Substance use disorders and racial/ethnic minorities matter: a meta-analytic examination of the relation between alliance and outcome

J Couns Psychol. 2013 Oct;60(4):610-6. doi: 10.1037/a0033161. Epub 2013 Jul 1.

Abstract

The purpose of this meta analysis was to examine the moderating impact of substance use disorder as inclusion/exclusion criterion as well as the percentage of racial/ethnic minorities on the strength of the alliance-outcome relationship in psychotherapy. It was hypothesized that the presence of a Diagnostic and Statistical Manual of Mental Disorders (DSM) Axis I substance use disorder as a criterion and the presence of racial/ethnic minorities as a sociocultural indicator are moderately correlated client factors reducing the relationship between alliance and outcome. A random effects restricted maximum-likelihood estimator was used for omnibus and moderator models (k = 94). The presence of (a) substance use disorder and (b) racial/ethnic minorities (overall and specific to African Americans) partially moderated the alliance-outcome correlation. The percentage of substance use disorders and racial/ethnic minority status was unexpectedly highly correlated in the present treatment research samples. Sociocultural contextual variables should be considered along with a DSM Axis I diagnosis of substance use disorders in analyzing and interpreting therapy process variables such as the alliance.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Ethnicity / psychology*
  • Ethnicity / statistics & numerical data
  • Humans
  • Minority Groups / psychology*
  • Minority Groups / statistics & numerical data
  • Professional-Patient Relations*
  • Psychotherapy / methods*
  • Substance-Related Disorders / psychology*
  • Substance-Related Disorders / therapy*
  • Treatment Outcome