Therapy Process and Outcome in Cross-Racial/Ethnic Therapy Relationships

How much do patient-therapist differences affect therapy process and outcome? Or more specifically, what individual, interpersonal, and treatment factors are associated with positive treatment outcomes in cross-racial or cross-racial therapy? 

To answer these questions,  we are conducting a mixed-methods study of interracial and intercultural patient-therapist dyads as they proceed through as many as 40 sessions of psychotherapy. We are interested in how patients and therapists negotiate the racial, ethnic, and cultural differences between them, and the impact of those negotiations on treatment outcome. As part of this effort, we are developing and validating the Multicultural Therapy Process Measure (MTPM), an observational coding system for analyzing cross-ethnic therapy relationships.  Results will be used to develop empirically-derived strategies for improving the quality of the therapy relationship and treatment outcomes for racial and ethnic minority patients working with racially/ethnically different therapists.

Collaborators: Jeremy Safran, Ph.D., J. Christopher Muran, Ph.D., and the Beth Israel Brief Psychotherapy Research Program; Nolan Zane and Shelley Blozis (University of California, Davis) Senior Research Team Members: Sophia Williams, M.A., Sara Waters, M.A., Kemi Soyeju, M.A., and Nancy Ng, M.A.

Broaching Racial/Ethnic Differences and Therapy Process

How do White therapists and patients of color talk about race and racial differences in therapy?  How do these conversations impact patients' experience of their therapists? 

My team is also studying the process and impact of discussions of racial/ethnic differences between racial/ethnic minority clients and their non-Hispanic White therapists.  Methods include qualitative analysis of therapy sessions in which differences are spontaneously discussed by racial/ethnic minority clients and their therapists, and an experimental study in which White therapists systematically broached or did not broach their racial differences with African-American participants receiving a single-session of counseling.

The First Session of Cross-Racial Therapy

This qualitative study examines approximately 20 first sessions in Brief Psychotherapy with African American, Hispanic, and Asian patients paired with White therapists.  It explores how race/ethnicity is brought up in session, what are the conditions for disclosure, what is the function of the disclosure, and how the therapeutic interaction proceeds from there.  Additionally, the study examines the specific tasks of first sessions in cross-racial psychotherapy, including distinctions between relationship engagement versus working alliance, and the negotiation of ethno-cultural differences and misattunements.

Culturally Adapting an Observer Measure of the Working Alliance for Black Americans

 An ethnically and racially diverse team of researchers are employing a hybrid deductive and inductive process to culturally adapt the Segmented Working Alliance Inventory, Observer-Based measure (S-WAI-O, Berk, Safran, Muran, & Eubanks-Carter, 2010) for Black Americans.The S-WAIO assesses the task and bond dimensions of Bordin’s concept of the working alliance through 12 items that are rated by observers in 5-minute increments (typically based on videotapes of the session). We are particularly interested in therapeutic processes that concern discussions of race. 

This overall goal of this study is to make a contribution to the field by developing an alliance measure that is attuned to the complexities of relational dynamics in cross-racial therapy. Furthermore, examining culture-based relational disconnections is one way to promote multicultural and social justice counseling competencies, which may help improve treatment outcomes. More Information

Project Team:

Hillary Litwin, M.A. (project director & principal investigator), Sophia Williams, M.A. (co-investigator), Stacy Crawford, B.A., Vivian Dzokoto, Ph.D. (collaborator; Virginia Commonwealth University), Doris Chang, Ph.D. (principal investigator).



Okun, L., Chang, D.F., Kanhai, G., Dunn, J., & Easley, H. (2017). Inverting the power dynamic: The process of first sessions of psychotherapy with therapists of color and non-Latino white patients. Journal of Counseling Psychology.

Chang, D.F., & Yoon, P. (2011). Clients’ perceptions of the significance and impact of race in cross-racial therapy. Psychotherapy Research, 21(5), 567-582.

Chang, D.F., & Berk, A. (2009). Making cross-racial therapy work: A phenomenological study of clients’ experiences of cross-racial therapy, Journal of Counseling Psychology, 56(4), 521-536.