The Association Between Patient-Provider Racial/Ethnic Concordance, Working Alliance, and Length of Treatment in Behavioral Health Settings

Impact Statement Blind raters objectively concluded that racially/ethnically concordant patient-provider dyads who have been in treatment for an extended period of time have better working alliance compared to discordant dyads. Patients themselves, however, did not note this difference, suggesting the importance of using both objective and self-report measures in future studies. Our study findings suggest that patient-provider racial/ethnic concordance improves working alliance and seems to support the diversification of the mental health workforce in our increasingly multicultural society. Racial/ethnic concordance between patients and providers concerning the quality of care has received interest over past decades yielding mixed results. Patients seem to prefer clinicians of their own race/ethnicity, but empirical studies have found small or inconsistent effects on the quality of care. Research on the impact of racial/ethnic concordance and treatment duration appears to suggest that racial/ethnic concordance is associated with retention and completion; however, exactly why racial/ethnic concordance improves treatment length remains unexplored. On the other side, the quality of working alliance is a well-established common factor underlying effective treatments. In this study, we examined the interaction between patient-provider racial/ethnic concordance, length of treatment in the therapeutic dyad, and working alliance as evaluated by both patients themselves and objective raters. The study included 312 patients and 74 providers from 13 community and hospital-based outpatient mental health clinics in Massachusetts. Results indicated that among racial/ethnic concordant therapeutic dyads, longer length of treatment was associated with better quality of working alliance as evaluated by objective raters. Implications for clinical practice and future research on racial/ethnic concordance studies linked to the length of treatment are discussed.