The Sum of Competing Parts: Religious and Sexual Identity Disparities in Therapist Effectiveness

The discussion of the influence of culture in psychotherapy is expanding to honor and incorporate the ways identities intersect within complex social systems. Some clients present for therapy with two or more identities that are in conflict, whereby the values or needs associated with different parts of the self are at odds. The resulting tension can be a significant driver of distress. This study sought to investigate therapist variability in facilitating change with clients depending on the interaction of their sexual orientation and the role of religion in their life (RR). We analyzed the depression scores of clients (n = 1,792) who received care at a university counseling center. After controlling for clients' pretherapy depression scores, the association between their sexual orientation and their posttherapy depression varied across therapists; however, the association between their RR and posttherapy depression did not. We also found that the association between the interaction of clients' sexual orientation and RR, and posttherapy depression varied across therapists. Therefore, some therapists had clients who experienced more or less change in their depression and that variability was predicted by the identity combinations clients endorsed. Clinical Impact Statement Question: There is an ever-present need to understand how therapists approach intersectionality in their psychotherapy practice, and to model the relationships between cultural identities more effectively in the process and outcome research we conduct. Findings: This study found that therapists varied in their ability to facilitate change in depression based on the religious and sexual identities of their clients. Meaning: There is nuance involved in how therapists intervene with clients based on the various identities they hold. Next Steps: Future studies should examine multiple identity statuses including, but not limited to race, gender, and ability status.