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Graduate Student Journal of Psychology                                                                             Copyright 2010 by the Department of Counseling & Clinical Psychology  
2010, Vol. 12                                                                                                                        Teachers College, Columbia University                          
  

Race-Matching in Psychotherapy: Findings, Inconsistencies, and Future 
Directions 

 
Jerren C. Weekes 

University of Cincinnati 
 

Race-matching has been proposed as a viable approach for increasing mental health 
treatment utilization and enhancing treatment outcomes among ethnic minorities. 
However, consistent empirical support for race-matching has been lacking since the initial 
investigations in the 1960s. The variability in findings may result, in part, from 
methodological inconsistencies across race-matching studies. The purpose of this 
literature review was to examine the methodology and inconsistent findings among 
race/ethnicity-matching articles published between 1990 and 2009. It was determined that 
race-matching findings differed according to the outcome of interest and analytic 
strategies. Based on the findings and gaps in the literature, recommendations were 
provided in an effort to facilitate scientific progress and improve treatment outcomes for 
ethnic minorities. 
 
 

Race -matching in psychotherapy (the coupling of 
client and therapist based on self-reported race/ethnicity) 

1983 and has continued to be an issue of interest.  The 
controversy stems from the disagreement between 
supporters of intra-cultural and cross-cultural counseling.  
According to Atkinson (1983), the cross-cultural 
perspective posits that culturally sensitive therapists can 
provide effective care regardless of racial and ethnic 
differences with their clients, whereas supporters of intra-
cultural counseling assert that counseling is most effective 
in racially matched psychotherapy dyads. 

Several studies have been conducted to assess the 
impact of racial dissimilarity on psychotherapy for ethnic 
minorities.  Findings reveal that racial dissimilarity may 
serve as a barrier to treatment, as it counteracts the 
establishment of a strong therapeutic alliance thereby 
negatively influencing the client-therapist interaction 
(Terrell & Terrell, 1984; Watkins, Terrell, Miller, & 
Terrell, 1989).  Sue and Sue (1977) note that it is not 
simply racial dissimilarity that serves as the barrier, but 
that cultural differences between the therapist and client 
can lead to poorer communication, understanding, and 
rapport.  In an attempt to address the barrier of racial 
dissimilarity, race-matching has been proposed as a 
method to increase ethnic minority treatment use.  
However, contradictory research findings make it difficult 
to deduce the efficacy of race-matching, thereby 
contributing to the ongoing controversy.  For example, 

                                                                                                  
Correspondence concerning this article should be addressed to 

Jerren C. Weekes, University of Cincinnati, Department of 
Psychology, 4150 Edwards Building One, PO Box 210376, 
Cincinnati, OH 45221-0376, Fax: 513/556.1904, Email: 
weekesjc@mail.uc.edu. 

consider the first race-matching study conducted by Banks, 
Berenson, and Carkhuff (1967) in which eight Black college 
undergraduates were coupled with a Black or White 
therapist.  Results indicated that Black clients were willing 
to return to treatment when racially matched with therapists, 
but Black clients in racially dissimilar dyads were unwilling 
to return to treatment.  A subsequent study conducted by 
Cimbolic (1972), in which seventeen Black college 
freshmen participated in treatment with Black or White 
therapists, yielded different results.  The results from this 
study did not indicate a client preference or that racial 
dissimilarity was a deterring factor for the Black clients 
involved. 

Several race-matching outcome studies were conducted 
after the investigation by Banks and colleagues (Atkinson, 
1983); however, the findings of research on the impact of 
race-matching on treatment outcomes remain inconsistent to 
date.  For example, in a study that examined race-matching 
in a sample of 302 drug users entering an outpatient 
substance abuse treatment facility (66% female, 43% 
African American, 30% White, 23% Latino, 4% Asian, M 
age = 34.1), race-matching was associated with greater 
ratings of counselor empathy, but was not found to be 
associated with abstinence from drug use (Fiorentine & 
Hillhouse, 1999).  In contrast, a study investigating the 
impact of race-matching on substance use in a sample of 96 
substance-abusing adolescents in family therapy (43 
Hispanic and 43 White, M age = 15.7) found a significant 
effect such that matched Hispanic adolescents showed a 
significant decrease in their substance use (Flicker, Waldron, 
Turner, Brody, & Hops, 2008). 

