Client and therapist match on gender, age, and income: Does match within the therapeutic dyad predict early growth in the therapeutic alliance?

Abstract

Because of the importance of the therapeutic alliance across psychotherapeutic treatments, it is important to study variables that predict the development of a positive therapeutic alliance. This study investigates if different levels of gender, age, and income match between therapists and clients predict early development of the therapeutic alliance. The sample consisted of 28 therapists and 547 adult clients receiving individual psychotherapy for depressive symptoms. There were no exclusion criteria and no control over treatment delivery. Session-to-session assessments of the therapeutic alliance were collected and a growth mixture modeling framework with a priori identified classes corresponding to different levels of therapist-client match was utilized to examine differential alliance growth trajectories. No differential effect of match on any level was found on initial ratings of the alliance. Across levels of attribute match, clients tend to rate the alliance positively. Regarding growth, a "youth effect" and an "affluence effect" was noted. Dyads where the therapist is younger than the client, and dyads where the therapist is from a higher income status than the client, show additional growth in the alliance beyond positive initial ratings. This is effect is not constant across sessions. Matching on gender, income, and age can be used for case assignment heuristic, in particular to produce additional growth in the alliance beyond initial positive ratings. Clinical and scientific consequences of the study are discussed.