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.

[1]  D. W. Sue.  Multicultural Counseling Competencies: Individual and Organizational Development , 1998 .

[2]  K. Herman,et al.  Cultural Sensitivity in Physician‐Patient Relationships Perspectives of an Ethnically Diverse Sample of Low‐income Primary Care Patients , 2003, Medical care.

[3]  C. Bingham,et al.  Race and inpatient psychiatric diagnoses among elderly veterans. , 2000, Psychiatric services.

[4]  D. W. Sue,et al.  Multicultural Counseling Competencies and Standards: A Call to the Profession , 1992 .

[5]  C. E. Watkins,et al.  Handbook of psychotherapy supervision , 1997 .

[6]  Christy K. Scott,et al.  The Cannabis Youth Treatment (CYT) experiment: rationale, study design and analysis plans. , 2002, Addiction.

[7]  K. Harris,et al.  Racial and Ethnic Differences in the Mental Health Problems and Use of Mental Health Care , 2005, Medical care.

[8]  B. Smedley,et al.  Unequal Treatment: Con-fronting Racial and Ethnic Disparities in Health Care , 2002 .

[9]  David C. Atkins,et al.  Rethinking how family researchers model infrequent outcomes: a tutorial on count regression and zero-inflated models. , 2007, Journal of family psychology : JFP : journal of the Division of Family Psychology of the American Psychological Association.

[10]  Andrew Gelman,et al.  Data Analysis Using Regression and Multilevel/Hierarchical Models , 2006 .

[11]  D. Bolt,et al.  Therapist effects in psychotherapy: A random-effects modeling of the National Institute of Mental Health Treatment of Depression Collaborative Research Program data , 2006 .

[12]  C. Brach,et al.  Can Cultural Competency Reduce Racial and Ethnic Health Disparities? A Review and Conceptual Model , 2000 .

[13]  S. López.  Cultural competence in psychotherapy: A guide for clinicians and their supervisors. , 1997 .

[14]  Madonna G. Constantine,et al.  Racial Microaggressions Against African American Clients in Cross-Racial Counseling Relationships , 2007 .

[15]  Karen W Tao,et al.  Clients' perceptions of their psychotherapists' multicultural orientation. , 2011, Psychotherapy.

[16]  Madonna G. Constantine,et al.  Predictors of Satisfaction with Counseling: Racial and Ethnic Minority Clients' Attitudes toward Counseling and Ratings of Their Counselors' General and Multicultural Counseling Competence. , 2002 .

[17]  H. Coleman.  General and multicultural counseling competency: Apples and oranges? , 1998 .

[18]  S. Sue,et al.  The case for cultural competency in psychotherapeutic interventions. , 2009, Annual review of psychology.

[19]  Patricia Arredondo,et al.  Multicultural Counseling Competencies = Ethical Practice , 2004 .

[20]  Eric B Bass,et al.  Improving health care quality for racial/ethnic minorities: a systematic review of the best evidence regarding provider and organization interventions , 2006, BMC public health.

[21]  Lisa Suzuki,et al.  Handbook of Multicultural Counseling , 2001 .

[22]  Jim Mintz,et al.  Implications of therapist effects for the design and analysis of comparative studies of psychotherapies. , 1991 .

[23]  M. Ryn,et al.  Research on the provider contribution to race/ethnicity disparities in medical care. , 2002 .

[24]  S. Schoenwald,et al.  Caregiver-therapist ethnic similarity predicts youth outcomes from an empirically based treatment. , 2005, Journal of consulting and clinical psychology.

[25]  M. van Ryn,et al.  Paved with good intentions: do public health and human service providers contribute to racial/ethnic disparities in health? , 2003, American journal of public health.

[26]  R. Weiss,et al.  Variations in therapist effectiveness in the treatment of patients with substance use disorders: an empirical review. , 1994, Addiction.

[27]  Bradley P. Carlin,et al.  Bayesian measures of model complexity and fit , 2002 .

[28]  J. Helms,et al.  Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists. , 2003, The American psychologist.

[29]  Janet B W Williams,et al.  Diagnostic and Statistical Manual of Mental Disorders , 2013 .

[30]  Dc Washington.  Diagnostic and Statistical Manual of Mental Disorders, 4th Ed. , 1994 .

[31]  Madonna G. Constantine,et al.  New visions for defining and assessing multicultural counseling competence. , 2001 .

[32]  A. MacLeod,et al.  Measures of Cultural Competence: Examining Hidden Assumptions , 2007, Academic medicine : journal of the Association of American Medical Colleges.

[33]  Paul Pedersen,et al.  Position Paper: Cross-Cultural Counseling Competencies , 1982 .

[34]  J. Gill.  Hierarchical Linear Models , 2005 .

[35]  Don C. Locke,et al.  Operationalization of the Multicultural Counseling Competencies , 1996 .

[36]  C. R. Ridley,et al.  Imperatives for ethnic and cultural relevance in psychology training programs. , 1985 .

[37]  G. Hall,et al.  Meta-analyses of ethnic match as a predictor of dropout, utilization, and level of functioning. , 2002, Cultural diversity & ethnic minority psychology.

[38]  Roger L. Worthington,et al.  Multicultural counseling competencies research : A 20-year content analysis , 2007 .

[39]  Thomas Babor,et al.  The Cannabis Youth Treatment (CYT) Study: main findings from two randomized trials. , 2004, Journal of substance abuse treatment.

[40]  Multicultural approaches in psychotherapy: A rejoinder. , 2010, Journal of counseling psychology.

[41]  David Satcher,et al.  Mental Health: Culture, Race, and Ethnicity—A Supplement to Mental Health: A Report of the Surgeon General , 2001 .

[42]  LaRae M. Jome,et al.  Reconceptualizing Multicultural Counseling , 1998 .