The results discussed above are a few examples of the 
inconsistent findings regarding the impact of race-matching 
on treatment outcomes and service use.  It is believed that 
methodological inconsistencies between race-matching 



WEEKES 
 

   9  

studies may contribute to the contradictory findings.  As 
such, the aim of this article is to (1) serve as a brief review 
of race-matching literature, (2) identify relevant 
inconsistencies in the race-matching literature that may 
have led to contradictory findings, and (3) provide 
recommendations for research in an effort to facilitate 
scientific progress.  The paper is organized into four 
sections.  The first section summarizes the search results 
and procedures used to gather relevant literature.  The 
second section serves as a brief overview of the race-
matching literature retrieved (aim 1).  The third section 
describes factors that may account for, or contribute to, the 
contradictory findings found in the literature (aim 2).  The 
last section provides specific recommendations for future 
research (aim 3). 

 
M ethod 

 
Search M ethod 

Pubmed and PsychInfo databases were searched for 
articles that assessed racial and ethnic match within mental 
health treatment.  Search terms included psychotherapy 
and either race,  racial similarity,  race-matching,  or 
ethnic match.   The reference lists of retrieved articles 

were then reviewed to search for publications that did not 
appear in the initial database search.  This analysis 
included a review of sample information, methods, 
statistical analysis, and results of the selected articles.  
Articles included in the current review met the following 
criteria: (1) assessed the utility of race-matching within 
mental health care, (2) were written in English, and (3) 
were published between 1990 and 2009.  The third 
criterion was established to avoid potential overlap with a 
similar review conducted by Atkinson (1983), in which the 
prior race-matching literature was reviewed and assessed. 

 
Search Results 

Using these methods, 30 articles were selected and 
analyzed by the author.  Of the 30 articles, 70% (n = 21) 
assessed the relationships between racial and ethnic match 
and treatment utilization, 50% (n = 15) assessed treatment 
outcomes (e.g., symptom improvement), and 20% (n = 6) 
assessed therapist-patient alliance and treatment 
satisfaction.  Sixty percent (n = 18) of the studies utilized 
archival data, and 40% (n = 12) used clinical samples.  
Within these studies, data was primarily gathered at 
community mental health or university/college counseling 
centers. 

 
Summary of the L iterature 

 
Several general themes emerged after a review of the 

literature.  First, race-matching is effective for a variety of 
ethnic minority groups (e.g., Farsimadan, Draghi-Lorenz, 
& Ellis, 2007).  Second, empirical support has been found 
for race-matching in child, adolescent, and adult samples 

(e.g., Jerrell, 1998; Yeh, Eastman, & Cheung, 1994).  Third, 
findings focus on the efficacy of race-matching with regard 
to increasing service utilization (Fujino, Okazaki, & Young, 
1994; Halliday-Boykins, Schoenwald, & Letourneau, 2005), 
enhancing treatment retention (e.g., Jerrell, 1998), the 
working alliance, counselor effectiveness, and perceived 
benefit of therapy (e.g., Farsimadan, Draghi-Lorenz, & Ellis, 
2007). 

 
Race-M atching in Various Racial and E thnic G roups 

Multiple studies support the efficacy of race-matching 
for Asians/Asian Americans (e.g., Fujino, Okazaki, & 
Young, 1994), African Americans (e.g., Thompson & 
Alexander, 2006), and Hispanics (e.g., Flicker, Waldron, 
Turner, Brody, & Hops, 2008).  Flaskerud and Liu (1991) 
assessed race, gender, and language match in a diverse Asian 
sample and found that ethnic match related to increased 
treatment duration (i.e., number of sessions attended), and a 
significant decrease in the drop-out rate for Asian clients.  In 
2007, Farsimadan, Draghi-Lorenz, and Ellis investigated the 
utility of race-matching in a multi-ethnic adult sample (N = 
100).  Race-matching was found to be useful in increasing 
client-reported therapist credibility, bond/alliance, and 
treatment outcomes for South Asian, Middle Eastern, Black 
African and Black Caribbean clients. 

 
Race-M atching in Child, Adolescent, and Adult 
Populations 

Empirical support for the effect of race-matching for 
children, adolescents, and adults was also found.  Though 
the number of race-matching investigations with child 
participants is fewer than those for adolescents and adults, 
studies (e.g., Jerrell, 1998) have found that children in 
racially-matched treatments remained in treatment longer 
than those who were not in racially-matched dyads.  A race-
matching study conducted by Yeh, Eastman, and Cheung 
(1994) found that minority adolescents, particularly Mexican 
and Asian Americans, who were racially matched with 
therapists were likely to attend more sessions, less likely to 
drop out of treatment, and more likely to have higher Global 
Assessment of Functioning (GAF) scores at discharge than 
adolescents who were not racially matched. 

