Addressing Ableism and Microaggressions in Therapy: Guidelines for Culturally Responsive and Inclusive Practice

Disability is a broad, diverse, and often misunderstood identity that intersects with many family systems. One key barrier that clients with disabilities face in therapy is ableism, which includes both overt discrimination and subtle, everyday microaggressions that can undermine the therapeutic alliance and retraumatize clients. This paper explores the role of ableism in clinical practice with individuals and families, emphasizing how marriage and family therapists can address ableist dynamics through a family systems lens. Beginning with a contextualization of disability in family systems work, this paper highlights the self of the therapist, microaggressions in the therapy room, and considerations for clinical training and supervision. Through a case illustration and practical recommendations, this paper offers guidance for creating affirming, ethical practices. The paper concludes with implications for evidence-based models, assessment measures, and teletherapy, followed with future directions in research and training, calling for intentional changes to promote culturally responsive and inclusive practice for clients and families with disabilities.