Making cross-racial therapy work: A phenomenological study of clients’ experiences of cross-racial therapy.

Abstract

A phenomenological/consensual qualitative study of clients' lived experiences of cross-racial therapy was conducted to enhance our understanding of whether, how, and under what conditions race matters in the therapy relationship. The sample consisted of 16 racial/ethnic minority clients who received treatment from 16 White, European American therapists across a range of treatment settings. Participants who reported a satisfying experience of cross-racial therapy (n=8) were examined in relation to gender-and in most cases, race/ethnicity-matched controls (n=8) who reported an overall unsatisfying experience. Therapy satisfaction was assessed during the screening process and confirmed during the research interview. Therapy narratives were analyzed using consensual qualitative research to identify the client, therapist, and relational factors that distinguished satisfied from unsatisfied cases. Findings reveal substantial differences at the level of individual characteristics and relational processes, providing evidence of both universal (etic) as well as culture/context-specific (emic) aspects of healing relationships. Recommendations for facilitating positive alliance formation in cross-racial therapy are provided based on clients' descriptions of facilitative conditions in the therapy relationship. KeywordsRacial/ethnic matching; psychotherapy; therapeutic alliance; phenomenology With the quickening pace of population growth among racial and ethnic minorities in North America, interracial encounters in the therapy context are becoming increasingly common. A 2007 survey of 20,046 American Psychological Association (APA) members indicated that 86% of respondents already provide services to racial and ethnic minority clients (APA Research Office, 2003). However, the bulk of these services continue to be provided by White, European American therapists despite efforts to diversify the mental health workforce. While there are a number of visible markers of difference (e.g., gender, social class, age), race and ethnicity have been identified as particularly salient for both therapists and clients (Comas-Diaz & Jacobsen, 1991). As a result, multicultural counseling competence guidelines have highlighted the importance of attending to racial and ethnic issues in particular as they impact the therapy relationship (Sue, Arredondo, & McDavis, 1992).Correspondence regarding this article should be addressed to Doris F. Chang, Department of Psychology, New School for Social Research, 80 Fifth Avenue, 7 th Floor, New York, NY 10011, changd@newschool.edu. Publisher's Disclaimer: The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or o...

Clients' perceptions of their psychotherapists' multicultural orientation.

“…For instance, Chang and Berk (2009) found that some racial/ethnic minority (REM) clients reported that cultural issues were not central in their psychotherapy process. Further, Maxie et al (2006) found that psychotherapists are most likely to attend to cultural issues when these topics are raised by clients or when they are associated with clients' presenting issues.…”

Counselling Psychology

“…Studies that match client and therapist based on similarities appear to suggest that some similarities can positively impact on the client's progress in therapy, whilst others do not affect any change (Chang & Berk, 2009;Flicker et al, 2008;SquarezMorales et al, 2010;Wintersteen et al, 2005). The predictive elements of which similarities are beneficial is unclear, since too many variables are reported to interfere with the outcomes (Dougherty, 1976;Karlsson, 2005;Sue, 2003).…”

“…There are studies that explore identification within the context of person centred and psychodynamic theories relating to empathy, countertransference, transference and projections (Ehrenberg, 1995;Racker, 1972;Rogers, 1951;Watkins, 1985;Zimberg et al, 1985). The literature that matches client-therapist dyads, based on similarities, also offers some insight into identification in the shared experience (Chang & Berk, 2009;Flicker et al, 2008;Squarez-Morales et al, 2010;Wintersteen et al, 2005). This study will now focus attention on these domains of knowledge.…”

Conceptualizing Culturally Infused Engagement and Its Measurement for Ethnic Minority and Immigrant Children and Families

“…Moreover, for ethnic minority and immigrant clients, beliefs regarding self-disclosure may be even more convoluted due to factors such as unfamiliarity with mainstream psychotherapy's emphasis on client self-disclosure, cultural mistrust toward providers, and stigmatizing beliefs related to seeking help for emotional distress (Nickerson et al 1994). Studies suggest that ethnic minority and immigrant clients are less likely to selfdisclose with a Caucasian provider due to fears of discrimination and unfair treatment (Chang and Berk 2009) and more likely to disclose willingly to racially similar providers (Helms and Carter 1991;Thompson et al 2004). This indicates that an important strength of the provider-client therapeutic relationship, without the understanding of culturally nuanced dimensions, may be diminished in effectiveness with ethnic minority and immigrant clients.…”

“…In contrast, when culture is overlooked in the therapeutic process, misunderstandings are likely to arise, stemming from conflicting worldviews, values, and goals, resulting in client discomfort and poor treatment engagement and outcome (Pan et al 2011). In fact, clients' level of trust and perceptions of clinician credibility were linked to clinicians' ability to tailor treatment to clients' specific contexts and history, and to address minority-specific experiences such as discrimination and acculturation (Chang and Berk 2009). …”