Several studies found race-matching to have beneficial 
effects in adult samples (e.g., Farsimadan, Draghi-Lorenz, & 
Ellis, 2007; Thompson & Alexander, 2006).  For example, a 
study of an ethnically diverse sample consisting of Asian 
American, African American, White, and Latino adults 
found that clients who were racially matched had lower odds 
of dropping out of therapy than unmatched clients, except 
for African Americans (Sue, Fujino, Hu, Takeuchi, & Zane, 
1991).  In the same study, ethnic match was associated with 
more sessions attended for matched clients than non-
matched, and related to improved treatment outcomes for 
Mexican Americans. 
 



RACE-MATCHING IN PSYCHOTHERAPY 
 

   10  

T reatment Utilization 
Empirical support for the impact of racial similarity 

between therapist and client on treatment use has been 
provided (e.g., Flaskerud & Liu, 1991).  For example, a 
2005 study investigating racial similarity between 
therapists and primary caregivers (N = 1711) in 
multisystemic therapy, a family based intervention 

s 
delinquent behaviors, found that racial similarity led to 
greater treatment enrollment, decreased symptoms, and 
higher likelihood of meeting treatment goals for the 
African American, Asian, Latino, and other ethnic 
minority child/adolescent clients involved (Halliday-
Boykins, Schoenwald, & Letourneau, 2005). 
 
T reatment Satisfaction and Outcomes 

Racial similarity between client and therapist has been 
demonstrated to increase treatment satisfaction for 
minority clients.  For example, race-matching was not 
found to affect the number of sessions attended, but did 
impact client perceived benefit of treatment and higher 
self-reported acceptance of therapist strategies (Thompson 
& Alexander, 2006).  Therapist credibility and empathy 
ratings have also tended to be higher in matched than non-
matched dyads (Farsimadan, Draghi-Lorenz, & Ellis, 
2007; Fiorentine & Hillhouse, 1999).   

Although there is reasonable empirical support for the 
impact of race-matching on treatment utilization (i.e., 
increased sessions completed, lower dropout rates), there is 
a paucity of empirical support for the beneficial effects of 
race-matching on treatment outcomes.  In addition, the use 
of race-matching has been questioned based on 
methodological flaws (e.g., measure of race vs. cultural 
match, which is the better proxy for similarity) and 
negligible effect sizes (Karlsson, 2005; Maramba & Hall, 
2002). 

While client satisfaction, working alliance, and 
counselor effectiveness are of great importance, the 
purpose of psychotherapy is to facilitate change within the 
client that leads to better functioning and quality of life.  
To this point, the beneficial effect of race-matching on 
treatment outcomes has not been consistently supported.  
Given these equivocal findings, it is difficult to determine 
exactly what researchers and clinicians are to deduce from 
the assortment of empirical results surrounding the effects 
of race-matching. 
 
Inconsistencies in Research M ethodology: M ajor 
Contributing Factors 

Despite evidence for the positive effects of race 
matching, the overall findings, particularly those 
surrounding treatment outcomes, have been inconsistent.  
Variability in how previous race-matching studies have 
been conducted may account for these conflicted findings.  
Two specific factors may be related to the discrepant 

findings: 1) variability in outcome variable(s) and 2) analytic 
strategy. 

First, race-matching findings differ depending on 
whether the researcher is studying treatment utilization, 
treatment outcomes (e.g., substance use or externalizing 
behaviors), or therapeutic alliance/treatment satisfaction.  It 
is clear that the aim of a study assessing the effect of race-
matching on treatment use, retention, and client functioning 
(Yeh, Eastman, & Cheung, 1994) largely differs from the 
focus of a study assessing the impact of race-matching on 
patterns of diagnosis (Mathews, Glidden, Murray, Forster, & 
Hargreaves, 2002).  The outcomes of these studies cannot be 
compared for multiple reasons, principally, dissimilar study 
aims and outcome variables.  Researchers must take note of 
differing aims of race-matching investigations, especially 
those who will be conducting meta-analyses in the future.  

