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Ethnic and racial differences between client and therapist affect therapy processes and outcomes, but little is known about the extent to which therapists have dialogues about their differences in therapy. A survey on this topic was completed by 689 APA-licensed psychologists with experience conducting cross-cultural therapy. Most psychologists reported having such discussions, but with less than half of their cross-ethnic/racial clients. Therapists and clients were equally likely to initiate discussions. Reasons for discussing differences varied greatly. Therapists consistently described themselves as comfortable with and skilled at these discussions, and reported that discussions facilitated therapy. Therapists who were female, older, nonminority, less experienced with diverse clients, and viewed training as an important factor were more likely to have discussions about differences. Results point to the need to better understand if, when, and how ethnic and racial differences should be addressed in therapy.