Queer in College? Sexual Orientation Disparities in Therapist Effectiveness in a National Sample of University Counseling Center Clients

Over the past 2 decades, a growing body of research has revealed that therapists differ in how effective they are at facilitating change depending on their clients’ social identities (see Imel et al., 2011, for example). Most studies examining the phenomenon of variability within therapists’ caseloads are based on the study of client race/ethnicity. However, two were recently published that found that therapists varied in the association between their clients’ sexual orientation and their therapy outcomes (Cabrera et al., 2023; Drinane et al., 2022). The present study sought to replicate and expand upon these findings in a national data set composed of 78,681 clients from university counseling centers who are part of the Center for Collegiate Mental Health. We employed multilevel modeling techniques to detect within-therapist disparities based on client sexual orientation on the following three outcomes: depression scores, an index of distress, and treatment dropout. The association between sexual orientation and all three outcome variables varied significantly across therapists. The presence of sexual orientation disparities within therapist caseloads in such a large and widespread sample is concerning and highlights a need for the analysis of other demographic variables and training that might mitigate this problem.