Therapist cultural intelligence as a moderator of working alliance and outcome in multicultural counseling

Abstract

There exist major disparities in mental health service utilization and outcome between ethnic minorities and non-minorities. As a response, counseling psychologists developed multicultural counseling competence (MCC) theories and instruments to define and measure MCC. Yet predominant theories of MCC lack definitional clarity, and measures of MCC have not demonstrated adequate construct and predictive validity. Cultural intelligence (CQ), developed in the field of global management, has been found to be a predictor of performance in cross-cultural situations. This study evaluates the effect of therapist CQ on clinical outcomes in a naturalistic setting at a university counseling center. Outcome data from 1621 clients attending therapy was combined with originally-collected data from 28 therapists. Therapists completed a self-report measure of their CQ and provided demographic information. Data were analyzed using a hierarchical linear modeling (HLM) approach. Two sets of models were tested. The first set of models was conducted on the entire sample and did not include therapeutic bond data. The second set of models used only those clients who completed the bond measure. Data analysis demonstrated no effect of client ethnicity or ethnic matching on client improvement over time. Results for the effects of cultural intelligence on outcome were equivocal across the two models. Results from the first model showed no relationship between CQ and outcomes. The second set of models showed a positive moderating effect of therapist motivational CQ on client improvement over time. Therapist behavioral CQ positively moderated the relationship between client readiness for therapy and outcome. These results suggest that therapist CQ may be a predictor of outcome in therapy.