(PS6-74) Client Race/ethnicity as a Moderator of the Association Between Therapist Facilitative Interpersonal Skills and Client Outcome

Abstract Text: Therapists account for a significant proportion of variability in clients’ psychotherapy outcomes, with some consistently achieving superior results. One predictor of better overall performance is higher therapist facilitative interpersonal skills (FIS)—such as accurate empathy, hope cultivation, and alliance rupture-repair responsiveness—assessed in response to challenging clinical situations (Allen et al., 2024). However, it remains unknown whether the positive therapist-level FIS-outcome association is stronger or weaker for certain clients. As one possibility, such person-centered, relational therapist skills may be particularly beneficial when working with clients from culturally diverse backgrounds who are often at greater risk of facing disparities in the quality of mental healthcare processes and outcomes (e.g., Davis et al., 2018; Duan, 2020). Testing this hypothesis, the present study will investigate whether the positive association between therapist-level FIS and symptomatic/functional improvement is stronger for clients who identify with one or more historically underrepresented racial/ethnic identities. The sample will include ~250 clients receiving naturalistic outpatient psychotherapy from 45 therapists with diverse theoretical orientations. Therapists provided demographic and professional information and completed the FIS performance task (Anderson et al., 2018), in which they responded to a series of standardized videos depicting interpersonally challenging moments with simulated clients. A team of trained observers coded the video-recorded FIS data (total score ICC = .93). Clients reported demographic information at their treatment’s baseline and rated their symptomatic and functional impairment severity on a routine outcome measure (i.e., the Treatment Outcome Package [TOP]; Kraus et al., 2005) at pretreatment, repeatedly throughout treatment, and at posttreatment. To account for the nesting of clients within therapists, we will use multilevel modeling to test the hypothesized cross-level interaction between clients’ racial/ethnic identities and therapist FIS as a predictor of therapist-level posttreatment improvement. Findings from this study will clarify the conditions under which FIS exerts the greatest influence on client outcomes and whether its potency is moderated by clients’ racial/ethnic identities. Results will help inform personalized therapist-client case assignments (e.g., matching People of Color to high FIS therapists) and clinical trainings designed to increase therapists’ multiculturally relevant relational competencies. Implications for improving equity, responsiveness, and effectiveness in psychotherapy for diverse clients will be discussed.