Second, race-matching findings differ according to the 
analytic strategy used.  This occurs as a result of collapsing 
ethnic minority groups instead of conducting separate 
analyses for each racial and ethnic group represented in the 
sample.  While the former is likely due to an insufficient 
number of subjects in each identified racial and ethnic 
group, combining different racial and ethnic minorities 
groups into one category is not best practice (Okazaki & 
Sue, 1995), as it does not yield detailed information about 
the impact of race-matching on treatment outcomes for 
independent ethnic minority groups.  Where race-matching 
could be more effective for one racial minority group than 
another, combined (i.e., collapsed) analyses may not reveal 
that valuable information.  Collapsing ethnic categories may 
be done to preserve statistical power, but it ignores the 
heterogeneity among ethnic minority groups (Burlew, 
Feaster, Brecht, & Hubbard, 2009).  Thus, it is possible that 
observed empirical differences in treatment outcomes may 
be due to methodological strategy rather than actual group 
differences. 

 
Recommendations and Future Directions 

 
The inconsistencies in the existing race-matching 

literature have important implications for future research in 
this area.  Additionally, several identified gaps in the 
literature should be addressed:   
 
1. A meta-analyses examining effect sizes for differential 

outcome variables, client characteristics, and analytic 
strategies among race-matching studies would be 
beneficial to the field.  Meta-analyses with inquiry focused 
upon evaluating the efficacy of race-matching based on 
specific outcome variables (e.g., the meta-analysis by 
Maramba and Hall in 2002) or client characteristics will 
assist the field in coming to an understanding of the 
efficacy of race-matching. 

 
2. Combining individuals of different racial and ethnic 

backgrounds into one group for analysis should be 



WEEKES 
 

   11  

avoided to steer clear of inaccuracy and 
overgeneralization.  Separate analyses for each racial 
group represented may prove to be most beneficial.  
Qualitative interviews foc
thoughts surrounding race-matching should be 
conducted with clients of varied racial and ethnic 
backgrounds, ages, and presenting mental health 

that have been overlooked thus far. 
 
3. Future studies should assess the extent to which the 

effects of race-matching differ based on treatment 
modality.  Mental health treatment modalities (e.g., case 
management, group/family therapy, and variants of 
individual therapy) differ in fundamental assumptions, 
objectives, and processes.  As such, the findings may 
differ in certain treatment contexts due to the unique 
way in which therapists must interact with clients.  For 
example, the duties and role of a family therapist versus 
an individual therapist differ.  In the family treatment 
context the therapist must establish rapport with all 
members present, understand the family dynamics, 
process the family interactions, and enter into the family 
system in order to elicit change.  The family unit may 
accept therapists more easily if racial similarity, and a 
deeper level of cultural understanding, exists.  Since 
treatment modalities differ in fundamental processes, it 
is possible that racial similarity may be more important 
in certain treatment contexts than others.  Research is 
needed to deduce more about the importance of 
treatment modality as it impacts the relationship between 
race-matching and treatment outcomes. 

 
4. Future studies should also assess the extent to which the 

effects of race-matching are moderated by client age and 
social-cognitive development.  Yeh, Eastman, and 
Cheung (1994) found race-matching to be effective in 
increasing session attendance, decreasing treatment 
drop-out, and increasing the Global Assessment of 
Functioning (GAF) scores for adolescent minority 
clients in their sample.  However, race-matching was not 
found to be effective in any way for the children (ages 6-
11) within their study.  Jerrell (1998) found that race-
matching was effective in increase treatment use of 
ethnic minority children; however, treatment outcomes 
(e.g., symptom improvement, improvement in overall 
functioning, or a decrease in externalizing behaviors) 
were not included as variables of interest.  Yeh, 
Eastman, and Cheung (1994) suggested that further 
research be conducted to determine if and why race-
matching has differing effects on child outcomes than 
adolescent and adult outcomes. 

 
5. The differential effects of race-matching may also be 

attributed to the varied social-cognitive development 
between children, adolescents, and adults regarding race 
perception, bias, and out-group (i.e., racially dissimilar 

groups) derogation (Cameron, Alvarez, Ruble, & Fuligni, 
2001; Quintana, 1998).  In addition, as a person progresses 
in his/her racial identity development the preference for a 
same-race therapist may become more salient.  For 
example, Parham and Helms (1981) discuss the relation of 
same-race counselor preference in the context of Black 
racial identity development.  Black/African American 
individuals in pre-encounter stage, a stage in which 

American culture/ideals, were more likely to have a strong 
preference for White therapists and non-acceptance for 
Black therapists.  Preferences differed, however, for 
individuals in the latter stages of the racial identity model.  
Given the statements above, it is possible that racial 
similarity of a therapist may increase in importance as 
children advance in age and development.  Future studies 
should seek to evaluate the importance of race-matching 
in child and adolescent populations, and conduct analyses 
to assess whether age and developmental stage act as 
moderator variables. 

