Racial/ethnic matching of clients and therapists in mental health services: A meta-analytic review of preferences, perceptions, and outcomes.

Across several decades the effects of matching clients with therapists of the same race/ethnicity have been explored using a variety of approaches. We conducted a meta-analysis of 3 variables frequently used in research on racial/ethnic matching: individuals' preferences for a therapist of their own race/ethnicity, clients' perceptions of therapists across racial/ethnic match, and therapeutic outcomes across racial/ethnic match. Across 52 studies of preferences, the average effect size (Cohen's d) was 0.63, indicating a moderately strong preference for a therapist of one's own race/ethnicity. Across 81 studies of individuals' perceptions of therapists, the average effect size was 0.32, indicating a tendency to perceive therapists of one's own race/ethnicity somewhat more positively than other therapists. Across 53 studies of client outcomes in mental health treatment, the average effect size was 0.09, indicating almost no benefit to treatment outcomes from racial/ethnic matching of clients with therapists. These 3 averaged effect sizes were characterized by substantial heterogeneity: The effects of racial/ethnic matching are highly variable. Studies involving African American participants demonstrated the highest effect sizes across all 3 types of evaluations: preferences, perceptions, and outcomes. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Psychotherapeutic services for ethnic minorities: Two decades of research findings.

Considerable controversy exists over the effectiveness of psychotherapy for ethnic minority clients, especially when treated by White therapists. Some researchers and practitioners believe that ethnic clients are less likely to benefit from treatment. Others maintain the position that ethnic clients are as likely as Whites to show favorable outcomes from treatment and that ethnic or racial matching of clients and therapists is unnecessary. The available research findings fail to demonstrate that ethnic minorities achieve differential treatment outcomes, which tends to support the latter position. Explanations for the persistence of the controversy have included the lack of rigorous research on the issue and the social-political context of the controversy. This article argues that the issue has been misconceptualized. Ethnic or racial match in treatment is more of a moral/ethical concern, whereas cultural match is more of an empirical issue. Failure to differentiate between the two types of matches has prolonged an unresolvable question. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Do therapists address ethnic and racial differences in cross-cultural psychotherapy?

Ethnic and racial differences between client and therapist affect therapy processes and outcomes, but little is known about the extent to which therapists have dialogues about their differences in therapy. A survey on this topic was completed by 689 APA-licensed psychologists with experience conducting cross-cultural therapy. Most psychologists reported having such discussions, but with less than half of their cross-ethnic/racial clients. Therapists and clients were equally likely to initiate discussions. Reasons for discussing differences varied greatly. Therapists consistently described themselves as comfortable with and skilled at these discussions, and reported that discussions facilitated therapy. Therapists who were female, older, nonminority, less experienced with diverse clients, and viewed training as an important factor were more likely to have discussions about differences. Results point to the need to better understand if, when, and how ethnic and racial differences should be addressed in therapy. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Cultural control in psychotherapy with minority clients.

Reviews the literature on mental health services for minority clients, suggesting that these persons experience special problems with the traditional mental health delivery system. Epidemiological and attitude studies have indicated that minority client and majority therapist expectations for psychotherapy are often discrepant. Counseling and psychotherapy outcome research on therapist–client racial pairing has yielded inconclusive results at present. It is hypothesized that the therapist–client racial pairing may interact with level of therapist dominance in affecting psychotherapy outcome. Dominant majority clinicians may manipulate minority persons toward majority values, which may comprise a form of cultural control. Highly dominant clinicians are posited to function more effectively with culturally similar clients than with culturally different clients in that domination may be appropriate to a certain degree in culturally homogeneous settings. Low dominant clinicians are posited as being more effective than highly dominant clinicians with culturally different clients in that they would be more likely to attempt to understand the client's cultural perspective in a nonmanipulative manner. (100 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ethnic matching and treatment outcome with Hispanic and Anglo substance-abusing adolescents in family therapy.

This study examined treatment outcomes of 86 highly acculturated Hispanic and Anglo substance-abusing adolescents in functional family therapy, testing the hypothesis that ethnic matching of therapist and client is related to better treatment outcomes for clients. Adolescents reported on their substance use pre- and posttreatment on a timeline follow-back interview. Ethnically matched Hispanic adolescents demonstrated greater decreases in their substance use compared with Hispanic adolescents with Anglo therapists. Ethnic match status was not related to treatment outcome for Anglo clients. Thus, the matching hypothesis was supported for Hispanic clients only. The results underscore the importance of greater ethnic diversity among therapists and better cultural competency training for Anglo therapists. More research is needed on individual differences in the effects of ethnic matching. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

How do graduate student therapists incorporate diversity factors in case conceptualization?

