Therapist effects, working alliance, and African American women substance users.

Abstract

African American (AfA) women with substance use disorders experience low rates of treatment retention compared to other groups of substance abusers. This is problematic since substance abuse treatment is effective only to the extent clients are retained. A weak working alliance is a significant barrier to treatment retention for AfA women. Thus, identifying therapist characteristics that facilitate a strong working alliance among this population stands as a promising step toward reducing disparities in treatment retention for this group. Therapist characteristics were explored as predictors of working alliance with AfA women substance users (N = 102). Two hypotheses were tested: (1) Population Sensitive Therapist Characteristics (PSTCs: multicultural competence, egalitarianism, and empowerment) will explain a significant amount of variance in working alliance beyond that explained by general therapist characteristics (GTCs: empathy, regard, and genuineness) and (2) GTCs will partially mediate the effect of each individual PSTC on working alliance. Hierarchical multiple regression revealed that PSTCs explained 12% of the variance in working alliance after controlling for GTCs. Bootstrapping analyses demonstrated that GTCs mediated the effect of each PSTC on working alliance. Findings suggest that therapists can facilitate a stronger working alliance with AfA women substance users through demonstration of PSTCs in addition to GTCs, and that PSTCs are facilitative because they increase the likelihood the therapist is perceived as empathic, having unconditional positive regard, and genuine. Clinical and therapist training implications are discussed.