Identifying whether same gender client-therapist dyads enhance therapy outcomes or not, is highly relevant for clinical practice. In this way, the burden of disease for patients and health care system can be reduced. Past evidence related to client therapist gender matching lacked statistical power or analyzed a single type of disorder. Hence, we examined several diagnosis in a robust sample, which distinguishes our research from past studies. Furthermore, previous evidence did not consider gender-matching in the context of specific psychotherapy methods. Therefore, our results were examined based on two established psychotherapy methods that are covered by the German health insurance, which is key when it comes to health-associated policies or individual preferences. In addition, we illustrate a picture of the psychotherapeutic landscape in Germany from the perspective of the patients, by providing detailed information on the problems and diagnosis of patients, including their symptom development.
Matching clients and therapist based on demographic variables is common clinical practice , as one possible approach in trying to optimize the fit between both parties (e.g., therapeutic relationship) as well as psychotherapy outcomes [2, 3]. As suggested by past evidence, a strong therapeutic relationship predicts positive treatment outcomes , including positive effects in symptom reduction and general ratings of success (among others); [4,5,6]. Thus, it is plausible to assume that, in average, a good fit between client and therapist could be reflected in a strong bond / therapeutic relationship, as suggested by other researchers [7,8,9]. A good fit between clients and therapist could also refer to as having a similar understanding about managing emotions and attitudes [10,11,12]. Bowlby  reported that the psychotherapeutic relationship is comparable to the concept of attachment. Like in a parental or primary caregiver relationship, the psychotherapist offers emotional support, comfort and a “secure base”. In general, a positive therapeutic relationship is related to positive effects [4, 6, 14, 15].
Ethnicity, age or personality variables have been also used as matching indicators. Nevertheless, analyzing gender as a matching indicator is widely recommended and is one of the most examined variables in counseling research [3, 16,17,18,19,20]. Some researchers even discussed, that gender matched client-therapist dyads are essential for therapist to optimally adapt to the client’s needs [16, 17]. Gender dyads or matching refers to client-therapist constellations of the same gender, e.g., female clients are assigned to female therapist, while male clients will be matched to male therapist.
Theories suggest that individuals better identify and empathize with others if they believe to be similar to themselves [21, 22]. Accordingly, individuals develop certain gender-based behaviors or interactional styles and the convergence or divergence of these influences the quality of the relationship and communication with others [23,24,25]. In this context, gender plays an important role, since it does not only refer to physical attributes, but to cultural aspects that affect personality, attitudes, and behaviors [2, 24]. The latter affects the individuals’ world view in a way, that gendered schemas and social roles are internalized. As a result, social roles and gender expectations are reflected in specific behavioral interactional styles associated to gender [23, 25]. As an example, in western cultures men are typically socialized with traits attributed to authority and agency, such as striving for power and independence. On the other hand, women are more acquainted with communal traits or pro-social behaviors, such as solidarity and connectedness [26,27,28]. Correspondingly, both theories imply that same-gender client-therapist dyads have a greater convergence in terms of internalized gendered perspectives. For instance, men might instantly suppose that the male therapist will “get it” and consciously or unconsciously assume already an alliance . Therefore, it is more likely that same-gender dyads share similar points of view and a comparable conceptualization of therapeutic related variables (e.g., working alliance, well-being). These are thought to account for a greater patient-therapist bond, translating into better therapeutic outcomes [3, 28].
In the case of psychotherapy, positive outcomes refer to successful treatment, measured by a favorable treatment response, i.e., reduction of disorder specific symptoms, improvement in the quality of life, lower drop-out rates and even a better working alliance [29, 30]. Many authors have posited that addressing client preferences may boost therapy outcomes. In this regard, research on client-therapist dyads has been reporting preferences towards same gender therapist [31,32,33,34,35]. However, in terms of outcomes empirical evidence shows inconsistent results. On the one hand, studies revealed an improvement in psychiatric symptoms of gender-matched client-therapist dyads [36, 37] reduced drop out [36, 38], better working alliance [3, 19], and greater satisfaction with the therapeutic relationship [20, 33, 36]. Importantly, a previous study demonstrated that matched clients had significantly less utilization of intensive care services, saving costs around $1000 (annually) per matched client . On the other hand, authors have stated that gender matching is not a priority for clients neither an appropriate predictor of the therapy processes and outcomes [1, 40,41,42], especially since the reported effect sizes are small [3, 37, 43] and in some cases unknown [19, 36]. A further explanation of these mixed findings may be related to limitations in methodological procedures, small sample sizes and heterogeneity concerning type of therapy.
Until now, symptom reduction has not been well documented in the context of same gender dyads and a specific types of therapy. For example, Staczan and colleagues  pointed out this gap and analyzed several treatment outcomes including symptom reduction in same gender pairings. Their study showed highly significantly results in most of the studied variables in matched than in mismatched gender dyads. Nevertheless, no significant differences were shown among psychotherapy methods in terms of symptom reduction.
Regardless, the mentioned study did not examine cognitive-behavioral, behavioral, or psychoanalysis-based methods and if, some calculations included very small sample sizes (e.g., Psychodynamic n = 4)—making findings susceptible to random fluctuations. Therefore, it is still not clear whether gender matching is relevant or not, depending on the type of therapy patients received.
The optimization of therapeutic outcomes may persistently reduce psychological symptoms and at the same time improve the quality of life of the patients [39, 44]. Identifying whether same gender client-therapist dyads enhance therapy outcomes or not has several advantages related to enhanced therapy outcomes (e.g., better quality of life, reduction of long-term financial burden for the health care system). Since cognitive-behavioral and psychoanalysis-based (i.e., depth psychotherapeutic and psychodynamic therapy approaches) methods are covered by the German public health insurance, cost-effective measures that improve psychological interventions is a public/social concern.
Effective symptom reduction based on client therapist dyads is a very feasible procedure that can be easily implemented, if it turns out to be a useful procedure that is evidenced based. Taking the described aspects into consideration the purpose of the present study is to determine the relationship between same-gender client-therapist dyads and symptom reduction based on different types of therapies (Cognitive Behavioral Therapy, Psychodynamic approaches: e.g., Psychoanalysis and Depth psychotherapy). Based on previous findings, we expect more positive outcomes in same gender client-therapist dyads, compared to mismatched dyads. For this purpose, we assessed the following outcome variables: Symptom reduction and quality of life in two different therapy approaches, 1. CBT and 2. Psychodynamic based methods.