Predictors of Therapist Adherence and Emotional Bond in Multisystemic Therapy: Testing Ethnicity as a Moderator

Ryan, Stacy R., Cunningham, Phillippe B., Foster, Sharon L., Brennan, Patricia A., Brock, Rebecca L., Whitmore, Elizabeth

Multisystemic Therapy is a home-based treatment approach designed to address the known correlates of antisocial behavior, including characteristics of the individual (e.g., positive attitudes toward delinquency and drug use), his/her family (e.g., poor monitoring, inconsistent or lax discipline), peers (e.g., deviant peers), school (e.g., poor discipline and structure, poor family-school communication), and community (e.g., availability of weapons and drugs, high instability, psychosocial stress).  To address these correlates, MST draws on empirically supported interventions (e.g., Behavior Therapy, Cognitive Behavior, Therapy, and Parent Management) and pragmatic family therapies (e.g., structural family therapy) and views problem behavior as the result of the adolescents interactions within and between systems (pg. 125).

This article reports the findings from a study that examined the interaction between problem severity and race/ethnicity as a predictor of therapist adherence and family-therapist emotional bond when using Multiystemic Therapy (MST).

The study aimed to address the gap between evidence of MST's efficacy gained from controlled university-based studies and results from real-world practice settings that serve more diverse clientele with more complex difficulties.  

Pre-Study Prediction
Greater youth problem severity early in treatment would be associated with worse adherence and poorer therapeutic emotional bonding for African American and Hispanic/Latino families than for Caucasian families(pg. 123).

Study Composition (pg. 124)
Adolescents
The study included 185 adolescents of whom 65.4% were male with a mean age of 15.35.  The ethnic makeup of the study was: 28% Hispanic/Latino, 20% African American, 48% Caucasian, and 4% Other.

Therapists
In addition, 76 therapists participated of whom 86% were white and 71% were female, while 85% were Masters level therapists.

Caregivers
Of the caregivers who participated in the study, 53% identified as Caucasian, 18% as African American, 26% as Hispanic/Latino, and 3% as other(multi-racial).

Significant Results (pgs. 132-133)
There is preliminary evidence that there may be therapeutic process differences across race/ethnic groups when youth exhibit high and low problem severity at treatment outset.

For Hispanic/Latinos, more troubled youth are at risk for therapeutic rifts--less adherence and poorer therapist-client overall levels of emotional bonding.

Therapists formed greater overall levels of emotional bonds (according to caregiver and youth report)with African American families who started treatment with more youth difficulties.

Results with Caucasians were as expected.

Findings (pg. 133)
MST may benefit from more specific attention to strategies for engaging families of more troubled Hispanic/Latino youth in treatment.

Limitations of Study:
1. Larger and more diverse sample of different ethnic minorities needed
2. Only one measure of therapist adherence used
3. Sample sizes within each ethnic group were relatively small
4. Therapists were mostly Caucasian