Category: Cultural Diversity / Vulnerable Populations

Symposium

Evaluating Congruence in Problem Definition of Latino Patients and Their Community Therapists Following an Initial Session

Sunday, November 19
10:15 AM - 11:45 AM
Location: Indigo 202, Level 2, Indigo Level

Keywords: Race / Ethnicity | Psychotherapy Process | Therapeutic Alliance
Presentation Type: Symposium

Background: Latinos in the United States tend to show poor engagement with mental health services (Olfson, Marcus, Tedeschi, & Wan, 2006). Past research has found that clinician inaccurate perception of the problem is associated with treatment dropout (Epperson, Bushway, & Warman, 1983). Some have suggested that poor engagement among Latinos may be partly related to issues of cultural congruence, or fit, between the perspectives of Latino clients and their mental health service providers (Lewis-Fernández et al., 2013). However, an assessment of congruence has not been conducted. Method: To address this gap, we separately interviewed Latino clients and their community mental health therapists to ask about their perspectives of the presenting problem. We conducted 34 semi-structured interviews following an initial therapy session. We utilized a theoretical thematic approach (Braun & Clark, 2006) to identify ten common topics present in each party’s descriptions of the presenting problem. Three pairs of independent coders reliably rated the presence and salience of these codes using a quantitative index (0-3; not present, present but of minor emphasis, present and moderately emphasized, present and central to the problem description). We then utilized an intraclass correlation to measure the fit between corresponding narratives. Results: With the exception of two codes, results yielded poor to no congruence among corresponding dyads’ descriptions (i.e., ICC<.12). There were two types of incongruencies: therapists emphasizing aspects of the problem more so than did their clients, and disagreement over the presence of problem factors, typically characterized by therapists endorsing explanations their clients did not. Discussion: One potential conclusion is that poor congruence was a result of therapists over-interpreting the problem relative to their clients. It is possible that early in treatment, therapists were already further ahead of their clients in their conceptualizations of the problem. The question of whether clinicians should do this is important to consider alongside the potential consequence of poorer shared understanding of the problem and treatment engagement. The clinical implications of poor cultural congruence, potential psychological pathways, limitations and future directions will be discussed. 

Sylvanna M. Vargas

PhD/ MPH student
University of Southern California/UCLA

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