Racial/ethnic disparities in client unilateral termination: The role of therapists’ cultural comfort

Owen, Jesse; Drinane, Joanna M.; Tao, Karen W.; Adelson, Jill L.; Hook, Joshua N.; Davis, Don E.; Fookune, Natacha

doi:10.1080/10503307.2015.1078517

Cited by 102 publications

(160 citation statements)

References 44 publications

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“…clinical skilfulness in delivering the therapy) rather than experience (years of practicing a therapy) can make a critical difference to a patient's experience. 16 Also, several studies highlight that the general competence of a therapist is not synonymous with either their cultural competence 17,18 or level of comfort in discussing sexuality. 19,20 Conclusions Empirical research on the negative effects of psychotherapy is insufficient, partly because there is a lack of a coherent framework for defining, discussing and monitoring issues such as unwanted events, adverse reactions, malpractice reactions or deterioration of illness.…”

Section: Discussionmentioning

confidence: 99%

Psychotherapies should be assessed for both benefit and harm

Scott

Young

2016

Br J Psychiatry

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The past four decades have witnessed a transformation in research on the benefits of psychological therapies. However, even though therapists highlight that negative and adverse effects are seen in day-to-day practice, research on the negative effects of psychotherapy is insufficient. Given the unrelenting popularity of therapies, the argument for examining the adverse effects of psychotherapy would seem to be compelling. Such a strategy would extend beyond supervision of individual therapists to the introduction of monitoring systems that allow for a more systematic examination of failed psychotherapy interventions (such as exist for medication prescribing). The starting point could be the development of a consensus on how to define, classify and assess psychotherapy side-effects, unwanted events, adverse reactions, etc. This would provide a conceptual framework for communication, monitoring and research. This approach should not be viewed as an attack on therapies: every branch of medicine learns from mistakes, the same must surely be true for psychological treatments.

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Section: Discussionmentioning

confidence: 99%

Psychotherapies should be assessed for both benefit and harm

Scott

Young

2016

Br J Psychiatry

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“…Therapists need to be able to fluidly engage with clients who express a range of worldviews or behaviours (Owen, ). Comfort may be cultivated as clinicians develop awareness of their own identities and biases (Owen et al , ). Given the importance of increasing the capacity of CALD treatment providers, training and education programmes also need to be compatible with cultural practices (Robertson et al , ).…”

Section: Cultural Competence Trainingmentioning

confidence: 99%

“…Clinicians are one of the primary sources of racial/ethnic disparities in mental health treatment outcome (Hayes, Owen, & Bieschke, 2015;Imel et al, 2011;Larrison, Schoppelrey, Hack-Ritzo, & Korr, 2011;Owen, Imel, Adelson, & Rodolfa, 2012). Owen et al (2015) argue that racial/ethnic disparities emerge mainly when differential outcomes between CALD and mainstream clients within therapist caseloads are examined. For example, Imel et al (2011) found that variability in client's reduction of cannabis abuse was related to cultural factors of clients within therapist caseloads; i.e, the clinicians had better outcomes with CALD than mainstream clients, or the opposite.…”

Section: Cultural Competence In Practicementioning

confidence: 99%

“…Studies have found associations between therapist's cultural humility and counsellor's ability to attend to cultural opportunities within session and therapy outcomes, including changes in psychological distress and interpersonal functioning (Hook et al , ; Owen et al, ). Owen et al () examined racial/ethnic comfort, i.e., observable levels of ease that clients with varying racial and ethnic backgrounds perceive their therapists to demonstrate when engaged in a range of therapeutic conversations. For example, calmly and openly discussing cultural identities and being positively engaged even when differences in personal values make this difficult.…”

Section: Evidence For the Effectiveness Of Cultural Competence In Addmentioning

confidence: 99%

“…Cultivating a sense of safety and working with ease and calm with all clients is likely to have benefits for retaining clients, e.g., by dispelling cultural trust beliefs. Owen et al () also suggest that cultural comfort is likely to be enhanced over time and with increased exposure to CALD clients. They highlight the need for therapists to be comfortable in culturally uncomfortable settings.…”

Section: Cultural Competence Trainingmentioning

confidence: 99%

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Cultural Competence in the Treatment of Addictions: Theory, Practice and Evidence

Gainsbury

2016

Clin Psychology and Psychoth

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Culturally and linguistically diverse (CALD) populations often have high rates of addictive disorders, but lower rates of treatment seeking and completion than the mainstream population. A significant barrier to treatment is the lack of culturally relevant and appropriate treatment. A literature review was conducted to identify relevant literature related to cultural competence in mental health services delivery and specifically treatment for addictive disorders. Several theoretical models of cultural competence in therapy have been developed, but the lack of rigorous research limits the empirical evidence available. Research indicates that culturally competent treatment practices including providing therapy and materials in the client's language, knowledge, understanding and appreciation for cultural perspectives and nuances, involving the wider family and community and training therapists can enhance client engagement, retention and treatment outcomes for substance use and gambling. Further methodologically rigorous research is needed to isolate the impact of cultural competence for the treatment of addictions and guide research to determine treatment efficacy within specific CALD populations. Training therapists and recruiting therapists and researchers from CALD communities is important to ensure an ongoing focus and improved outcomes for CALD populations due to the importance of engaging these populations with addiction treatment. Copyright © 2016 John Wiley & Sons, Ltd. Key Practitioner Message: The treatment needs of culturally diverse individuals with addictions are often not met. Theoretical models can guide therapists in incorporating cultural competence. Culturally targeted treatments increase recruitment, retention and treatment outcomes. Cultural competence includes matching clinicians and clients on linguistic and cultural backgrounds as well as being mindful of the impact of culture on client's experience of addiction problems. Few methodologically rigorous trials have been conducted to guide treatment practices and research needs to be incorporated into existing culturally relevant treatment services.

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