Unconscious bias in the therapy room: a practical guide for counsellors

What do we mean by unconscious bias in counselling

Unconscious bias refers to rapid, outside-awareness judgements influenced by social identity, culture and lived experience. It is distinct from general cognitive biases, though both can show up in our work and skew decisions if left unchecked. The task is to notice the tilt and act ethically to reduce harm.

Power asymmetry and reflexivity

Power asymmetry is the built-in difference between therapist and client. We set the frame, hold records, and often speak the professional language.

Reflexivity means turning the lens on our own assumptions and positionality, then adjusting how we work. A reflexive stance brings bias into view without shame and supports cleaner repairs when we get it wrong.

Where bias hides in plain sight

• Intake decisions: who we accept, waitlist or signpost, and why.
• Formulation: the first story we write and what it leaves out.
• Goal-setting: whose goals drive the plan and how success is defined.
• Risk notes: language that pathologises protective strategies.
• Attendance stories: meanings we give to lateness or cancellations.
• Interventions: who receives behavioural tasks and who gets relational depth.
• Airtime: who we challenge and who we protect from discomfort.
• Trauma lens: who is seen through a trauma-informed lens and who is not.
• Endings: who we invite to co-plan endings and who drifts out.
• Referrals: when we label something not our modality rather than explore a parallel process in supervision.

A note on weight bias and countertransference

Weight bias is a clear example of how cultural narratives can leak into the room. Countertransference around bodies can hinder attunement until it is owned and worked through in supervision. Acknowledging our reactions is a protective step for clients.

Common thinking traps that skew clinical judgement

Alongside social bias, familiar decision errors can tilt our calls:

• Anchoring on first impressions
• Confirmation bias
• Premature closure
• Availability and framing effects
• Base-rate neglect
• Sunk-cost effects
• Omission versus commission
• Overconfidence and visceral reactions

It is essential you put these unconscious bias on your supervision agenda so they are visible, not hidden.

What helps to reduce bias in everyday practice

• Slow the first three sessions. Generate at least two alternative hypotheses before you close on a formulation. Invite the client to co-author.
• Consider the opposite. Ask what would disconfirm your view, or what evidence would support an alternative story. This simple move reduces several biases.
• Use light-touch data. Simple client-rated alliance and outcome measures surface ruptures your gut might miss.
• Prefer structured prompts where possible. In many areas of human judgement, structured or actuarial tools outperform unaided clinical impressions. When appropriate, add a checklist or brief template to standardise how you combine information.
• Debrief difficult sessions with a bias checklist. Ask what bias might have shown up, and what would have proved you wrong. Pair this with a quick language audit of your notes.
• Supervision across difference. Periodically choose a supervisor or peer who differs in modality or background to widen your lens.

A short self-audit you can use this month

• In my last ten assessments, who did I accept, waitlist or refer, and what patterns do I notice?
• Which client groups evoke most ease or strain in me, and why?
• Where do I generalise from one client to people who are similar?
• Which CPD have I avoided because it challenges my preferred lens?
• Whose voices are missing from my bookshelf and podcast list?

Supervision prompts:

• Where might my theory be leading the clientupes here?
• If the client read my notes, what story would they say I missed?
• How are class, race, disability, size, gender or sexuality shaping the alliance?
• What am I avoiding because it threatens my self-image as a good therapist?
• If I am wrong about this client, what would I be missing?

Key take-away

You will not remove every bias. You can build a culture of noticing, inviting feedback and testing alternative views. That is how we protect the relationship and improve therapy. A no-shame stance helps us and our peers stay open enough to change habits over time.