Do Gender and Racial Differences Between Patient and Therapist Affect Therapeutic Alliance and Treatment Retention in Adolescents?

Abstract

Parents, referral sources, and even therapists wonder whether the gender and racial match between therapists and patients contributes to poorer alliances and treatment dropout. Six hundred adolescent substance abusers and their therapists from a large randomized clinical trial were grouped according to matches and mismatches on both gender and race, and alliance ratings were collected from both patients and therapists. Results revealed that gender-matched dyads reported higher alliances and were more likely to complete treatment. Racial matching predicted greater retention but not patient-rated alliance. However, therapists in mismatched dyads rated significantly lower alliances. Results suggest that, although multicultural training remains critical, training emphasis should also be placed on understanding how gender and racial differences affect therapeutic processes.

Early Therapeutic Alliance as a Predictor of Treatment Outcome for Adolescent Cannabis Users in Outpatient Treatment

“…Neither patient-rated nor therapist-rated alliance predicted treatment attendance for either the five-or 12-week treatment models. The lack of impact alliance played on attendance was surprising given prior research findings, 13,30 although the study by Shelef and colleagues 18 found it was parents' alliance with the therapist that predicted treatment attendance. Unfortunately, a similar process was not evident in therapist ratings, despite the potential confound of therapist ratings to reflect their own negative attitudes about patients, which may inadvertently contribute to early termination.…”

“…While we know that outcomes do not vary significantly based on treatment modality or site and that, as a whole, the CYT sample significantly improved, 20 this strategy allows us to control for these nested effects within each therapist. Block 4 (Patient-Therapist Match): Previously, we found patient-therapist sex and racial match to predict treatment retention; 30 therefore, we included these variables as possible covariates. In this model, alliance is entered first to examine whether or not its relationship to measured outcomes drops out once covariates are entered into the model.…”

The female therapist and the client’s gender

“…There have been indications that same-gender therapist-client dyads succeed better than those with different genders [35] . Research on the subject has shown that the needs of female clients differ from those of male clients; among others women's substance abuse problems and their progression, risk factors, treatment motivation and reasons for relapses differ from those of men [11,36] .…”

Modèle de l’engagement et de l’abandon de traitement de l’adolescent avec trouble de personnalité limite

“…Le sexe et l'ethnie du soignant ne semblent pas faire de différence dans le maintien en traitement des adolescents. Les cliniciens de sexe féminin ne comptent pas plus de décrocheurs que les thérapeutes masculins ou les cliniciens d'une ethnie en particulier (Robbins, Liddle, Turner, Dakof, Alexander, & Kogan, 2006 Wintersteen, Mensinger, & Diamond, 2005). L'affiliation professionnelle, par contre, ne fait pas consensus.…”