Researchers interviewed 17 psychotherapists in training in an analogue study of psychotherapists' use of broadly defined diversity factors in conceptualizing clients and cases. Each therapist watched two 5-minute staged videotapes of clients who varied along dimensions of race and ethnicity, age, and gender. Each acting client described problems in an initial psychotherapy interview, and then participant therapists responded to questions. Participants demonstrated varying levels of multicultural competence. Many exhibited knowledge in the areas of culture-specific values, and family and gender roles; awareness of their own cultural background and its effects on the therapeutic relationship; and skills in treatment planning, including assessment of levels of acculturation and culturally appropriate treatment methods. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Understanding the psychological processes of the racial match effect in Asian Americans.

Some studies on mental health outcomes research have found that when clients and therapists are ethnically or racially matched, this tends to be related to greater satisfaction and better outcomes. However, the precise underlying mechanism for the match effect has not been extensively examined. In this experimental study, we tested the effect of racial match on critical counseling processes (i.e., therapist credibility and the working alliance) using a sample of 171 Asian American respondents. We also examined Asian ethnic identification as a potential moderator of the racial match effect. Structural equation modeling analyses indicated that racially matched individuals perceived greater experiential similarity with the therapist than nonmatched individuals, and experiential similarity was positively associated with therapist credibility. Although racial match did not predict attitudinal similarity, attitudinal similarity was strongly related to the working alliance and therapist credibility. Counseling implications are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Predicting cultural competence: Implications for practice and training.

Training and work experience with clients from diverse groups were examined among 266 recent PhDs in counseling and clinical psychology. Surveys were mailed to 600 participants who completed their graduate work between 1985 and 1987. Analyses examined which training variables predicted self-rated competence in providing services to various cultural groups. Results indicated that most therapists reported competence in working with diverse clients, but there was notable variability among ratings of therapists' self-perceived competence with different client groups. Exposure during training to working with clients from specific cultural groups was important in predicting therapists' current perceived competence. Most respondents reported accessing education and training experiences in providing services to diverse client groups. A small but troubling number of respondents reported seeing clients despite reporting low levels of competence with that client group. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Caregiver-Therapist Ethnic Similarity Predicts Youth Outcomes From an Empirically Based Treatment.

The effects of caregiver-therapist ethnic similarity on youth outcomes from multisystemic therapy (MST), as implemented in dissemination sites, were examined. Consistent with hypotheses, findings confirmed that youths whose caregivers were ethnically matched with their therapists demonstrated greater decreases in symptoms, longer times in treatment, and increased likelihood of discharge for meeting treatment goals relative to youths whose caregivers and therapists were not ethnically matched. In addition, for youths whose caregivers were of mixed ethnic heritage, caregiver-therapist ethnic match was associated with greater improvements in psychosocial functioning. Ethnic match effects on both treatment length and discharge success were partially mediated by therapist adherence to MST. This study shows the importance of examining the effects of both client and therapist ethnicity on outcomes from empirically based treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changing what has gone before: The enhancement of an inadequate psychology through the use of an Afrocentric-feminist perspective with African American women in therapy.

African American women face a variety of mental health issues due to their racial, historical, cultural, and economic position in American society. The synergistic effect of these variables and their interaction with mental health correlates creates an atypical therapeutic situation for many therapists and clients. The heritage of racism and sexism found within traditional psychological concepts severely limits the effectiveness of therapy with this population. Effective therapy with the African American female client (1) identifies the therapist's world view based on developmental and sociocultural influences, (2) examines therapist and client differences that could affect the therapeutic process, (3) makes use of community and interagency resources, and (4) stresses an approach that synthesizes Afrocentric and feminist perspectives. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-reported sources of stress among psychotherapists.

264 therapists from a state in the midwestern US were surveyed to (1) confirm and clarify sources of stress for psychotherapists that originate in client sessions and the professional role and (2) explore certain irrational beliefs that therapists may hold and that may contribute to their own stress. Ss were asked to complete a questionnaire that assessed background information and therapist beliefs and that contained a 36-item therapist stress scale. Irrational beliefs (e.g., that one should operate at peak efficiency and competence with all clients at all times) are examined. Suicidal ideation, aggression/hostility, premature terminating, agitated anxiety, and apathy/depression were held to be the most stressful client behaviors, while crying, absence of gratitude, and negative community stereotypes were the least stressful. Group differences in stress are described, and implications for training programs and for more refined research endeavors are discussed. (36 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

White therapist and female minority clients: Gender and culture issues.

Discusses ramifications of a White female therapist working with female minority clients. The personality of the therapist and the meaning of White and minority to him/her appear to be important variables for success with minority clients. It is argued that therapy with minorities must always be viewed in the context of one's own political perspective, attitudes, and biases and that racial homogeneity for client and therapist is less important than interpersonal trust in a situation of gender likeness and equality. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dynamics of Race and Culture in the Supervisory Encounter.

