Outcome study of brief relational-cultural therapy in a women's mental health center

Abstract

The current study is the first to evaluate the effectiveness of a brief relational-cultural model of therapy in a community-based mental health center for women. The study was distinctive in its use of a hybrid model that employed elements of randomized control and naturalistic design. Results showed that the entire treatment group of 91 women improved significantly on all eight outcome measures. Therapeutic gains were maintained at 3- and 6-month follow-ups. The results lend support to the importance of including relational-cultural factors in the treatment of women. An adherence scale/manual was developed and implemented and will allow for replication.

Die vorliegende Studie ist die erste zur Evaluation der Effektivität eines kurzen, relational-kulturellen Modells von Therapie in einem gemeindebasierten Mental Health Zentrum für Frauen. Die Besonderheit der Studie lag im Einsatz eines hybriden Modells, dass sowohl Elemente randomisiert kontrollierter und naturalistischer Designs vereinigt. Die Studie zeigte, dass sich die komplette Behandlungsgruppe von 91 Frauen auf allen acht Ergebnismaßen signifikant verbessert hat. Die therapeutischen Gewinne waren stabil in der 3- und 6-Monatskatamnese. Die Ergebnisse betonen die Wichtigkeit relational-kulturelle Faktoren in die Behandlung von Frauen mit einzubeziehen. Ein Adhärenzskalierungs-Manual wurde entwickelt und implementiert, welches die Replikation der Ergebnisse ermöglicht.

Il presente studio è il primo a valutare l'efficacia del modello di terapia relazionale-culturale breve in un centro di salute mentale community-based per donne. Lo studio si distingue per l'adozione di un modello ibrido che utilizza elementi di controllo randomizzati e progettazione naturalistica. I risultati hanno mostrato che l'intero gruppo di trattamento di 91 donne è migliorato in modo significativo su tutte le otto misure di outcome. I miglioramenti terapeutici sono stati mantenuti a 3 e a 6 mesi di follow-up. I risultati avvalorano l'importanza di includere fattori relazionali-culturali nel trattamento delle donne. Una scala/manuale di aderenza è stata/o sviluppata/o e implementata/o e consentirà la replicazione.

O presente estudo é o primeiro a avaliar a eficácia de um modelo de uma breve terapia relacional-cultural num centro comunitário de saúde mental para mulheres. O estudo foi distinguido na aplicação de um modelo híbrido que utiliza elementos de controlo aleatório e design naturalista. Os resultados mostraram que todo o grupo de tratamento, constituído por 91 mulheres melhorou significativamente em todas as oito medidas de resultados. Os ganhos terapêuticos foram mantidos entre 3 - e 6 meses de follow-up. Os resultados corroboram a importância da inclusão de factores relacionais-culturais no tratamento de mulheres. Uma credível escala / manual foi desenvolvida e implementada e vai permitir a sua replicação.

El presente estudio es el primero que busca evaluar los resultados de la terapia breve cultural-relacional en un centro comunitario de salud mental para mujeres. Lo que caracteriza esta investigación es que utiliza un modelo híbrido tomando elementos tanto del control randomizado como de los estudios de diseño naturalístico. Los resultados muestran que la totalidad de la población de estudio (91 mujeres) mejoró significativamente según los resultados de los ocho instrumentos de evaluación utilizados. En los seguimientos a 3 y 6 meses se mantenían los logros terapéuticos. Los resultados jerarquizan la importancia de incluir elementos culturales y relacionales en los tratamientos de mujeres. Se ha desarrollado un manual de adherencia con una escala que harán factible la replicación de este estudio.

Keywords:

• outcome
• women
• relational-cultural
• feminist
• brief psychotherapy

Acknowledgements

We wish to acknowledge the Ontario Women's Health Council, Ministry of Health and Long-term Care for their funding of this Demonstration Project OWHC000038. The results and conclusions are those of the authors and no official endorsement by the Ministry is intended or inferred. At the time the study was carried out, the Brief Psychotherapy Centre for Women was part of Sunnybrook and Women's College Health Sciences Centre, although it was founded by Women's College Hospital where once again it is situated. We also wish to acknowledge the many other individuals who have contributed to this outcome study with particular thanks to our clients who have contributed their time and energy to this project. Finally, thanks to Anthony Joyce who was always willing to provide valuable input and expertise.

Notes

1. While BRCT does not utilize Luborsky's core concept of CCRTs, nor does it focus on interpretation or transference interpretation, it is influenced by his ideas about exploring relationship episodes, including the mutual exploration of the client-therapist relationship with the aim of improving the quality of the relationships in the client's life.

2. Safran and Muran (2000) identify seven key characteristics of Brief Relational Therapy including “it involves an intensive focus on the here-and-now of the therapeutic relationship” (p. 175) and “it features an ongoing collaborative exploration of both patients' and therapists' contributions to the interaction” (p. 175). There is also an emphasis on “the importance of [patients] developing the capacity to observe their internal processes and their actions in relationships with other people as they are taking place” (p. 179). The theory postulates that this helps patients increase awareness of their own role in problematic/maladaptive relational patterns. BRCT may employ some of the principles and interventions common to this and other brief relational approaches, but it emphasizes the exploration of the role of power and equity in relationships as well as the role that gender, culture and values play in contributing to the client's quality of relationships, relational networks and real-life difficulties.

3. The current study is best described as an effectiveness study combining elements of both randomized control and naturalistic design.

4. Table I reflects minor revisions to the scale, i.e., reducing the number of items from 29 to 27.

5. Detailed results are not relevant to the current report but are available on request from the authors.