I was a staff psychologist at the New York University Counseling and Wellness Service from 2017 through 2019. During that time, I saw about 500 clients from around the country and the globe. As a Black male therapist, I learned that I could never take for granted that all my Black clients would have strong therapeutic alliances with me just because we had a shared racial identity. I am grateful that these clinical relationships often worked out well, but that was not always the case. Meanwhile, some of the strongest therapeutic alliances I developed were with clients who had different heritages from me. I had to work on each one like it was the only one.
In graduate school I was first introduced to the concept of ethnic matching in psychotherapy, the idea of matching a client and their therapist based on racial/ethnic identities. I did not always appreciate hearing how my non-Black colleagues described their Black research participants and clients, so that amplified my protectiveness of Black populations. As an occasional therapy client, I have taken what I learned in the classroom and applied it to my own criteria in finding therapists over the years: they had to be Black. Sometimes that has worked for me. Sometimes it has not.
For a while now, we have known that ethnic matching can lead to more positive therapeutic outcomes. Sue (1998) conducted a seminal ethnic match study and found that unacculturated Asian, Black, and White American therapy clients pursued more sessions when they were matched with an ethnically similar therapist. Results indicated similar findings for Mexican American research participants, although those findings were less dramatic than for Asian American participants. Sue (1998) also found that Asian and White American therapy clients tended to drop out of treatment less when matched with Asian and White therapists, respectively.
Years later, Karlsson (2005) reviewed the literature on psychotherapeutic ethnic matching between clients and their therapists. Karlsson found a sequence of studies that provided support for the idea that ethnic group members viewed high educational status, age, similar personality traits of the therapist and value congruence between themselves and their therapists was found to be more important than sharing an ethnic identity (Atkinson et al., 1990; Bennett & BigFoot-Sipes, 1991). This suggests that for some clients, there are far more salient aspects of personal identity that the therapist brings to the table than the color of their skin. Karlsson (2005) found another study that indicated ethnic mismatch was negatively correlated with treatment session attendance for Black, Latinx, and White American clients, but no ethnic matching-related treatment outcomes were identified (Erdur, Rude, & Baron, 2003).
It appears that the issue of ethnic matching within therapy is complex (like most issues within psychology). Couples therapy makes that arena even more complicated. Horst et al. (2012) conducted a qualitative study examining this complexity of ethnic matching within the context of domestic violence treatment. Several themes emerged: clients shared that culture mattered more than race (e.g., when religion, politics, and gender role adoption are similar, these personal aspects are more salient than racial identity), domestic violence as a human problem (e.g., interpersonal violence is a universal issue that transcends racial group membership), therapist qualities [are important] (e.g., close listening skills, perceptiveness, compassion, and self-esteem were listed as more important than sharing a racial identity), matching leads to shared understanding (e.g., there are some experiences that ethnically matched dyads are more likely to share [i.e., experiences with discrimination, language, childhood experiences] and that these can help therapists understand their clients better), ambivalence [about ethnic matching] (e.g., sometimes ethnic matching matters but sometimes not so much), and therapist perceptions [about ethnic matching] (e.g., therapists demonstrated awareness that verbal cognizance of racial/ethnic differences in therapy could benefit some clients).
So, ethnic matching: does it matter? It depends on the client and where they are in their journey towards wellness. The research I have reviewed does not suggest that ethnic matching harms the clinical relationship, but it does not always aid it. Ethnically matched therapists must remember to bring more into the therapy space beyond their complexion: shared lived experiences, understanding of cultural norms, language and slang are all helpful. However, other parts of the identity have utility too. Therapists without shared heritage must remain aware of cultural differences and develop the humility necessary to bring those up in conversation when appropriate. Neither group can afford to ever get too comfortable with their clients. Both groups would do well to check their biases at the door and be prepared to dig deep if necessary to fortify the clinical bridge between parties, so the intervention is delivered as smoothly as possible. At the end of the day, we want to make this work for the client and work ourselves out of a job to make space for the next client.