A qualitative study examining the quality of working alliance as a function of the social identifies of clients and therapists during the mental health intake

Ora Nakash, Michal Cohen, Liron Aharoni, Shir Zur, Maayan Nagar

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Therapists are faced with the challenge of developing effective ways to advance cross-cultural engagement with a rapidly growing diverse client population. In this qualitative study, we characterized the way clients and therapists described the quality of working alliance during the mental health intake and examined whether these descriptions vary as a function of their social identities. We conducted in-depth interviews with Ashkenazi (socially advantaged group; n = 22) therapists and their Mizrahi (socially disadvantaged group n = 29) or Ashkenazi (n = 26) clients immediately following their intake session in four mental health clinics in Israel. We performed a thematic analysis. Overall, interrater reliability among three raters who coded the narratives was high (kappa = 0.72, therapist; 0.70, client). Across all client and therapist interviews, we identified eight central themes detailing different qualities of the working alliance: (1) feeling understood, (2) feeling comfortable, (3) openness and cooperation, (4) trust, (5) empathy and identification, (6) frustration and disappointment, (7) anger and hostility, and (8) emotional disengagement. On average, clients reported 2.56 (standard deviation = 1.17) and therapists described 2.65 (standard deviation = 1.45) themes in each session. Overall, concordant and discordant dyads described similar themes with few exceptions. In particular, being part of a discordant dyad may affect the client’s interpretation of non-verbal communication as well as the therapist’s evaluation of the client’s openness and trustworthiness. Although less frequent, when anger and hostility were described by therapists, these characterized the interaction with Mizrahi clients. We discuss implications to care including the need to promote a culturally humble approach to providing care for minorities.

Original languageEnglish
Pages (from-to)1006-1024
Number of pages19
JournalQualitative Social Work
Volume20
Issue number4
DOIs
StatePublished - Jul 2021
Externally publishedYes

Bibliographical note

Publisher Copyright:
© The Author(s) 2020.

Keywords

  • Working alliance
  • ethnic minorities
  • intake
  • mental health

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