and steps to overcome it in your practice. 

What is unconscious or implicit bias? 

Unconscious bias, or implicit bias, refers to the attitudes or stereotypes that can unconsciously affect one's understanding, actions, and decisions. 

These biases differ from known biases that people may choose to conceal and are often hidden, even from ourselves. Research indicates these biases are often formed in early life to middle childhood from our learned experiences, reinforcement of social stereotypes, and experiences from those around us. As children grow and interact with the world around them, they start to internalize observed behaviors and attitudes, which gradually contribute to the formation of these implicit biases. 

The impact of unconscious bias on diversity and inclusion

Unconscious bias can have a negative impact on diversity and inclusivity in a team. It can be a challenge to DEI (diversity, equity, and inclusion) in organizations, healthcare, and education. Certain factors, such as backgrounds, media, and learned behaviors, may influence a person’s behavior. This can unconsciously affect their perception of people based on gender, race, age, and other characteristics. 

Unconscious biases in the workplace, education, & healthcare

Unconscious biases can have significant impacts on behavior. They can influence actions in workplaces, educational institutions, and healthcare environments. They can lead to a range of microaggressions and systemic discriminatory behavior, often without conscious awareness by the individuals perpetrating them. 

Examples of unconscious bias or implicit bias in a workplace that affect diversity and inclusion 

Some workplaces may experience the following implicit biases:

• The preference of male over female candidates in promotion or hiring.
• An individual who spends more time with another employee because they have the same interests, background, gender, or other characteristics. 
• Assuming that a younger employee does not deserve the promotion because they have less experience.
• Name bias during the hiring process.

What causes implicit biases? 

Heuristics are cognitive shortcuts that our brains use to make quick judgments in our complex world, and they involve categorizing information or people based on past experiences, societal norms, and social conditioning. For example, our brains might automatically categorize people into certain groups based on visible characteristics, like race, gender, or age. This categorization process, while efficient, can lead to the development of stereotypes. 

Environmental factors, like the culture we grow up in, the attitudes of those around us, and our personal experiences, can play a significant role in shaping these biases. Recognizing and understanding biases is often the first step towards addressing them and making more informed decisions. 

22 examples of unconscious biases 

There are different types of unconscious prejudices that can affect a person's view of the world. Here are a few examples. 

1. Affinity bias – The tendency to lean toward people who are similar to you in appearance, beliefs, or backgrounds.
2. Ageism – This bias involves making assumptions based on a person's age. 
3. Anchoring bias – The reliance on the first impression to make decisions later. 
4. Attribution bias – The tendency to attribute one's success to personal skills and failures to outside factors but do the opposite for others. 
5. Authority bias – The inclination to value the opinions of authority figures, regardless of their actual credibility. 
6. Availability bias – Overestimating the importance of available data while underestimating the importance of information that's not immediately present. 
7. Bandwagon effect – The tendency to do or believe things because many others do or believe them. 
8. Beauty bias – The subconscious preference for physically attractive people. 
9. Class bias – The tendency to make assumptions about people based on their social class or economic status. This can affect perceptions of intelligence, worthiness, or character. 
10. Confirmation bias – This cognitive bias is the inclination to pursue and interpret information in a way that confirms your preconceptions. 
11. Contrast effect – This occurs when you compare things and exaggerate their differences. 
12. Dunning-Kruger effect – One of the most discussed cognitive biases is where people with low ability overestimate their ability at a task. 
13. Gender bias – This is the unconscious preferences and stereotypes related to gender. 
14. Halo effect – This is the tendency to let one positive aspect influence your entire impression of a person. 
15. Height bias – This is a subconscious preference for taller people. One study found that one centimeter of height can increase earnings by as much as 13%. 
16. Horn effect – This is the opposite of the halo effect, and it's the tendency to judge a person based solely on one negative trait. 
17. In-group bias – The tendency to favor one's own group, viewing it more favorably than out-groups. 
18. Name bias – The tendency to favor people based on their names – particularly when the names are racially ambiguous or of Anglo origin. 
19. Negativity bias – The tendency to pay more attention to negative events than positive ones. 
20. Overconfidence bias – This bias leads individuals to overestimate their own abilities, knowledge, or influence. 
21. Social identity bias – The inclination to favor or discriminate against someone based on a particular identity they hold, which could be related to their race, ethnicity, gender, sexual orientation, or any other defining characteristic. 
22. Sunk cost fallacy – The tendency to continue something once an investment in money, effort, or time has been made, even when continuing is not the best course of action. 

Therapists and patients: How unconscious biases can show up in therapy

These unconscious biases can significantly impact interpersonal interactions, including therapy. They can influence how patients perceive and interact with their therapist. For example, they may have preconceived notions about the therapist's competence based on age, gender, or appearance, which could impact their openness and trust. Additionally, biases can impact mental health treatment outcomes too. For instance, a patient with depression might hold a gender bias, believing that expressing emotional vulnerability is a sign of weakness, or a patient with PTSD might carry biases based on their traumatic experiences, leading to distrust or fear towards certain groups or situations. 

How unconscious biases can affect therapists

For therapists, unconscious biases can subtly influence their perceptions, interpretations, and interactions with clients. It can also impact the level of empathy and understanding. Some research shows that therapists may inadvertently minimize or misunderstand the experiences of clients from different backgrounds – particularly when cultural or racial biases are at play. When therapists are unaware of their implicit biases, they might struggle to create an empathetic and supportive environment and fail to connect with clients. This is why it's important for therapists to identify and address their biases. 

Steps therapists can take to navigate implicit or unconscious biases

Everyone has implicit biases, but research shows that they are malleable and that people can take steps to minimize their impact. Here are some steps therapists can take to start the process. 

Identify your own blind spots 

The first step to overcome biases is to identify them. This can be challenging since these biases are unconscious. Reflecting on your personal experiences and seeking feedback from colleagues can be helpful. It can also be beneficial to take self-assessments, like the Implicit Association Test, to get a better idea of what biases may not be initially apparent.  

Continue learning about biases 

Ongoing education about biases via workshops, books, and conversations can provide valuable insights and practical tools for handling biases effectively. This continuous learning can also help you stay current and sensitive to the diverse needs of your clients.  

Consider incorporating tools into your practice 

Consider using diagnostic tools, like the APA's Cultural Formulation Interview (CFI) or a culturagram, to understand your client's cultural background better. These diagnostic tools can minimize your subjective bias in diagnosis and treatment planning. 

Help your clients navigate their biases during therapy

If you notice your clients' unconscious biases could be affecting their treatment outcomes, you can help them address their biases by: 

• Providing education about biases 
• Encouraging self-reflection to help them recognize their biases.
• Facilitating open discussions about social dynamics and biases  
• Providing resources for learning more about biases.
• Modeling unbiased behavior in therapy sessions

Addressing unconscious bias: Speak with a professional

Talking through your biases with a therapist can be helpful. They may be able to see issues or biases that you can't or offer insights into different cultures and experiences. Getting help from another therapist can ensure you hold yourself accountable in a non-judgmental and supportive space. Self-reflection from therapy can be critical to ensure that you provide the most unbiased and effective care to your patients. 

Online therapy for unconscious biases

If talking about your biases face-to-face feels uncomfortable, or if you don't have much time in your schedule for your own therapy appointments, consider online therapy. With online therapy, you get more flexibility and the ability to attend sessions in a space that feels comfortable to you. 

In addition, research shows that online therapy is as effective as in-person therapy for self-reflection.