Need a therapist? Race, class may matter
Are psychotherapists biased against some potential clients? Based on the results of a new study from a Princeton University sociology grad student, the answer appears to be yes.
Are psychotherapists biased against some potential clients?
Based on the results of a new study from a Princeton University sociology grad student, the answer appears to be yes.
Heather Kugelmass, who wanted to study barriers to mental health care access, used male and female voice actors to portray depressed or anxious people who sought coveted evening appointments with 320 psychotherapists in New York City. Through using names like Darnell or Ashley, employing various accents and grammar, they pretended to be black or white, middle or working class. Each therapist got two calls, a month apart, from patients with different demographic characteristics.
All the patients said they had Empire Blue Cross Blue Shield insurance. The therapists were all in-network.
The therapists weren't great at calling anyone back, but class and race mattered.
"The class difference was larger than the race difference," Kugelmass said. Working-class callers were at a "severe disadvantage" compared with middle-class competitors. White middle-class women were at the top of the heap.
The study, she wrote, provides "strong prima facie evidence of racial and class discrimination by psychotherapists."
Among middle-class callers, 28 percent of the whites and 17 percent of the blacks were offered any appointments. The rate was the same - just 8 percent - for both races when callers used heavy Queens or Brooklyn accents or lower-class African American vernacular.
Appointment offers were similar for middle-class men and women, 28 and 29 percent, respectively. Within all the other categories, women got more offers than men. Only 6 percent of working-class men - white or black - were offered appointments, compared with 10 percent of white working-class women and 9 percent of their black peers. Twenty-one percent of black female middle-class callers were offered appointments while only 13 percent of men in that category were.
When a black working-class man called 80 therapists in the network, only one offered him a weekday evening appointment. Twenty percent of a white middle-class woman's calls yielded appointment offers.
All of the therapists were doctoral-level psychologists in solo practice, increasing the odds that the therapists themselves were screening calls, Kugelmass said.
"Based on previous research, I expected to see discrimination, but not to this extent," she said.
She did not talk to any of the therapists, so she could only guess what was going on. Biases about who is most likely to be "psychologically minded" or able to pay their share of the bills are possibilities. It could be that therapists tend to prefer patients who are similar to themselves or that they fear they will be less effective when working with patients from a different race or class.
Only about a third of black working-class callers got any kind of return call compared with about half of both black and white middle-class callers.
In the paper, Kugelmass pointed out that return calls could have been helpful even if the therapist said he or she was not taking new patients. The therapist could have offered reassurance that getting help was a good idea plus information about how to find another counselor. A call could also reduce "distrust" of the mental health providers or "disillusions with the mental health-care system."
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