Psychotherapy racial/ethnic disparities in treatment outcomes: The role of university racial/ethnic composition.

Abstract

Objective: Mental health disparities between racial/ethnic minorities (REM) and White individuals are well documented. These disparities extend into psychotherapy and have been observed among clients receiving care at university/college counseling centers. However, less is known about if campus RE composition affects outcomes from psychotherapy for REM and White clients. Method: This study examined psychotherapy outcomes from 16,011 clients who engaged in services at 33 university/college counseling centers. Each of these clients completed the Behavioral Health Measure as a of part routine practice. Campus RE composition was coded from publicly available data. Results: The results demonstrated that White clients had better therapy outcomes than REM clients when they were at campuses where there were more White students. For universities 1 SD below the mean percentage of White students, the average difference in therapy outcomes for White and REM clients was Cohen's d = .21 (with White students experiencing more improvement); however, for universities 1 SD above the mean, the between group outcome disparity was greater (Cohen's d = .38). Conclusion: Therapists and higher education professionals should consider environmental impacts on counseling services. Implications for higher education, counseling centers, and mental health disparities are provided. Public Significance StatementThe demographic composition of universities and colleges contributes to racial/ethnic disparities in psychotherapy outcomes. Providers and administrators should not only examine contextual factors on campuses, but also consider how to better support the students who comprise their unique campus communities.

Psychotherapy outcomes with Latinx clients attending Hispanic-serving institutions and predominantly White institutions.

“…Still, the overarching story of these findings is clinically encouraging. They add to the literature showing the value of UCCs in helping students—including students of color—cope with psychological difficulties (e.g., Hayes et al, 2016; Kivlighan et al, 2021; Lockard et al, 2013, 2019; Owen et al, 2021). Moreover, although not a primary focus of our study, we should also note that the therapist effects we found were small; across HSIs and PWIs, therapists accounted for 4%–5% of the variance in therapy outcomes.…”

“…To extend previous empirical literature on the impact of contextual or institutional factors on psychotherapy outcomes for racial and ethnic minority clients in UCCs (e.g., Owen et al, 2021), we examined whether Latinx clients seeking individual psychotherapy in HSIs experienced greater relief in symptoms of depression, generalized anxiety, and academic distress compared to Latinx clients in PWIs. We found some support for our hypothesis.…”

“…We also had a sizable amount of missing data for therapist demographics. This is a common occurrence for psychotherapy research in naturalistic settings, such as UCCs, where there is great variability in how and which type of data is collected (e.g., Owen et al, 2021). Nonetheless, due to this limitation, we could not meaningfully examine therapist demographics in our models or whether similarities or differences in client and therapist demographics were associated with therapy outcomes.…”

“…Pybis et al (2017) and Firth et al (2019), for example, found that White and racial and ethnic minority clients in the United Kingdom had better outcomes in UCCs that treated more White clients. Using data from 16,011 clients in 33 UCCs across the United States, Owen et al (2021) similarly found that White clients who received therapy on more compositionally White campuses had better therapy outcomes than White clients on more diverse campuses. There were no differences in outcomes for racial or ethnic minority clients based on the demographic composition of their institutions; however, the degree to which White clients experienced more improvement than racial or ethnic minority clients was more pronounced on campuses with a higher share of White students.…”

“…In sum, there is evidence that the campus and institutional contexts in which UCCs are located influence therapy outcomes (e.g., Firth et al, 2019; Owen et al, 2021; Pybis et al, 2017). An open question is whether the HSI context is likewise associated with therapy outcomes for Latinx clients.…”