The rapid increase in racial/ethnic minority populations in the United States implicates the necessity of implementing new approaches to the training of psychologists. The author proposes that the integration of racial and cultural diversity related issues in clinical supervision is an essential component of clinical and teaching competence, which has important implications for the provision of services to ethnic minorities and, more broadly, to better addressing the full realm of clients' intrapsychic and interpersonal worlds. Psychodynamic aspects of the supervisory encounter, such as the narcissistic struggles of the supervisor and supervisee and racial and cultural elements in transference, contribute to supervisory interactions around race and culture. Clinical illustrations are discussed to elaborate these dynamic processes. Recommendations for supervisors on how to explore race and culture in a safe supervisory space are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cultural competence and evidence-based practice in mental health services: A complementary perspective.

The need for cultural competence and the need for evidence-based practice in mental health services are major issues in contemporary discourse, especially in the psychological treatment of people of color. Although these 2 paradigms are complementary in nature, there is little cross-fertilization in the psychological literature. The present article illustrates the complementary nature of these 2 paradigms. A main point of convergence is related to the development of culturally adapted interventions in the move from efficacy research to effectiveness studies. The implications of cultural adaptations of empirically supported treatments for mental health services in terms of research and practice with ethnic/racial minority populations are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Racial/ethnic differences in breast cancer outcomes among older patients: Effects of physician communication and patient empowerment.

Objectives: To examine racial/ethnic disparities in older women's health-related quality of life (QoL) and type of breast cancer treatment as mediated by physician-level and individual-level variables. Methods: A cross-sectional survey of a population-based, consecutive sample identified through the Los Angeles Cancer Surveillance Program of Latina (n = 99), African American (n = 66), and White (n = 92) women aged 55 years or older (N = 257) between 3 and 9 months after primary breast cancer diagnosis and at least 1 month posttreatment. An exploratory, empirically developed latent variable model tested the relationships among demographic and physician-related variables, patient attitudes, and health-related outcomes. Health-related outcomes included QoL measures and receipt of breast conserving surgery (BCS). Results: Latinas reported less BCS and poorer QoL compared with Whites. Physician communication that can empower patients, in terms of patient efficacy in patient?physician interactions and breast cancer knowledge, mitigated racial/ethnic disparities in receipt of BCS. Physician emotional support was not related to patient cognitive empowerment and treatment outcomes. Medical mistrust in minority women was related to less self-efficacy and less positive coping, as well as, both directly and indirectly, to reduced QoL. Latinas reported poorer QoL in the tested model. Conclusion: Physician communication style, specifically information giving and participatory decision making, may empower older women with breast cancer and help mitigate racial/ethnic disparities in surgical treatment received. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

“Those who learn have a responsibility to teach”: Black therapists' experiences supervising Black therapist trainees.

This phenomenological study examined how 12 Black psychotherapists in college counseling centers around the country experienced the supervision of Black therapist trainees. Participants described how their relationships and methods of supervision differed when working in same-race dyads. They reported feeling closer to their Black supervisees in ways that often felt familial. The therapists described serving as mentors for their Black supervisees. They also reported discussing race more frequently in supervision, and they perceived that their Black supervisees felt safer having Black supervisors. The study also suggests implications for the training of ethnic minority therapists and supervisors. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Sex bias in psychotherapy: An examination of the effects of client sex, pathology, and therapist sex on treatment planning.

Investigated the effects of therapist sex, client sex, and client pathology on treatment goals formulated by a pool of 32 male and 32 female practicing psychotherapists (psychiatrists, clinical psychologists, psychiatric social workers, and therapists from related disciplines). Each therapist recommended treatment goals for either 2 male or 2 female pseudoclients who differed in their presenting pathology, which was severe and clearly defined. Male therapists chose significantly more feminine treatment goals for all their clients, whereas female therapists chose significantly more masculine goals, regardless of client sex. Therapists responded to the client's pathology, rather than the client's sex, in formulating treatment goals. This suggested either that client sex is not important in determining treatment goals or that client sex may affect therapists' treatment goal choice only when pathology is vague or not severe. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cultural competence: A new way of thinking about integration in therapy.

This article, based on a keynote speech delivered to the 2009 conference of the Society for the Exploration of Psychotherapy Integration, offers a model for understanding cultural competence as a strategy for psychotherapy integration. Paradigms for what constitutes cultural competence in psychotherapy are explored, and the development of an epistemology of cultural competence that includes understandings of therapist bias and both therapist and client intersectionalities of identity are examined. (PsycINFO Database Record (c) 2010 APA, all rights reserved)