Black clients' perceptions of therapists' cultural comfort, alliance, and outcome and the discussion of anti-Black racism in psychotherapy.

Abstract

Prior scholarship has helped demonstrate therapists' perceptions of the value of discussing anti-Black racism with Black clients in a manner that espouses cultural comfort or the ability to be at ease when discussing lived experiences related to clients' culture during treatment. Better understanding cultural comfort, an aspect of multicultural orientation, when discussing anti-Black racism with Black clients could help clarify paths by which psychotherapy does not perpetuate harm reflected in the dehumanization of such racism. However, Black clients' perspectives are missing in the literature. As such, we collected data from 153 Black participants with recent therapy experiences. They were asked about discussing anti-Black racism during therapy, satisfaction/helpfulness of these conversations, and items related to initiation and frequency of such discussions. Participants also completed measures of cultural comfort, working alliance, and perceived outcome. Perceived therapist cultural comfort did not significantly vary if anti-Black racism was discussed, and discussing anti-Black racism did not moderate the relationship between cultural comfort and working alliance or cultural comfort and outcome. Satisfaction and helpfulness positively correlated with cultural comfort. Cultural comfort scores also varied by who initiated these conversations and their frequency. We contextualize these findings in a need for greater nuance with respect to examining discussions of racism in psychotherapy and consider our findings with respect to broaching literature. (PsycInfo Database Record (c) 2025 APA, all rights reserved).