Race/ethnicity as a predictor of change in working alliance during cognitive behavioral therapy for intimate partner violence perpetrators.

Abstract

Despite evidence that the working alliance (WA) is an important factor in psychotherapy outcome and that race/ethnicity plays an important role in the processes of therapy, few studies have directly examined associations between WA and race/ethnicity. These relationships may be particularly salient for difficult-to-engage populations, such as men participating in treatment for intimate partner violence. The current study examined WA ratings in a sample of 107 male intimate partner violence perpetrators attending a 16-week cognitive-behavioral group program. Approximately 50% of these participants were Caucasian and 50% were members of a racial/ethnic minority group (African American, Asian American, Hispanic, and American Indian). Growth curve modeling was used to assess changes in both therapist and client WA ratings across four time points during therapy. Findings indicated that there was no mean level of change in therapist WA ratings over time. However, clients' WA ratings demonstrated a reliable, steady increase across sessions. A significant interaction between WA and race/ethnicity emerged such that Caucasian participants reported a significant increase in WA over time, whereas members of racial/ethnic minority group did not report a consistent pattern of change. The interaction between client race/ethnicity and WA was also a significant predictor of treatment outcome at 6-month follow-up.

Treatment of Posttraumatic Stress Disorder Reduces Suicidal Ideation

“…The analyses were carried out in multiple steps. First, using the procedure described by Griffin, we conducted standard growth curve analyses to derive Level‐1 (within‐participants) empirical Bayes estimates of initial status and change over time in PTSD symptoms (PSS) during treatment for each participant . Second, the derived change parameters were included as Level‐2 (between participant) predictors in multilevel logistic growth curve analyses to examine whether changes in PTSD were associated with changes in the likelihood of endorsing suicidal ideation (a dichotomous outcome variable) when controlling for initial SCID major depression diagnostic status.…”

Implementation of Cognitive Therapy for PTSD in routine clinical care: Effectiveness and moderators of outcome in a consecutive sample

“…The results were often inconsistent and few moderators have been identified. Variables that were shown in some studies to be associated with less favorable treatment response included demographic variables such as male sex (Blain, Galovski, & Robinson, 2010), younger age (Rizvi et al., 2009; Taylor, Fedoroff, & Koch, 1999), higher level of education (Ehlers et al., 2005) or ethnic minority (Walling, Suvak, Howard, Taft, & Murphy, 2012); comorbidity with other anxiety disorders or high symptoms of anxiety and arousal (Rosenkranz & Muller, 2011; Tarrier et al., 2000; but see van Minnen et al., 2002; Richardson et al., 2011; for negative findings); with depression or suicidal ideation (Duffy et al., 2007; Tarrier et al., 2000; but see van Minnen et al., 2002; Richardson et al., 2011; for negative findings); substance abuse (van Minnen et al., 2002; but see Richardson et al., 2011; for negative findings); personality disorders (Clarke, Rizvi, & Resick, 2008; Feeny et al., 2002); use of psychotropic medication (van Minnen et al., 2002), and permanent physical disability resulting from the trauma (Gillespie et al., 2002; but see Duffy et al., 2007; for negative findings); trauma characteristics such as multiple trauma (van Minnen et al., 2002), childhood trauma (van Minnen et al., 2002; but also see Jaycox, Foa, & Morral, 1998; for negative findings), interpersonal trauma committed by a perpetrator (van Minnen et al., 2002), longer time since the trauma (Duffy et al., 2007; but see Ehlers et al., 2005; Rizvi et al., 2009; for negative findings).…”

“…demographic variables such as male sex (Blain, Galovski, & Robinson, 2010), younger age (Rizvi et al., 2009; Taylor, Fedoroff, & Koch, 1999), higher level of education (Ehlers et al., 2005) or ethnic minority (Walling, Suvak, Howard, Taft, & Murphy, 2012);…”

Domestic Violence Perpetrator Programs: A Proposal for Evidence-Based Standards in the United States

“…Scant research examines the difference in effectiveness of state-mandated BIPs between different racial and ethnic minority groups Buttell & Pike, 2003;Buttell et al, 2011;Walling, Suvak, Howard, Taft, & Murphy, 2012), and the available studies have produced mixed conclusions. In a study of 91 men (57% African American) court ordered to complete a BIP, Buttell and Pike (2003) determined that significant, positive changes occurred at equal rates in both White and African American perpetrators.…”