Richard Niolon, Ph.D.
12/99

Beutler remarks on the problems of drawing conclusions from the literature because the literature is confusing and many studies are poor. However, it appears that:

1)female and male clinicians rate male and female clients differently on measures of improvement (females rate females as improved when males don't)

2)there is a modest correlation between same sex dyads and outcome

Whitley provides a possible explanation for this when he notes that there are different standards for mental health for men and women (men are assertive and women dependent), and this holds for MHP, MH Trainees, and non-profs. Whitley also found that men tend to stereotype more (when tested with forced choice questionnaires).

A client's utilization of cross-sex behaviors tends to result in an adverse judgement less often by professionals and more often by non-profs (college students). Mediators are

sex of rater (females less critical overall, males recommend less change for dependent women),

sex of the ratee (females will be rated more critically, less assertive males will be prompted to change more than less assertive females)

and context and DV interactions (aggression is ok in some settings and not in others regardless of sex)

Thus, therapist may have the same sex-biases as non-professionals, but there is little evidence that it effects their practice. This hasn't been measured I don't think. Some argue that the research on attitudes is not relevant in predicting the actual behavior of psychologists.

Others interpret this to mean that the assigned poorer mental health among women may be legit and real.

Mogul presents several arguments on therapist-patient sex matching, and notes that the literature is usually biased in that it discusses mostly the needs of female clients. It is unclear whether it is best to pair same-sex dyads or opposite-sex dyads, but either can be effective or ineffective. It depends on things such as the sensitivity of the therapist and the strength of the therapeutic bond in longer term therapy, but sex may make a difference in shorter term therapy. As some clients may not be willing to start therapy with opposite sexed therapists; thus, pairing same-sexed dyads may be more effective because it gets the client in for treatment. Often adolescents need a same-sexed therapist to help them work out adolescent issues. Often, reason for referral will determine the sex pairing (women who have been sexually abused may prefer a same-sexed dyad, paranoid males may prefer a woman…). Thus, sex may matter to get the client into treatment to get the minimum dose of therapy, but after that it appears to be the sensitivity of the therapist that counts.

Garfield and Bergin (G&B) suggest that the lit indicates that black patients may stay in therapy longer with black therapists, but the lit is not very clear cut. Sue clarifies the issue by discussing the difference between ethnic and cultural match, which is like the difference between black and African American, homosexual and gay. Thus, a race match may be a cultural mismatch, and racial mismatches may be cultural matches. A black therapist and an African American patient may be mismatched, although their race is the same. A culturally sensitive caucasian therapist and an African American patient may be a better match. The other problems with the research is experimenter loyalty. Like many who have done meta-analysis, Sue notes that the beliefs of the researcher are often highly corollated with the results of the study. The research is unclear in part because it asks the wrong questions (race instead of culture) and asks them the wrong way (by limiting variables and contrasting them rather than examining increasing effects of therapy and how the positive effects of the therapist-client relationship can be maximized).

G&B suggest that lower SES patients are more likely to be rejected for therapy, may be recommended for therapy less often, are more likely to drop out, and may have very different expectations of the therapy process. Lower SES status or origin therapist see more lower SES clients. Thus, SES may make a difference, but if the client can be prepared for therapy, this difference may be reduced. Lower SES patients may also be minorities, or which there may be few available for offering services, and thus race and culture may enter into the matter.