Department of Educational and Counseling Psychology, University of Louisville, Louisville, KY 40092, USA.
J Couns Psychol. 2012 Apr;59(2):314-20. doi: 10.1037/a0027091. Epub 2012 Feb 20.
In the present study, the authors examined the source of racial/ethnic minority (REM) disparities in unilateral termination (i.e., the client ending therapy without informing the therapist)--a form of dropout that is associated with poor alliance and outcome. First, the authors tested whether some therapists were more likely to have clients who reported unilaterally terminating as compared with other therapists. Next, the authors examined 2 competing hypotheses regarding the therapists role in termination disparities: (a) that racial/ethnic disparities in unilateral termination are similar across therapists and thus due to other components of the treatment process or (b) that racial/ethnic disparities in unilateral termination are specific to therapists, where some therapists are more likely, on average, to have higher rates of unilateral termination with REM clients as compared with White clients. The sample included 155 REM clients and 177 White clients who were treated by 44 therapists at a university counseling center. The results showed that therapists accounted for a significant proportion of the variation in clients' unilateral termination, and REM clients were more likely to report they unilaterally terminated from therapy as compared with White clients. Furthermore, racial/ethnic disparities in clients' report of unilateral termination varied across therapists' caseloads. These results suggest that therapists have a central role in their clients' unilateral termination and have implications for understanding racial/ethnic mental health disparities.
在本研究中，作者探讨了种族/少数民族（REM）在单方面终止治疗（即客户在未通知治疗师的情况下结束治疗）方面存在差异的原因——这种形式的脱落与不良联盟和结果有关。首先，作者测试了某些治疗师是否比其他治疗师更有可能让客户报告单方面终止治疗。其次，作者检验了关于治疗师在终止差异中的角色的两个相互竞争的假设：（a）在单方面终止治疗方面，种族/少数民族的差异在治疗师之间是相似的，因此是由于治疗过程的其他组成部分造成的；（b）在单方面终止治疗方面，种族/少数民族的差异是特定于治疗师的，一些治疗师平均更有可能比白人客户更有可能与 REM 客户一起终止治疗，其结果表明，治疗师在客户单方面终止治疗方面存在显著差异，与白人客户相比，REM 客户更有可能报告他们单方面终止了治疗。此外，客户单方面终止治疗的报告中存在种族/少数民族差异，这在治疗师的工作量中存在差异。这些结果表明，治疗师在客户单方面终止治疗方面起着核心作用，这对理解种族/少数民族心理健康差异具有重要意义。
