Therapists' Cultural Comfort and Clients' Distress: An Initial Exploration

The extent to which therapists are comfortable discussing clients' cultural identities in psychotherapy has been considered a valuable component of how therapists integrate clients' cultures into treatment. Cultural comfort specifically reflects a therapist's way of being at ease, relaxed, and open when discussing clients' cultural identities in treatment. Some initial research has demonstrated the relationships between cultural comfort and clinical outcomes, yet this work has relied largely on cross-sectional designs. The purpose of this preliminary study was to use longitudinal psychotherapy data to explore the relationships between clients' perceptions of their therapists' cultural comfort and clients' distress over the course of psychotherapy. Data were collected from 48 clients who attended 476 sessions in a doctoral training clinic. Multilevel modeling was used to account for the nested nature of the data. Results showed that, when session number was held constant, within-client increases in their perceptions of their therapists' cultural comfort were predictive of decreases in psychological distress. We discuss these findings in light of the multicultural orientation literature and with respect to the implications for therapists striving to be comfortable with culture in sessions. Clinical Impact Statement Question: This study was guided by the central question: "what is the relationship between therapists' cultural comfort and clients' outcome over the course of psychotherapy treatment?" Findings: Our findings show a negative relationship between clients' perceptions of their therapists' cultural comfort and clients' outcomes in treatment. Clinicians may, therefore, improve outcomes by working to be more comfortable with their clients' cultures in psychotherapy. Meaning: The nature of cultural processes in psychotherapy has often been theoretically discussed, and with these data, we contribute new findings that support the clinical relevance of therapists being culturally comfortable with their clients. Next Steps: As this brief report offers initial evidence, future research needs to be undertaken with a broader client sample and with other variables such as countertransference and the working alliance also considered.