Affective Cultural Countertransference Reactions to Asian American Clients

The primary aim of this study was to explore affective manifestations of cultural countertransference toward English-speaking Asian American clients in psychotherapy and to investigate the roles of therapist race and therapist racial attitudes. Fifty-six therapist participants completed measures of affective cultural countertransference toward and clinical assessments of a current client who is either White or Asian American. Participants also completed measures of racial attitudes toward Asian Americans as well as demographic questionnaires about themselves and their client. For the qualitative portion of data collection, five White psychologists were interviewed to further understand the relationship of these variables in White therapist-Asian American client dyads, the primary cross-cultural therapeutic relationship of interest. Thematic Analysis was used to explore qualitative data. Statistical results failed to show moderate or larger effect sizes for overall differences in cultural affective countertransference based on therapist-client race combination. Results suggest that White therapists experience similar levels of both positive and negative countertransference toward clients, regardless of race. Although qualitative data on White therapists reflected themes of racial biases consistent with Asian stereotypes of high competence and lack of sociability, quantitative comparisons distinguished that White therapists do not experience any more racial bias toward Asian clients than do Asian therapists. In fact, there was a trend suggesting the latter may experience more. For Asian therapists, countertransference in intraethnic dyads was strongly associated with Asian racial biases. There were a couple trends reflected in the quantitative data that should be interpreted conservatively given this study's methodological limitations, but, nevertheless, warrant further investigation: Compared to Asian therapists, White therapists experience more negative countertransference toward both White and Asian clients. White therapists' negative countertransference also showed small to medium associations with their racial bias against Asians. Qualitative evidence supported and expanded upon these trends: There was a dominant countertransferential theme among White therapist participants to counter Asian clients' culturally-syntonic drives for achievement and performance. Independent of therapist-client race, negative countertransference showed significant negative relationships to GAF, prognosis, and working alliance, while positive countertransference was positively related to prognosis and working alliance, as expected. Countertransference was also found to be related to client diagnosis, but not therapist theoretical orientation. The clinical, research, and theoretical implications of these findings are explored and limitations discussed.