Clients' Race/Ethnicity as a Moderator of the Relationship Between the Therapeutic Alliance and Treatment Outcome

Although the therapeutic alliance has been established as among the most potent ingredients that promotes positive treatment outcome, the alliance-outcome relationship for Black, Indigenous, People of Color (BIPOC) clients as compared to White clients remains unexamined. The current study investigated the differences between BIPOC and White clients regarding therapeutic alliance and treatment outcome, as well as clients' race/ethnicity as a moderator of the alliance-outcome relationship such that it would be weaker for BIPOC clients. Archival data from a training clinic at a large Midwestern university in the USA was used, including 308 White and 132 BIPOC clients. The differences in therapeutic alliance and treatment outcome were analyzed using independent-sample t-tests. Moderation analysis was conducted using hierarchical linear regression. Therapeutic alliance reported by BIPOC clients, especially Asian and Pacific Islander and Black clients, was significantly lower than White clients. There was no significant difference in treatment outcome between BIPOC vs. White clients. Clients' racial/ethnic status did not moderate the alliance-outcome relationship. The findings indicated that BIPOC clients who persisted in psychotherapy benefited from it as much as White clients. However, BIPOC clients experienced a weaker therapeutic alliance. The results highlighted the importance of building an effective therapeutic alliance with BIPOC clients by providing culturally sensitive and race-informed psychotherapy.