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Taft CT, Walling SM, Suvak MK, Murphy CM. Ethnicity as a Predictor of Change in Working Alliance During CBT for Partner Violence. Paper presented at: Association for Behavioral and Cognitive Therapies Annual Convention; 2009 Nov 19; New York, NY.
Ethnic disparities in access to mental health care and psychotherapy treatment outcomes are well documented (U.S. Department of Health and Human Services, 2001). Despite evidence that therapeutic processes such as therapist-client working alliance are important factors in psychotherapy outcome (Martin, Garske, and Davis, 2000), and evidence that ethnicity plays an important role in the processes of therapy (Gelso and Mohr, 2001; Helms, 1984, 1990; Helms and Cook, 1999), few studies have directly examined associations between minority group status and the working alliance. The relationships between these factors may be particularly important among difficult to engage populations such as men court mandated to treatment for intimate partner violence (IPV). Previous work indicates that minority status individuals are at an increased risk for dropping out of IPV group treatment (Taft, Murphy, Elliott, and Keaser, 2001), and alliance-enhancing interventions can decrease ethnic disparities in session attendance (Taft, Murphy, Elliott, and Morrel, 2001). The current study examined a sample of 107 largely court-mandated male IPV perpetrators referred to 16 weeks of cognitive behavioral group therapy (13 groups). Approximately 50% of these participants were Caucasian and 50% were members of an ethnic minority group (African American, Asian American, Hispanic, American Indian). Growth curve modeling using hierarchical linear modeling (which allowed us account for participants being nested within treatment groups) was employed to assess changes in both therapist and client ratings of working alliance across four time points during the course of therapy and to assess the impact of ethnic minority status. Overall, there was no mean level change in therapist ratings of working alliance over time, and ethnic minority status did not moderate change over time in these ratings. On the other hand, clients' ratings of working alliance demonstrated a reliable, steady increase in working alliance across therapy sessions. Interestingly, a significant ethnic minority status x time interaction emerged. Caucasian participants reported a significant increase in working alliance over time, while minority participants' reports of working alliance did not demonstrate reliable change over the course of therapy. This suggests that clients and therapists ratings of the development of the working alliance during therapy for IPV are differentially determined by the ethnicity of the client. Implications for IPV treatment programs will be discussed during the proposed symposium presentation.
