(PS10-59) Understanding Therapist-level Outcome Disparities When Working with Sexual Minority Patients

Abstract Text: Research demonstrates that therapists can vary in their general effectiveness depending on the racial/ethnic identities (e.g., Imel et al., 2011) and gender identities (e.g., Owen et al., 2009) of the patients they treat. Notably, some therapists exhibit effectiveness disparities when treating patients with marginalized identities, others achieve similar outcomes across patients irrespective of their identities, and some are most effective when treating marginalized patients. Sexual minority patients (e.g., gay, lesbian, bisexual, queer, etc.) represent another vulnerable group for which therapists may exhibit within-caseload outcome disparities, but few studies have examined this question. In each of just two relevant studies of which we are aware (Cabrera et al., 2023; Drinane et al., 2022), sexual orientation did not significantly predict patients’ overall therapy outcomes, but there was significant therapist-level variability in the sexual orientation–outcome association. However, more research is needed to corroborate the presence of such variability and delineate specific therapist effectiveness patterns. Accordingly, the present study will extend this literature by characterizing the extent to which therapists demonstrate reliable patterns of differential (or equitable) effectiveness when treating sexual minority versus heterosexual patients. Data derive from 707 outpatients (160 self-identified as a sexual minority; 547 self-identified as heterosexual) who received naturalistic psychotherapy from 84 therapists. Patients reported their sexual orientation at baseline and rated their symptomatic/functional impairment at baseline, repeatedly throughout treatment, and at posttreatment. Consistent with prior literature, initial results from our multilevel models indicated no average disparities in treatment outcomes between sexual minority and heterosexual patients; however, there was notable variability across therapists (p < .001). To unpack such variability, we will first calculate the proportion of therapists in this sample who exhibit disparities, competencies, and equitable effectiveness when treating sexual minority patients. Second, we will generate therapist-specific confidence intervals to determine the statistical significance of any effectiveness sexual-orientation-specific differences. Finally, we will calculate standardized effect sizes to illustrate the size of these differences, both on average and for individual providers. Findings will help to inform personalized training efforts and data-informed case assignment to therapists’ multicultural competencies.