Racial/ethnic disparities in therapist effectiveness: a conceptualization and initial study of cultural competence

As a result of mental health disparities between White and racial/ethnic minority clients, researchers have argued that some therapists may be generally competent to provide effective services but lack cultural competence. This distinction assumes that client racial/ethnic background is a source of variability in therapist effectiveness. However, there have been no direct tests of the therapist as a source of health disparities. We provided an initial test of the distinction between general and cultural competence by examining client racial/ethnic background as a source of variability in therapist effectiveness. We analyzed cannabis use outcomes from a psychotherapy trial (N = 582) for adolescent cannabis abuse and dependence using Bayesian multilevel models for count outcomes. We first tested whether therapists differed in their effectiveness and then tested whether disparities in treatment outcomes varied across therapist caseloads. Results suggested that therapists differed in their effectiveness in general and that effectiveness varied according to client racial/ethnic background. Therapist effectiveness may depend partially on client racial/ethnic minority background, providing evidence that it is valid to distinguish between general and cultural competence.     

Racial/ethnic matching of clients and therapists in mental health services: a meta-analytic review of preferences, perceptions, and outcomes

Across several decades the effects of matching clients with therapists of the same race/ethnicity have been explored using a variety of approaches. We conducted a meta-analysis of 3 variables frequently used in research on racial/ethnic matching: individuals' preferences for a therapist of their own race/ethnicity, clients' perceptions of therapists across racial/ethnic match, and therapeutic outcomes across racial/ethnic match. Across 52 studies of preferences, the average effect size (Cohen's d) was 0.63, indicating a moderately strong preference for a therapist of one's own race/ethnicity. Across 81 studies of individuals' perceptions of therapists, the average effect size was 0.32, indicating a tendency to perceive therapists of one's own race/ethnicity somewhat more positively than other therapists. Across 53 studies of client outcomes in mental health treatment, the average effect size was 0.09, indicating almost no benefit to treatment outcomes from racial/ethnic matching of clients with therapists. These 3 averaged effect sizes were characterized by substantial heterogeneity: The effects of racial/ethnic matching are highly variable. Studies involving African American participants demonstrated the highest effect sizes across all 3 types of evaluations: preferences, perceptions, and outcomes.     

Sex, race/ethnicity, and romantic attractions: multiple minority status adolescents and mental health

This study examined the association between multiple minority statuses and reports of suicidal thoughts, depression, and self-esteem among adolescents. Data from the National Longitudinal Study of Adolescent Health were used to examine mental health outcomes across racial/ethnic groups for same-sex-attracted youths and female youths. Hispanic/Latino, African American, and White female adolescents reported more suicidal thoughts, higher depression, and lower self-esteem compared with male adolescents in their racial/ethnic group. Same-sex-attracted youths did not consistently demonstrate compromised mental health across racial/ethnic groups. Follow-up analyses show that White same-sex-attracted female adolescents reported the most compromised mental health compared with other White adolescents. However, similar trends were not found for racial/ethnic minority female youths with same-sex attractions.     

Racial and Ethnic Disparities in Education–Occupation Mismatch Status Among Immigrants in South Africa and the United States

In this study, a comparative–international approach is used to examine race–ethnic disparities in education–occupation mismatch status among immigrants. Using data from the USA and South Africa, this study finds that immigrants are most likely to be undereducated, or have less schooling for their jobs, when their racial characteristics are similar to those of the local racial majority. Black immigrants in South Africa and White immigrants in the USA are the most likely to be undereducated. Having racial characteristics similar to those of the local racial majority is associated with a lower likelihood of overeducation among immigrants.     

Client and therapist variability in clients' perceptions of their therapists' multicultural competencies

This study examined therapist differences in their clients' ratings of their therapists' multicultural competencies (MCCs) as well as tested whether therapists' who were rated as exhibiting more MCCs also had clients who had better therapy outcomes (N = 143 clients and 31 therapists). All clients completed at least 3 sessions. Results demonstrated that therapists accounted for less than 1% of the variance in their clients' Cross-Cultural Counseling Inventory–Revised (CCCI-R; T. D. LaFromboise, H. L. K. Coleman, & A. Hernandez, 1991) scores, suggesting that therapists did not differ in terms of how clients rated their MCCs. Therapists accounted for approximately 8.5% of the variance in therapy outcomes. For each therapist, their clients' CCCI-R scores were aggregated to provide an estimate of therapists' MCCs. Therapists' MCCs, based on aggregate CCCI-R scores, did not account for the variability in therapy outcomes that were attributed to them. Additionally, clients' race/ethnicity, therapists' race/ethnicity, or the interaction of clients'–therapists' race/ethnicity were not significantly associated with clients' perceptions of their therapists' MCCs.     

