‘To show or No-show’? Therapist Racial-ethnic Disparities in Clients’ Nonattendance in Therapy

Kivlighan, Dennis M.; Jung, Ae-Kyung; Berkowitz, Alayna; Hammer, Joseph H.; Collins, Noah M.

doi:10.1080/87568225.2018.1424597

Cited by 5 publications

(4 citation statements)

References 32 publications

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“…Previous studies find that, compared to White youth, youth of Color attend fewer sessions (Kivlighan et al, 2019;Marrast et al, 2016), which is consistent with our findings for Black and Latinx youth. Previous studies also suggest that youth of Color are less likely to complete treatment (Becker & Chorpita, 2023;de Haan et al, 2018;Hack et al, 2020;Marotta et al, 2022;Pinedo, 2019), and report lower attitudinal engagement (Chu et al, 2022;Flicker et al, 2008) compared to White youth.…”

Section: Discussionsupporting

confidence: 93%

“…diagnosis (Chen et al, 2019;Lu, 2019), engagement (Flicker et al, 2008;Kivlighan et al, 2019) and effectiveness (Huey et al, 2023). These inequities appear to have worsened amidst the COVID-19 pandemic (Friis-Healy et al, 2021;Shim & Starks, 2021), which posed a disproportionate burden on racially and ethnically minoritized youth (i.e., "youth of Color" herein, for brevity), including worsening mental health (Rothman et al, 2020;Smith et al, 2020).…”

Section: Engagement and Outcomesmentioning

confidence: 99%

“…Color have also been found to attend fewer sessions than their White counterparts (Kivlighan et al, 2019;Marrast et al, 2016). Regarding attitudinal engagement, research finds that clients of Color (vs. White clients) report weaker therapeutic alliance and satisfaction (Chu et al, 2022;Flicker et al, 2008).…”

Section: Engagement and Outcomesmentioning

confidence: 99%

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Examining Racial and Ethnic Differences in Youth Psychotherapy Treatment Engagement and Outcomes

Johansen,

Saran,

Cho

et al. 2023

Preprint

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Objective: Research has identified racial/ethnic disparities in mental health treatment engagement. Yet, most existing effectiveness research overlooks the potential moderating effects of treatment attitudinal and behavioral engagement. The study addressed this gap and built on recent calls to examine effects of mental health treatment engagement on clinical outcomes among marginalized youth. Methods: N=200 youth (ages 7-15; 33% White, 28% Black, 25% Hispanic/Latinx, and 14% Multiracial; 52% male) and their N=200 parents participated in a randomized controlled trial testing the effectiveness of a transdiagnostic psychotherapy for common youth emotional and behavioral problems. Youth and parents reported internalizing and externalizing symptoms and treatment engagement (e.g., behavioral and attitudinal). Multilevel regression models examined variations in youth symptom trajectories by racial/ethnic group. Results: In the full sample, the number of sessions attended was significantly associated with reductions in youth-reported internalizing problems, and there were significant racial differences in treatment session attendance: Black and Latinx youth attended significantly fewer sessions than White and Multiracial youth (8-9 versus 13). However, youth in all racial/ethnic groups showed significant, and similar, improvements in treatment outcomes. All racial/ethnic groups also showed comparable attitudinal engagement scores. Conclusions: Youth of Color attended fewer sessions than White youth, but their clinical outcomes were similar to those of White youth. Future research should examine the meaning and implications of session attendance in relation to outcomes in youth of Color.

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Section: Discussionsupporting

confidence: 93%

Section: Engagement and Outcomesmentioning

confidence: 99%

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Examining Racial and Ethnic Differences in Youth Psychotherapy Treatment Engagement and Outcomes

Johansen,

Saran,

Cho

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…In a more recent study, Hayes and colleagues (2016) examined between-therapist disparities in treatment outcomes with White and REM clients, and similarly found evidence of racial-ethnic disparities within therapists’ caseloads. Therapists have also been found to differ in dropout rates (Owen et al, 2012) and nonattendance patterns (Kivlighan, Jung, Berkowitz, Hammer, & Collins, 2018) with REM clients compared to their white clients. Based on these findings, researchers have argued that therapists’ cultural competence should be operationalized in terms of their effectiveness (i.e., treatment outcomes) across diverse client groups (Hayes et al, 2016; Wampold & Brown, 2005).…”

mentioning

confidence: 99%

Examining therapist effects in relation to clients’ race-ethnicity and gender: An intersectionality approach.

Kivlighan¹,

Hooley²,

Bruno³

et al. 2019

Journal of Counseling Psychology

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Women and Men of Color experience racism in unique and complex ways, just as White Women and Women of Color experience unique forms of sexism (i.e., gendered racism). Traditional analyses of therapists' cultural competence, broadly defined, have yet to examine the effect of intersectionality on the processes and outcomes of psychotherapy. Although previous research suggests that therapists differ in their effectiveness with Racial-Ethnic Minority (REM) clients, no study has examined therapist effects in terms of the intersectionality of clients' race-ethnicity and gender. This study applied an intersectionality framework to test therapist effects due to clients' race-ethnicity and gender. Data for this study consisted of 415 clients treated by 16 therapists. Results indicated that therapists differed in their ability to produce changes in symptom-defined psychological distress as a function of clients' intersecting identities of race-ethnicity and gender. Clinical implications and future research are discussed. Public Significance StatementThis study provides evidence of therapists' differential effectiveness with Women of Color, Men of Color, White women, and White men. Therapist effectiveness differed based on clients' intersecting identities of race-ethnicity and gender.

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Predictors of Client Attrition in a University‐Based Community Counseling Clinic

Harris

Mitchell²,

Tabet

et al. 2020

Jour of Counseling & Develop

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The purpose of this study was to investigate how symptom distress, social role, interpersonal relationships, gender, age, number of supports, and education level predict client attrition in a community sample. Using binary logistic regression and cross‐sectional data, the authors examined the predictive impact of 8 variables on adult client attrition in a university‐based community counseling clinic. Results indicated that education level, interpersonal relationships, and number of supports significantly predicted attrition. In this sample, gender, age, symptom distress, social role, and race did not significantly predict attrition. Implications for clinical assessment and counseling practice are discussed.

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‘To show or No-show’? Therapist Racial-ethnic Disparities in Clients’ Nonattendance in Therapy

Cited by 5 publications

References 32 publications

Examining Racial and Ethnic Differences in Youth Psychotherapy Treatment Engagement and Outcomes

Examining Racial and Ethnic Differences in Youth Psychotherapy Treatment Engagement and Outcomes

Examining therapist effects in relation to clients’ race-ethnicity and gender: An intersectionality approach.

Predictors of Client Attrition in a University‐Based Community Counseling Clinic

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