What Works in Therapy  |  Douglas Behan, DSW, LCSW

Common Factors and Working with Diverse Populations

The deep level of person-to-person connection inherent in the therapeutic relationship makes it essential to consider the intersectional identities of both the client and therapist.

 

A unique constellation of race, ethnicity, gender, sexual orientation, social class, place of origin, and many other factors, can influence the way a person asks for, perceives, and uses help.  It would be short-sighted to assume that an empirically-derived treatment somehow negates the need to consider these factors.

What the Research Says...

Psychotherapy outcome research typically does not consider identity variables - a problem that warrants consideration in future studies. A 2018 meta-analysis of 295 studies on the therapeutic alliance, covering more than 30,000 clients, found that the studies included very few ethnic minorities and rarely reported intersecting dimensions of client diversity - with even less identity information reported about the therapists in the studies (Flückiger, Del Re, Wampold, & Horvath, 2018). This lack of research attention to the unique needs of diverse populations can lead to clients feeling culturally invisible and misunderstood in treatment. This lack of guidance leaves decisions of if and when to use a culturally-sensitive treatment approaches up to individual clinicians. Clearly more research is needed to understand how clients' multicultural identities are a factor in the effectiveness of psychotherapy approaches.

Given the strong evidence on the importance of the therapeutic alliance, it is distressing to learn research has shown minority populations often have a suboptimal therapeutic alliance. This is sometimes due to a perceived need to conceal their negative reactions from the therapist (Vasquez, 2007) and sometimes from experiencing unintentional microagressions by the therapist (Sue, 2016).

A common factors approach can be a part of a culturally sensitive and informed practice. The early discernment of the common factors is rooted in looking at effective healing practices outside Western, positivistic medicine, highlighting practices that may connect at a human/relational level more than a technical/skills level. Research has shown that therapy is more effective when evidenced-based treatments are adapted to be congruent with a cultural groups beliefs (Benish, Quintana, & Wampold, 2011; Wampold, 2015)

What it Means for Therapists

Common factors can help clinicians better connect with a range of unique clients.

 

Stay aware of:

The primacy of the relationship & therapeutic alliance

1.

Unique client preferences & strengths

2.

"Resistance" may not be resistance. It may stem from a client's cultural beliefs or behaviors.

3.

Your own intersectional identities and their contribution to the therapy

4.

The collection of routine client feedback on the alliance is a valuable way to explore differences.

5.

The clients cultural and spiritual beliefs about healing.

6.