Counselors' and clients' ethnic similarity and therapeutic alliance in time-limited outcomes of counseling

A Longitudinal Analysis of Factors Associated with Therapeutic Alliances

This study examined the impact, on therapeutic alliances, made by client motivation to change, insight, mistrust, and other factors; as well as therapist's clinical experience. This secondary data analysis used a sample of 212 client respondents extracted from the Treatment of Depression Collaborative Research Program's data set. Results of generalized least squares random-effects modeling showed a significant impact exerted by client social-adjustment difficulties, insight, alcohol use, and gender; and client-therapist matching gender. Also, four elements of therapeutic alliances-regard, empathic understanding, unconditionality, and congruence-had four unique patterns of significant factors. To foster therapeutic alliances, therapists need to help clients develop awareness of and insight into the clients' social-adjustment difficulties; therapists should also be particularly sensitive to expectations of clients of the opposite sex. Implications for future research are suggested.

Using Needs Assessment to Resolve Controversies in Diversity Training Design

Needs assessment is an important element in training design, and organizational diversity training programs are frequently criticized for their lack of attention to the needs assessment process. This paper explores the link between needs assessment and diversity training design. First, a review of the needs assessment literature reveals that an emphasis on organizational analysis has led to the neglect of other kinds of assessment data. Second, a review of the diversity training literature identifies five areas of controversy. We describe the needs assessment questions that organizations can ask to resolve each controversy and better tailor diversity training to their own needs. Finally, based on the design controversies and needs assessment questions, we provide an agenda for future research on the effectiveness of various kinds of diversity training interventions

Mental health service and provider preference among American Indians with type 2 diabetes

In this study, we investigated mental health service and provider preferences of American Indian adults with type 2 diabetes from two tribes in the northern Midwest. Preferences were determined and compared by participant characteristics. After controlling for other factors, living on reservation lands was associated with increased odds of Native provider preference, and decreased odds of biomedical service preference. Anxiety also was associated with decreased odds of biomedical service preference. Spiritual activity engagement and past health care discrimination were associated with increased odds of traditional service preference. We discuss implications for the types of mental health services offered and characteristics of providers who are recruited for tribal communities.

Racial/ethnic match and treatment outcomes for women with PTSD and substance use disorders receiving community-based treatment

This study examined the relationship between racial/ethnic match and treatment outcomes for 224 women who participated in a clinical trial of group treatments for posttraumatic stress disorder (PTSD) and substance use disorders. Generalized estimating equations were used to examine the effect of client-therapist racial/ethnic match on outcomes. Results revealed racial/ethnic match was not significantly associated with session attendance. There was a significant three-way interaction between client race/ethnicity, baseline level of PTSD symptoms, and racial/ethnic match on PTSD outcomes. White clients, with severe PTSD symptoms at baseline, who attended treatment groups where they were matched with their therapist, had greater reductions in PTSD symptoms at follow-up than their counterparts who were racially/ethnically mismatched with their group therapist. Racial/ethnic match did not confer additional benefits for Black clients in terms of PTSD outcomes. Racial/ethnic match interacted with baseline substance use to differentially influence substance use outcomes at follow-up for all women. Clinical implications are discussed.

Therapeutic alliance perceptions and medication adherence in patients with bipolar disorder

BACKGROUND

Despite the dissemination of practice guidelines for bipolar disorder, outcomes remain suboptimal, largely due to poor treatment adherence. The episodic nature of bipolar disorder disrupts appropriate patient-provider dynamics, interfering with appropriate care. Maintaining a beneficial therapeutic alliance with providers is one important strategy for improving adherence. We examine the association between adherence and therapeutic environment perceptions among veterans with bipolar disorder.

METHODS

Participants were recruited from the Continuous Improvement for Veterans in Care--Mood Disorders (CIVIC-MD) study (N=435). Individual items and a summary score from the Health Care Climate Questionnaire (HCCQ) for bipolar disorder solicited patient evaluations of their therapeutic environment. Multivariable logistic analyses examined the association between therapeutic alliance and two measures of adherence (missed medication days and intrapersonal barriers), adjusting for relevant patient characteristics.

RESULTS

Adherence difficulty was reported on both measures, with substantial differences between perceived barriers and actual medication behavior. Significantly fewer minority veterans endorsed good adherence than white patients (59% versus 77%), although no ethnic differences were noted in therapeutic environment perceptions. Multivariable results indicated that positive therapeutic alliance was associated with better adherence (HCCQ effect sizes 13-20%). Notably, patients reporting providers encouraged "staying in regular contact" were more likely to be adherent, as were patients whose "providers regularly review their progress".

LIMITATIONS

Generalizability from observational study; adherence defined by cross-sectional patient self-report.

CONCLUSIONS

The observed association between medication adherence and therapeutic alliance with bipolar treatment supports intervention efforts to strengthen the patient-provider relationship, a bond likely to yield positive clinical outcomes.

Ethnic Matching Between Therapist and Patient in Psychotherapy: An Overview of Findings, Together With Methodological and Conceptual Issues

This article reviews the empirical support for ethnic matching between therapist and patient in psychotherapy. The research has 3 sources: analog studies, archival studies of number of attended sessions and dropout rates, and process-outcome studies of psychotherapy. Clinical trials studying ethnic matching are absent. Empirical support for ethnic matching suffers from low validity and is inconclusive, with few studies of actual psychotherapy. The research is hampered by poor conceptualization of key concepts, difficulties in forming ethnically homogeneous groups for comparisons, and an abundance of uncontrolled within-group variables. Therapist variables, for example cultural sensitivity, are rarely investigated. There is a need for large-scale psychotherapy studies with well-defined key concepts in which the impacts of within-group and therapist variables are investigated.