Ethnic minorities' racial attitudes and contact experiences with white people

In this article, the authors examine the relationship between ethnic minorities' racial attitudes and their intergroup contact experiences with White people. In Studies 1 and 2, the authors demonstrate that the more negative the racial attitudes held by ethnic minorities, the less positive their interactions are with White friends and roommates. With a daily report methodology, Study 2 revealed that ethnic minorities' racial attitudes predicted the decline in the quality of their intergroup contact experiences over a 3-week period. In Study 3, the authors examined a possible mechanism underlying the relationship between racial attitudes and intergroup contact, as well as the influence of ethnic minorities' racial attitudes on White participants' experiences in intergroup contact settings. The authors discuss the findings in terms of the importance of examining ethnic minorities' attitudes in research on intergroup relations.     

National ethnic and racial disparities in disciplinary practices: A contextual analysis in American secondary schools

Previous research has documented ethnic/racial disparities in the implementation of school discipline, including exclusionary practices. The current study focused on ethnic/racial disparities in four types of school exclusionary policies through the Civil Rights Data Collection (2013–2014) based on 15,901 middle and 18,303 high schools from the United States. Consistent with an ecological model of multi-contextual influences, school- and region-level characteristics were tested in a multi-level analytic model. Sex, disability status, and ethnicity/race were estimated at level 1, with the following school-level predictors at level 2: proportion of youth eligible for free or reduced lunch, school size, diversity (percentage of students of different ethnicities/races in school), urban/suburban/rural locale, and region (Northeast, Midwest, South, and West). Findings provided robust evidence of persistent discrepancies in disciplinary practices across ethnic/racial groups. Specifically, African American students and students self-identifying as two or more races were found to be at greater risk for school discipline actions across all disciplinary measures in both middle and high schools. Regarding school-level variables, students from lower SES schools and smaller schools were at greater risk for some disciplinary measures. Unexpected findings were found for regional differences, as Midwestern schools had significantly higher rates for most disciplinary measures as compared to Southern schools. Moreover, ethnic/racial discrepancies were moderated by school-level characteristics, such that African American students and students self-identifying with two or more races were more likely to be disciplined at low SES schools and at schools with greater diversity.     

Co-Occurring Youth Profiles of Adverse Childhood Experiences and Protective Factors: Associations with Health,Resilience, and Racial Disparities

It is important to understand racial/ethnic differences in adverse childhood experiences (ACEs), given their relationship to long-term physical and mental health, and the public health cost of the significant disparities that exist. Moreover, in order to inform interventions and promote resilience, it is critical to examine protective factors that mitigate the relationship between adversity and poor health. The current study utilized latent transition analyses (LTA) to examine co-occurring profiles of ACEs and protective factors (from school, family, and community contexts) and links to health outcomes among 30,668 Black (10.4%), Latinx (12.3%), and White youth (77.3%) ages 12–17 (52.5% male) who participated in the 2011–12 National Survey of Children's Health (NSCH). Results suggested that greater adversity was associated with worse health, while more access to protective factors was associated with better health. White youth had consistently lower endorsement of ACEs, greater access to protective factors, and better health compared to their Black and Latinx counterparts. Efforts to improve child health and racial/ethnic disparities in research and practice must consider adversity, protective factors, and the systemic inequities faced by racial/ethnic minority youth in the United States.     

Race/ethnicity and sex in U.S. occupations, 1970–2010: Implications for research,practice, and policy

We used census data on the civilian non-institutional adult population to analyze trends in labor force participation by race/ethnicity and sex in U.S. occupations from 1970 to 2010 in decennial periods. We examined these data for the main effects and interactions of race/ethnicity and sex across the total labor market and within 35 detailed occupations. Results from a log-linear analysis revealed that, as a whole (across race/ethnicity), more women participated in the labor force from 1970 to 2010. The proportions of working racial/ethnic minorities to both the population and the people in the labor force increased across all decades except for Black men. Although White (Caucasian) men continuously comprised the largest racial/ethnic–sex group working across five decades in absolute numbers, their percentage of the total working population declined from 1970 (54%) to 2010 (37%). In our analyses of 35 occupations, significant sex differences within racial/ethnic groups emerged. Overall, with some exceptions, Asian men and women and White women were more likely to be absorbed into occupations typically associated with professional status whereas Black, Hispanic, and American Indian men and women were more likely to be absorbed into occupations typically associated with low skill, low wages, and low status. Implications for the role of psychologists in future research, practice, and policy are discussed.     

