Online Program

A longitudinal examination of therapeutic relationship variables in an ethnically diverse community mental health sample

Tuesday, November 5, 2013 : 11:10 a.m. - 11:30 a.m.

Gabriela Stein, PhD, Department of Psychology, University of North Carolina - Greensboro, Greensboro, NC
INTRODUCTION: Quality interactions between mental health providers and patients can help ensure that racial, ethnic, and linguistic (REL) minorities receive quality mental health care. However, for several decades, “cultural gaps” have been suspected between providers and patients from these backgrounds, and these “gaps” have been hypothesized to be an important factor in the low treatment utilization of REL patients. This paper examines REL differences across time in working alliance and patient-provider communication with therapists. METHODS: The sample of 318 patients was drawn from a larger patient activation intervention trial. Of the sample, 67% identified themselves as Latino, 11% as African American, 16% as non-Latino white, and 6% as Other (mainly Asian, Native American or mixed race). Patients completed the therapeutic relationship variables at three separate time points over a 6 month period. RESULTS: Controlling for sociodemographic characteristics (gender, insurance status, age, education, severity, and time in treatment), Latino patients reported significantly greater working alliance and communication than non-Latino white (NLW) patients at baseline. However, contrary to expectations, there were no significant ethnic differences in either working alliance or communication over time. DISCUSSION: Latino patients in our sample reported better therapeutic relationships with their providers than NLW patients. These findings may be attributable to the fact that Latino patients were seeking care in settings that accommodated their needs (i.e., had Spanish-speaking therapists) and culturally specific clinics.

Learning Areas:

Diversity and culture
Provision of health care to the public

Learning Objectives:
Define working alliance in therapeutic encounters. Describe 5 potential barriers to working alliance for racial, ethnic, and linguistic minority patients. Compare the trajectories of working alliance across different racial, ethnic, and linguistic minority patients.

Keyword(s): Minority Health, Mental Health Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was the Co-PI on this study at one of the mental health clinics involved in the study. I was involved in all aspects of the study from implementation to writing the results. I have been the recipient of one federal funded grants examining mental health processes. Among my scientific interests has been the development of culturally grounded mental health treatments.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.