Cultural humility, therapeutic relationship, and outcome: Between-therapist, within-therapist, and within-client effects

Abstract

The present study longitudinally examined the association between client-perceived cultural humility (CH) of the therapist, dyadic working alliance (WA), and dyadic session evaluation (SES). We analyzed cultural humility scores at three levels: a) between therapist b) within-therapist and c) within-client. Using a sample of 79 clients, 15 therapists, and 231 time periods, we conducted two multilevel analyses using dyadic WA and dyadic SES as predictors. We found that high between-therapist, within-therapist, and within-client CH yielded higher dyadic WA scores. We also found that within-therapist and within-client CH yielded higher dyadic SES scores. However, importance of client identity did not act as moderator as predicted for CH and dyadic WA; nor did importance of client identity moderate the relationships between within-therapist and within-client CH and dyadic SES. We did find that importance of client identity moderated the relationship between-therapist CH and dyadic SES. Implications for future research will be discussed. Keywords: cultural humility, working alliance, session evaluation, psychodynamic, HLM