The Effect of Therapist–Client Racial Similarity on Client Satisfaction and Therapist Evaluation of Treatment

Client satisfaction with therapy services and therapists' perspectives of treatment evaluation were examined in relation to therapist and client racial similarity. Secondary data from a university marriage and family therapy clinic located in the southeast was used to pair therapists and clients on racial similarity or difference. Statistical analyses revealed no major differences in clients' perceptions of satisfaction based on similarity to therapists' race. Therapists indicated some differences in their perceptions of the success of services provided to clients based on similarity to client's race. Implications for researchers, clinicians, and educators are included.     

Influence of Racial/Ethnic Membership and “Therapist Culture” on Therapists' Worldview

The authors investigated 2 competing hypotheses related to therapists' worldview and therapists' race/ethnicity: (a) whether therapists of different racial/ethnic groups differed on worldview reflecting group membership, and (b) whether therapists were similar to each other on worldview reflecting membership in a “therapist culture.” Results indicated that therapists shared similar worldviews regardless of group membership, and differences found between therapists based on racial/ethnic membership were minimal.     

Low-income, nonresident father involvement with their toddlers: variation by fathers' race and ethnicity

Using data from a racially and ethnically diverse sample of low-income mothers of 2-year-old children participating in the Early Head Start Research and Evaluation Project (N = 883), the authors examined fathers' education and employment, mother-father relationship, and mothers' relationships with kin in the household to explain variation in nonresident father involvement across racial and ethnic groups. Nonresident White fathers were less involved with their children than were African American and Latino fathers. This difference was explained by the status of mother-father relationships. White nonresident fathers were less likely than minority nonresident fathers to maintain romantic relationships with their child's mother. Mothers in the White father group were also more likely to re-partner, which negatively related to biological fathers' involvement. These findings suggest that approaches to strengthen nonresident father involvement in children's lives need to consider how father ethnicity and mother-father relations are associated with differential patterns of father involvement.     

The Importance of Therapist/Client Ethnic/Racial Matching in Couples Treatment for Domestic Violence

Outcome research indicates a relative degree of variability regarding the effectiveness of client and therapist ethnic/racial matching (see Cabral and Smith 2011; Shin et al. in J Couns Psychol 52(1):45–56, 2005). Considering these findings, our study hopes to further understand the complexity behind ethnic/racial matching in treatment. In this study, we examined interviews with clients and therapists regarding ethnic/racial matching in couples treatment for domestic violence (e.g., McCollum and Stith in Violence Vict 23(2):187–201, 2008). Our findings indicated that ethnic/racial matching is a complex multi-faceted issue and connected ethnic/racial matching with issues of culture, human experience, and others. We recommend clinicians consider the complexity of ethnic/racial matching in practice.     

Psychotherapy as a Process of Value Stabilization

The Rokeach Value Survey (RVS) and a confidence rating scale (CRS) were given to 13 experienced psychotherapists and 62 of their clients in field settings at the beginning and termination of therapy, or after 6 months. Results from the RVS demonstrate that therapists are more value stable than their clients and that clients shift their value systems toward their therapists' value configurations. Results from the CRS indicate that therapists are more confident than are clients and that clients' confidence increases across therapy.     

Resilience from Childhood Stressors: The Role of Cultural Resilience,Ethnic Identity,and Gender Identity

This study examined the potential influence of cultural resilience, ethnic identity, and gender identity on resilience processes across diverse racial/ethnic groups of young women. A sample of 200 women who attended a large state university were studied, of whom 50 self-identified as White, 50 as African American, 50 as Asian or Asian American, and 50 as Latina. Results indicated significant racial/ethnic differences in childhood stressors experienced by the women such that African American, Asian/Asian American, and Latina women reported more overall childhood stressors and more stress associated with racism and sexism than their White counterparts. Furthermore, ethnic identity search and an androgynous gender identity contributed to greater resilience. Implications for research and practice are discussed.     

Students’ Motivation and Engagement Predict Reading Achievement Differently by Ethnic Group

The authors examined Grade 3 and Grade 5 teacher-rated classroom engagement and student self-reported motivation for reading as predictors of reading achievement. They investigated the patterns of prediction of achievement for three racial/ethnic groups (White, Black, and Hispanic) and five levels of socioeconomic status (SES) in a combined within-group model. Groups were created by crossing race/ethnicity with SES to form 15 independent groups for each grade level. Results indicated that self-reported motivation was a significant predictor of reading achievement mainly for White third-grade students; teacher-reported engagement was a better predictor for all racial/ethnic groups for both Grade 3 and Grade 5 reading achievement. Results show higher achievement for White and higher-SES students compared with non-White and lower-SES students.     

