Should your therapist look like you? Have had similar experiences? Because there are so many ways that people can match, it’s impossible to answer this in a simple way. Let’s look at the different types of backgrounds that people might want to share with their therapists—and that therapists may want to treat clients.
The short version is that people tend to prefer therapists who are like them in gender, sexual orientation, race and less often, age. There is limited research on whether the outcomes match these preferences, however.
There is some indication that therapists tend to rate clients who match racially/ethnically as higher functioning than ones who don’t match (this is true for both white clinicians and clinicians of color) (from Shiraev and Levy).
Another study found that gender matching and racial matching can lead to better client retention and therapeutic alliances for adolescents.
A retrospective study asked adults from a variety of backgrounds and their therapists about their outcomes and therapeutic alliances. Clients of all genders reported greater therapeutic alliance with female therapists, as did the female therapists. That said, clients of all genders did report improvement with male therapists.
An important gender group is transgender clients. There is very little research on this population, but it is important for clinicians to get educated about transgender issues and learn to work in a competent and sensitive with this population.
As far as sexual orientation goes, a fairly large retrospective study found that “gay, lesbian, and bisexual therapists of both genders and heterosexual female therapists were all rated more helpful than heterosexual male therapists.”
Again, clients tend to prefer clinicians who are like them. But is there evidence that they are more likely to improve with a “matched” therapist?
Most evidence-based therapies don’t specifically include religion, yet there is extensive evidence that spirituality is an important resource for many people, including those who struggle with trauma, depression or anxiety.
There is some evidence that both white and clinicians of color overestimate pathology in clients not of their race/ethnicity. That is, most people tend to think that clients from a different culture are sicker than someone from their own culture would. Shiraev and Levy argue that our cultural “schemas greatly influence what we perceive and the manner in which we perceive it” (p249). That is, we have ideas about how people are supposed to behave—from eye contact to body language to emotional affect to formality. These expectations are somewhat dependent on culture. When we meet someone who does not meet expectations, we naturally will conclude that they are failing to adapt somehow.
Arguably the most well-known treatment for addiction is 12-step peer support programs. The whole structure of the program is predicated on the belief that connection and mentorship from fellow addicts is crucial to recovery. And there is evidence that 12 step programs are helpful, both on their own and in conjunction with professional support.
I could find no research on therapist-client diagnosis matching, partly because this isn’t exactly something that therapists usually disclose indiscriminately. The little bit of research out there that mentions therapists’ backgrounds is usually about vicarious trauma and burnout, but it tends to look at the impact of the burnout on the client, rather than any initial conditions or experiences. That said, there are clinician-peers out there and it would be interesting to learn more about their work and how their experiences impact them and their clients.