The provision of effective psychotherapeutic services is a constantly evolving process. This process is challenged by the demands of meeting the needs of a clientele that is growing increasingly ethnically diverse (Sue et. al, 2019). Acknowledging the increased demands, it is important to consider cultural considerations in psychotherapeutic services (Guerrero et. al, 2013). It has been noted that clients of color have substantial barriers to seeking psychological services (Arnett & Brody, 2008; Jacoby et. al, 2018; Mendez et. al, 2019), are less likely to receive expected benefits of counseling, report poorer quality of care (Cai & Robst, 2016; Saha, Arbeleaz & Cooper, 2003), and are at a greater risk of prematurely discontinuing counseling services (Mays, et. al, 2017; Nelson, 2002; Sue & Sue, 2003). Furthermore, low-income ethnic minority individuals have accessibility barriers that decrease the likelihood of seeking and completing mental health treatment (Agosti, Nunes, & Ocepeck-Welikson, 1996; Rebach, 1992; Young & Rabiner, 2015).
Although low socioeconomic status has been often referred to as one of the major contributors to societal inequalities between different ethnic groups, disparities in health care have been documented even when controlling for socioeconomic status (LaVeist, 2005; Owen, Feng, Thrush, Hudson, & Austen, 2001; Rose, 2017). Particularly, many recent studies have posited disparities in treatment for substance use disorders (SUD) (Alegria et. al, 2011) including unmet needs (Mulvaney-Day et. al, 2012) and disparities in matriculating through programs (Guerrero et. al, 2013)
In the mental health field, one resolution that has been proffered in response to this quandary involves matching client and therapist in terms of shared race/ethnicity, which has been broadly defined as “racial matching” (Stinson & Thurston, 2002). There are primary, “first order” treatment predictors such as therapeutic alliance (Wampold, 2001) and the client’s relative status in the stages of change process (Heather & McCambridge, 2013). Racial matching can be perceived as a secondary, but important component to the treatment process. Racial matching has been identified as one component of culturally sensitive treatment (Banks, 1999; Kim & Kang, 2018; Maramba & Hall, 2002; Presnell, Harris, & Scogin, 2012). More specifically, research has supported matching services to need in SUD treatment, particularly for racial/ethnic groups (Marsh et. al, 2009). However, throughout the human-service literature, considerable debate exists concerning the potential benefits and limitations associated with matching clients and psychotherapists in terms of shared ethnicity (Chenot et. al, 2019; Kim & Kang, 2018; Perry & Limb, 2004).
The belief in the efficacy of racial matching has roots in social psychological literature, which indicates that people tend to identify with individuals similar to themselves (Festinger, 1954). This literature base further suggests that ethnic preferences may be based on the perception that similar appearances indicate similar attitudes (Atkinson, 1983). Psychotherapy research has shown that clients prefer a counselor whose ethnicity matches that of their own, especially ethnic minority clients (Coleman, Wampold & Casali, 1995; Constantine, 2001; Smith & Trimble, 2016). Specifically, African American clients may prefer to see African American therapists as opposed to seeing Caucasian therapists (Atkinson, 1983; Helms & Carter, 1991; Smith & Trimble, 2016; Thompson, Bazile, & Akbar, 2004). Furthermore, ethnic differences between client and therapist contribute to attrition, especially for Caucasian therapists who are working with ethnic minority clients (Smith & Trimble, 2016; Wintersteen, Mensinger, & Diamond, 2005).
Despite these findings, empirical support for the practice of racial matching has yielded at best, inconclusive results, and at worst, contradictory results. In individual studies, racial matching has been demonstrated to be a viable means of enhancing the psychotherapeutic experience in terms of clients experiencing more favorable clinical outcomes (Bellini, 2003), receiving more favorable Global Assessment of Functioning Scores (Hall, Guterman, Lee, & Little, 2002), and attending more clinical sessions (Gamst, Dana, Der-karabetian, & Kramer, 2004). While these findings support the practice of racial matching as a means of improving client experience, other research findings do not maintain this assertion (Sterling et. al, 2001; Wintersteen et al, 2005).
Historically, there have been a number of analyses that synthesized the findings of studies conducted on racial matching. Both Maramba and Hall (2002) and Shin, Chow, Camacho-Gonsalves, Levy, Allen, and Leff (2005) have conducted meta-analytic reviews on racial matching in psychotherapy, while Karlsson (2005) provided a qualitative overview of racial matching findings with the inclusion of a discussion of methodological and conceptual issues. More recently, Cabral & Smith (2011) and Smith & Trimble (2016) have explored racial/ethnic matching in mental health services through a meta-analytic review. These studies have attempted to consolidate the literature base and shine a more definitive light on the empirical support (or lack thereof) for racial matching.
Similar to the meta-analytic reviews, there have been several contending research findings in the literature. In a study exploring the impact of racial matching in SUD centers, Marsh et. al. (2009) posits that need-service matching is more effective than racial matching in SUD centers. Other studies have found that racial matching has an impact on treatment outcomes of the client (Flicker et. al, 2008; Wintersteen et. al. 2005).
These reviews further illustrate the inconclusive and often contradictory empirical support for the practice of racially matching clients and therapists in psychotherapy. The reviews support that racial matching may be a viable practice for enhancing the psychotherapeutic experience for clients; however, there are important considerations. The methodological and conceptual issues are hampering the emergence of empirical support.
The topic of racial matching has been unequivocally complex. Examining SUD clinics at the national level using the Substance Abuse and Mental Health Services Administration (SAMHSA), this study examined the perceived importance and prevalence of racial matching. More specifically, this study aimed to ascertain the perception of importance placed on providing culturally sensitive treatment, based on the contention that racial matching represents a component of culturally sensitive treatment (Banks, 1999; Maramba & Hall, 2002; Smith & Trimble, 2016). The guiding research questions are intended to: (1) discern the importance that these clinics placed on racial matching of clients and therapists, and (2) explore the prevalence rates of racial matching practices, as well as the degree to which these centers have the potential to engage in this practice, if in fact they are.