The Association of Multiple Identities with Self‐Directed Violence and Depression among Transgender Individuals

Transgender individuals have a high prevalence of self‐directed violence; however, there is scant literature focusing on their unique experiences. The differences in self‐harm, suicidal ideation, suicide attempt, and depression based on racial/ethnic identity and sexual orientation were examined among transgender individuals. Data were gathered from the Fall 2008 and Spring 2009 National College Health Assessment. Across racial/ethnic identities, greater proportions of transgender students endorsed self‐directed violence than their cisgender peers. Among transgender individuals, sexual minorities were more likely to report suicidal ideation than their heterosexual peers, and racial/ethnic minorities had higher odds of attempting suicide than non‐Hispanic White individuals.     

Depression and coping in candidates for kidney transplantation: Racial and ethnic differences

Subjects were 288 adolescents and adults with end-stage renal disease who were candidates for kidney transplantation, a group identified at risk for noncompliance. The purpose was to examine racial and ethnic variations in coping—variables that may underlie noncompliance and impact upon health outcome. Secondarily, the relationship between depression and particular styles of coping was investigated. Race/Ethnicity was divided into three categories: Black/Non-Hispanic, White/Non-Hispanic, and Hispanic. Coping and depression were assessed using the COPE and Beck Depression Inventory, respectively. Results indicated that Hispanic and Black subjects were more likely to use maladaptive styles of coping and less likely to use adaptive coping than were White subjects and that Black subjects reported more physical symptoms of depression. These findings point to possible mechanisms underlying the occurrence of noncompliance and resulting poorer health outcome for individuals of different racial and ethnic groups.     

The Costs of Silencing the Self and Divided Self in the Context of Physical Abuse,Racial/Ethnic Identity,and Medication Adherence in Women Living with HIV

Racial/ethnic minority status and physical abuse history are risk factors for higher mortality rates and lower adherence to antiretroviral therapy (ART) in women living with HIV (WLWH) in the United States. The current study tested the hypotheses that minority status and physical abuse history might lead women to silence the self (minimize and hide thoughts and feelings in order to avoid relational conflict, loss, and/or abuse) as measured by the Silencing the Self Scale (STSS), and that STSS might mediate and moderate relationships of physical abuse and racial/ethnic minority status with ART adherence. Divided Self (DS; acting in ways inconsistent with inner thoughts and feelings), an STSS subscale, was targeted for study along with the total STSS score. Participants were 513 women from the U.S. Women’s Interagency HIV Study (M_age?=?46; 387, 75%, Black; 66, 13%, Hispanic; 60, 12%, White). Multiple logistic regressions indicated that across all racial/ethnic groups, physical abuse history related to higher DS and lower adherence. DS significantly mediated relationships between abuse and adherence. Compared to White women, Black women demonstrated worse ART adherence, but had lower total STSS. Racial/ethnic minority women and women with a physical abuse history who had higher DS had lower adherence than other groups. Results indicate that being a racial/ethnic minority or having a history of physical abuse may increase vulnerability to the deleterious effects of DS on ART adherence, findings that can help inform interventions to decrease health disparities in WLWH.

     

Symptom reduction and termination: client change and therapist identified reasons for saying goodbye

Empirical efforts have focused on predicting whether or not clients prematurely terminate therapy, with nonattendance of last session equated to premature termination. However, this fails to explore the relationship between clients’ distress reduction and reasons for termination. With this study, we aimed to understand how clients’ distress change relates to premature termination and examine clients’ distress change in conjunction with therapists’ perceptions of termination reasons. We collected data from 797 clients who prematurely terminated or attended termination but completed therapy a minimum of three individual sessions provided by 38 therapists. Clients completed an assessment of psychological symptoms before each session. At the end of treatment, therapists identified the reasons they believed termination occurred for all clients in the sample. Results demonstrate that total sessions attended and missed predict premature termination, whereas distress change does not. Additionally, clients who were believed to accomplish goals do show greater change. However, therapists’ indicated that over half of clients did not reach goals at termination and they did not perceive nonattendance at last session to equate to drop out in all cases. Implications are discussed with respect to understanding why clients’ terminate, therapeutic goal conceptualization, and review of goals during termination in time-limited psychotherapy.