 
6. Studies examining the utility of race-matching within 

underrepresented racial and ethnic minority groups can 
provide valuable information and should be considered. 
As the United States continues to diversify, the issues of 
race become more than just Black and White.  An increase 
in race-matching studies for other ethnic groups (such as 
Hispanic, Pacific Islander, Alaskan/Native American, and 
Middle Eastern) is needed.  For example, only one 
reviewed study included Middle Eastern ethnic groups 
into race-matching analyses (Farsimadan, Draghi-Lorenz, 
& Ellis, 2007).  Studies should seek to recruit individuals 
from the aforementioned racial groups in an effort to 
provide information on client preferences and effective 
components of psychotherapy for these underserved and 
increasingly populous groups. 

 
7. Race-matching studies should include cultural similarity, 

acculturation, and racial identity measures in an effort to 
better assess client-therapist cultural similarity and 
understand the pathway(s) through which race-matching 
has its impact.  To date, studies have not included those 
measures.  This may be due to the fact that a good portion 
of race-matching analyses utilized archival data in which 
racial identity, acculturation, and cultural commitment 
measures were not a part of the initial study design.  
Including such measures will allow for greater 
understanding of the dynamics of cultural similarity and 
sensitivity that are particularly helpful in the therapeutic 
process. 

 
8. Additional variables that relate to race-matching and 

treatment outcomes should be investigated.  Extant race-
matching literature has not fully described the factors 
associated with the success or limited effect of race-
matching.  There are several important variables that have 
not been investigated that will prove helpful in delineating 



RACE-MATCHING IN PSYCHOTHERAPY 
 

   12  

possible mediator or moderator variables.  Variables 
including, but not limited to, socioeconomic status, 
family history (e.g., parental or sibling drug use or legal 
problems) or family conflict, and the severity of client 
problems (e.g., severity of externalizing behaviors) are 
worthy of exploration.   

 
Race-related research has revealed a distrust of 

professional health services that can deter ethnic minorities 
from seeking psychological treatment (Terrell & Terrell, 
1984; Whaley, 2001).  Due to numerous factors (e.g., 
distrust, stigma), ethnic minorities have been noted to 
largely underutilize mental health treatments (U.S. 
Department of Health and Human Services, 2001).  Race-
matching has been proposed as a method to increase ethnic 
minority treatment use, treatment retention, and 
satisfaction with treatment, while associated research has 
been utilized to gain a better understanding of the effective 
factors in psychotherapy for ethnic minorities.  While this 
line of research appears promising, the inconsistent 
findings make it difficult to glean a clear understanding on 
the efficacy of race-matching. 

Race-matching findings differed based on the outcome 
assessed (i.e., treatment satisfaction, treatment use, 
treatment outcomes) and analytic strategy used.  It is 
believed that the noted inconsistencies account, in part, for 
the discrepancy in findings.  The recommendations above 
are meant to facilitate scientific progress and advance 
knowledge regarding race-matching in psychotherapy. 

It should be noted that extreme race-matching 
practices (i.e., automatically race-matching without 
consulting the client first) is not advocated here.  Racial 
identification and acculturation vary from individual to 
individual (Karlsson, 2005), and there are multiple factors 
that contribute to identity development  racial and ethnic 
factors notwithstanding.  As such, there are within-group 
differences regarding the facet of identity individuals 

and age may be more important than race for some 
minority clients.  Race-matching should not be imposed on 
clients, but considered in an effort to increase minority 
client satisfaction, treatment engagement and retention, 
and to address mental health disparities that currently exist. 

Lastly, it is fully recognized that agencies across the 
United States may not have diverse representation in staff 
to meet the request for race-matching in psychotherapy.  
The lack of minority professionals may stem from the lack 
of minority representation in higher education, specifically 
clinical psychology programs (Maton, Kohout, Wicherski, 
Leary, & Vinokurov, 2006).  While the field may not 
realistically be able to provide racially similar therapists to 
all clients who request one, it is important to reiterate that 
race-matching is not the end point.  This line of research is 
a pathway to improve understanding of the therapeutic 
dynamics needed to provide better services to ethnic 
minorities.  Research must continue, as it can inform the 
training of therapists from all racial and ethnic 

backgrounds on how to best work with racially and 
ethnically dissimilar clients.  As the inconsistencies are 
clarified, and gaps in the literature filled in, significant gains 
will emerge in regards to the nature and quality of 
psychotherapeutic services provided to racial and ethnic 
minorities.  

 
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