Is there bias in psychotherapy?

When Heather Kugelmass, a doctoral student at Princeton University, decided to study access to psychotherapy according to race and class, she found levels of discrimination that exceeded her expectations. Kugelmass and her associates called 320 psychotherapists with PhD or PsyD degrees in New York City who were listed as providers for a single health insurance company. Each therapist received a call from clients who, by virtue of vocabulary, grammar, or accent, could be identified as black or white and middle-class or working-class. All callers had the same insurance coverage and asked for evening appointments, so that financial considerations were not a factor. 

Psychotherapists showed a clear preference for middle-class and white clients. They offered appointments to 28 percent of the white middle-class callers and 17 percent of black middle-class callers. Only 8 percent of working class seekers, of either race, were offered appointments.

The finding adds to the growing literature on how inequities are replicated through the mental health system. Previous studies have documented that those positioned on the bottom rungs of America’s socioeconomic and racial ladder experience higher levels of trauma, adversity, and mental health difficulties, and more barriers to care. Low income and minority participants enter psychotherapy less often, drop out more frequently, and reap fewer benefits. Some reasons may be practical. Lack of child care, scheduling differences, or transportation can interfere with attending sessions. Cultural differences in how treatment is delivered may also play a factor. Despite an emphasis on cultural competency, most modern psychotherapies are based on dominant cultural ideas about how individuals change and develop that may not be widely shared.   

Psychotherapy aims to heal trauma and adversity. In order to do so effectively, therapists may need to look more closely at their own practices and weed out biases that get in the way.

Originally posted on From Research to Practice Blog:  http://karenzilberstein.info/blog