A longitudinal examination of therapeutic relationship variables in an ethnically diverse community mental health sample

INTRODUCTION: Quality interactions between mental health providers and patients can help ensure that racial, ethnic, and linguistic (REL) minorities receive quality mental health care. However, for several decades, “cultural gaps” have been suspected between providers and patients from these backgrounds, and these “gaps” have been hypothesized to be an important factor in the low treatment utilization of REL patients. This paper examines REL differences across time in working alliance and patient-provider communication with therapists. METHODS: The sample of 318 patients was drawn from a larger patient activation intervention trial. Of the sample, 67% identified themselves as Latino, 11% as African American, 16% as non-Latino white, and 6% as Other (mainly Asian, Native American or mixed race). Patients completed the therapeutic relationship variables at three separate time points over a 6 month period. RESULTS: Controlling for sociodemographic characteristics (gender, insurance status, age, education, severity, and time in treatment), Latino patients reported significantly greater working alliance and communication than non-Latino white (NLW) patients at baseline. However, contrary to expectations, there were no significant ethnic differences in either working alliance or communication over time. DISCUSSION: Latino patients in our sample reported better therapeutic relationships with their providers than NLW patients. These findings may be attributable to the fact that Latino patients were seeking care in settings that accommodated their needs (i.e., had Spanish-speaking therapists) and culturally specific clinics.