CLIENTS’ RACE/ETHNICITY AS A MODERATOR OF THE RELATIONSHIP BETWEEN THE THERAPEUTIC ALLIANCE AND TREATMENT OUTCOME

Abstract

The importance of understanding racial/ethnic minorities’ (REM) mental health issues and treatment effectiveness is paramount because the American society has become increasingly diverse with regard to race and ethnicity. Whereas psychotherapy process-outcome research has established that the therapeutic alliance is one of the most potent therapeutic ingredients that promotes positive treatment outcome, these studies have involved predominantly White samples. REM clients may experience psychotherapy differently from White clients considering their oppressed and racialized experience in everyday life as well as in psychotherapy. Therefore, whether the alliance-outcome relationship is as strong for REM clients as it is for White clients warrants further examination. The current study was designed to investigate if there were differences between REM and White clients with regard to the therapeutic alliance and treatment outcome, as well as to test if clients’ race/ethnicity was a moderator of the alliance-outcome relationship. The researcher hypothesized that clients’ racial/ethnic status would moderate the alliance-outcome relationship and that the alliance-outcome relationship would be weaker for REM clients as compared to White clients. The study used archival data from a training clinic at a large Midwestern university, included 308 Caucasian and 132 REM clients who received counseling services at the clinic. The differences in the therapeutic alliance and treatment outcome measures between the two groups were analyzed by using independent-samples t-tests. Clients’ race/ethnicity as the moderator was examined by using hierarchical linear regression. Results of the study indicated that, first, the therapeutic alliance reported by REM clients was significantly lower than that by White clients. Second, there was no significant difference in treatment outcome between White and REM clients. Third, clients’ racial/ethnic status did not moderate the alliance-outcome relationship, which suggested that there was no significant difference in the strength of the alliance-outcome relationship between White and REM clients. Findings of the study suggested that, while REM clients who persisted in psychotherapy benefited from it as much as White clients, they experienced a weaker therapeutic alliance. The results of the study highlighted the importance of building an effective therapeutic alliance with REM clients. Practical implications of the study suggested that therapists should provide culturally sensitive and race-informed psychotherapy in order to build a strong therapeutic alliance with REM clients. Limitations and direction for future research were also discussed.