Racial/Ethnic Disparities in Therapist Effectiveness: A Conceptualization and Initial Study of Cultural Competence

It is an established fact in psychotherapy practice that client racial/ethnic background is a variable in their health outcomes. As different racial/ethnic minority groups assimilate their own set of cultural values, it has a bearing on their psychological outlook. Their cultivated worldview, in turn, affects their response to psychotherapy. However, the unanswered question was whether the cultural competence of the therapist is in itself a key factor. It is this question that the research paper seeks to address.

The researchers identify and devise experiments to be conducted on adolescent cannabis users. The Bayesian multilevel model is the chosen method for the study. Two areas were evaluated: first, whether therapists differed in their overall effectiveness; second, whether treatment outcomes differed across therapist caseloads. Results suggest that both of these are true, answering the initial proposition that therapists display varying levels of cultural competence.

Termed the Cannabis Youth Treatment (CYT), the researchers designed a large multisite trial. Care is taken to present a balanced racial/ethnic minority representation. Five different treatments for cannabis addiction were evaluated for their effectiveness and cost. The target population were adolescents with cannabis-related disorders who could be given outpatient care. In total, 600 adolescents were included in this 2-year long study. The participants were spread randomly over the five treatment options. Treatment modality was not included in the analyses because there was no prima facie evidence to suggest differences in efficacy of the five treatment options. The adolescents included for the study were within the age group of 12 to 18. They must have suffered a bout of addition/abuse in the three months leading up to the start of the experiment. This way, both the pre and post-treatment scores of the 582 participants could be compared across the 13 therapists whom they visited. It was ensured that the therapists saw a mix of white and racial/ethnic minority clients. The gender distribution among the participants was 18% female and 82% male. The ethnic distribution was 62% Caucasian and 38% ethnic minorities. Among the latter a proportional mix of African Americans, Hispanics and Asians were included. The racial/ethnic minority variable was dichotomized to compensate for their low representation in the group. Even among therapist there was variability in terms of educational qualifications, years of work experience, as well as their ethnic backgrounds. The baseline characteristics of clients comprised of three basic variables – their age, gender and days of cannabis abuse. And then the time-tested Bayesian Multilevel Over-dispersed Poisson statistical model was applied to the analyses.

The results vindicate the initial suspicion of the researchers that there is something distinctly called cultural competence that is exclusive of the therapist’s professional expertise. In other words, some therapists were more effective with ethnic minority clients even after adjusting for their general competence. It should also be mentioned that even those therapists who were languishing in their cultural competence handled some ethnic minority clients exceptionally well. So, cultural competence is not a generic indicator but an overall aggregate. The next logical area of inquiry for researchers is to examine the source of disparities in cultural competence and attendant treatment outcomes. They can endeavour to find how factors of clients’ identity, socioeconomic status, scholastic achievement, professional backgrounds, etc contribute to variability in treatment outcomes.


Imel, Zac E. Baldwin, Scott. Atkins David C. Owen, Jesse. Racial/Ethnic Disparities in Therapist Effectiveness: A Conceptualization and Initial Study of Cultural Competence, Journal of Counselling Psychology, 2011, Vol. 58, No.3, pp. 290-298.