An Examination of the Therapeutic Alliance and Treatment Outcome for Marginalized Populations
Abstract
Although evidence demonstrates that most clients benefit from psychotherapy, evidence of mental health disparities in treatment outcome persist among marginalized populations. Research has yielded limited and inconsistent findings to explain why they exist. Recently, it has been suggested that the therapeutic alliance is key to addressing disparities in outcomes with clients from varying cultural backgrounds. This study reviewed existing data collected from a community mental health clinic in Bryan, Texas to address disparities, particularly for rural and socioeconomically disadvantaged adults and adolescents.
Multiple linear regression used the Session Sample (n = 1,046) to predict treatment response (measured by the Outcome Rating Scale) with the therapeutic alliance (measured by the Session Rating Scale) and client demographic variables (age, gender, race/ethnicity, rurality, poverty). The results yielded significant findings for all variables except for race/ethnicity. Yet, the alliance was found to be the strongest predictor. This suggested that clients who were female, adults, at or below the federal poverty line, and resided in rural areas had worse treatment outcomes than their counterparts. Multiple regression was also used to assess the predictive value of the independent alliance domains (relationship, goals/topics, approach/method, and overall), but revealed that no domain by itself was significant.
Logistic regression was used with a Client sample (n = 119) to predict a Good alliance, Therapist Appraisal of sufficient progress, and Client-Therapist Agreement on treatment outcome. Results found that client gender was the only significant predictor of the therapeutic alliance, suggesting that women were more than four times as likely than men to report experiencing a Good alliance. Additionally, Client Age Group and the Last Total ORS (final treatment outcome score) were the only significant predictors of receiving a Therapist Appraisal of sufficient progress. This suggested that being an adolescent increased the likelihood of receiving a positive Therapist Appraisal. Finally, the overall model predicting Client-Therapist Agreement was not found to be significant based on the variables included in this study, and therefore not interpreted. Moreover, the present study sought to increase our understanding of the alliance and outcomes for marginalized populations to address disparities and the provision of culturally competent care.
Citation
Quintana, Nina Inez (2020). An Examination of the Therapeutic Alliance and Treatment Outcome for Marginalized Populations. Doctoral dissertation, Texas A&M University. Available electronically from https : / /hdl .handle .net /1969 .1 /191828.