Psychotherapy with clients who are incarcerated: Therapists’ multicultural orientation, alliance, and outcomes.

Abstract

Jails and prisons commonly offer mental health treatments as many people experiencing incarceration suffer from significant psychological distress and substance use problems. One modality through which individuals who are incarcerated receive care is psychotherapy; however, process and outcome data in this population are limited. More specifically, little is known about how culture and identity impact the development therapeutic relationship in this context. The multicultural orientation framework, which includes three pillars (cultural humility, cultural opportunities, and cultural comfort), aims to operationalize cultural processes in psychotherapy (J. Owen, 2013). We examined the relationship between therapy outcomes and client ratings of their therapist's cultural humility (positive and negative), cultural opportunities, and the working alliance in two jails. Ninety-four clients engaging in routine psychotherapy rated their experience of the therapy process during their third session. Interestingly, we did not find significant associations between therapy outcomes (i.e., psychological distress and relational distress) and negative cultural humility or cultural opportunities. We did find a significant positive association between the working alliance and therapy outcomes. Notably, therapy outcomes were negatively associated with positive cultural humility, suggesting that clients who rated their therapist higher on positive cultural humility had worse therapy outcomes. Therefore, there may be important setting specific factors that contribute to the importance of orienting to culture in psychotherapy. Public Significance StatementThe present study examined therapy with individuals experiencing incarceration and found that therapist expressions of positive cultural humility were associated with worse therapy outcomes. This is significant because the extant literature suggests that expressions of positive cultural humility, a pillar of the multicultural orientation framework, are generally supportive and improve therapy outcomes.