Mental Health Treatment Adherence and Minority Clients' Perception of Clinician Cultural Awareness

144 Pages·2015·1.03 MB·English

by  Patricia Parker

Walden University
ScholarWorks
Walden Dissertations and Doctoral Studies
Walden Dissertations and Doctoral Studies
Collection
2015
Mental Health Treatment Adherence and Minority
Clients' Perception of Clinician Cultural Awareness
Patricia Parker
Walden University
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Walden University

College of Social and Behavioral Sciences

This is to certify that the doctoral dissertation by

Patricia Parker

has been found to be complete and satisfactory in all respects,
and that any and all revisions required by
the review committee have been made.

Review Committee
Dr. Tiffany Rush-Wilson, Committee Chairperson, Psychology Faculty
Dr. Jay Greiner, Committee Member, Psychology Faculty
Dr. Rodney Ford, University Reviewer, Psychology Faculty

Chief Academic Officer
Eric Riedel, Ph.D.

Walden University
2015
Abstract
Mental Health Treatment Adherence and Minority Clients’ Perception of
Clinician Cultural Awareness
by
Patricia Parker

Dissertation Submitted in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Philosophy
Psychology

Walden University
May 2015
Abstract
Psychological counseling is known to be an effective option for people in need of
emotional support. Previous research has shown counseling to be valuable among various
age, sex, religious, socioeconomic, and racial groups. Despite its successes, members of
certain demographic groups reportedly end supportive psychological therapies early. The
purpose of this study was to investigate the experiences of 10 self-identified African
American and Hispanic clients who prematurely terminated therapy. A particular focus of
this investigation was the clients’ perceptions of clinician cultural awareness. This
phenomenological study yielded descriptive data in a context sufficient for analysis with
the use of broad or axial coding systems. Participants indicated that the experience of
benign and malign forms of cultural insensitivity precipitated their decision to terminate
treatment early. Findings supported that therapists need to have greater cultural
sensitivity toward the specific needs of African Americans and Hispanics in the therapy
room. Additionally, some of the data was lacking in richness, which may indicate the
possibilities that clients from these groups lack (a) full awareness of their roles within
the power system of therapy, (b) may need encouragement to articulate a more critical
point of view, or (c) the luxury to introspect about the nature of their experiences, which
inhibits their responses. Based on these possibilities, future recommendations are
presented for gathering richer data from minority clients who terminate therapy early.
Improving cultural sensitivity, which may be a matter of respect and transparency more
than culturally specific knowledge, has implications for social change by leading to
higher retention and, therefore, better treatment outcomes in therapy.
Mental Health Treatment Adherence and Minority Clients’ Perception of
Clinician Cultural Awareness
by
Patricia Parker

Dissertation Submitted in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Philosophy
Psychology

Walden University
May 2015
Dedication
I would like to dedicate this dissertation to my family.
Acknowledgments
I would like to take this opportunity to thank both my chairperson, Dr. Tiffany-
Rush-Wilson, and Dr. Jay Greiner, both of whom have always shown confidence in me.
They have offered their patience, remarks, propositions, and understanding. I would also
like to mention my mother, Eunice Parker, and brother, Jesse Parker, both of whom have
always believed in me for all my hard work. My family, including my other brothers and
sister, has endlessly supported me during my life and academics. This support has helped
me in making positive decisions for my life. I would also like to mention my peers and
coworkers; I appreciate their collaboration and expert advice on every circumstance. I am
also grateful towards my university and my department, including administrators, faculty
members, and fellow students, for their support throughout this study.
Table of Contents
List of Tables ...................................................................................................................v
List of Figures ..................................................................................................................vi
Chapter 1: Introduction ....................................................................................................1
Background .................................................................................................................1
Statement of the Problem ............................................................................................5
Nature of the Study .....................................................................................................6
Research Questions .....................................................................................................6
Purpose of the Study ...................................................................................................7
Theoretical Framework ...............................................................................................8
Definitions...................................................................................................................10
Assumptions, Delimitations and Limitations ..............................................................15
Assumptions ...........................................................................................................15
Delimitations ..........................................................................................................15
Limitations .............................................................................................................16
Significance of the Study ............................................................................................16
Summary and Transition .............................................................................................17
Chapter 2: Literature Review ...........................................................................................19
Overview of the Literature ..........................................................................................19
Cultural Psychology and Racial/Ethnic Needs ...........................................................20
Mental Health Care Experiences of African Americans.............................................24
i
Methods of Addressing Cultural and Social Disconnects in Mental Health Care ......29
African American and Hispanic Response to Psychotropic Medications ..................31
Summary .....................................................................................................................33
Chapter 3: Research Method ............................................................................................35
Introduction .................................................................................................................35
Role of the Researcher ................................................................................................37
Research Questions .....................................................................................................39
Sample and Sample Selection .....................................................................................39
Inclusion and Exclusion Criteria ............................................................................40
Instrumentation ...........................................................................................................41
Data Collection ...........................................................................................................42
Data Analysis ..............................................................................................................43
Ethical Considerations ................................................................................................44
Summary .....................................................................................................................45
Chapter 4: Results ............................................................................................................46
Introduction .................................................................................................................46
Descriptive Statistics ...................................................................................................47
Overview ................................................................................................................47
Cross-Tabulations and Other Two-way Graphs ....................................................52
Coding and Data Analysis .....................................................................................57
Coding and Data Analysis: RQ1 ............................................................................57
ii
Key excepts from participants’ narratives ........................................................57
Coding and Data Analysis: RQ2 .................................................................................60
Key excerpts from participants’ narratives .......................................................60
Coding and Data Analysis: RQ3 ............................................................................61
Key excepts from participants’ narratives ........................................................62
Discussion of Themes ............................................................................................64
Professionalism ......................................................................................................65
Misalignment ..........................................................................................................66
Discrepant Themes and Cases ....................................................................................68
Summary of Results ....................................................................................................69
Conclusion ..................................................................................................................69
Chapter 5: Discussion, Conclusions and Recommendations ...........................................71
Introduction .................................................................................................................71
Summary of Findings ..................................................................................................71
Limitations ..................................................................................................................71
Relevance of Findings to Previous Research ..............................................................74
Recommendations for Future Research ......................................................................77
Reflection and Conclusion ..........................................................................................80
References ........................................................................................................................82

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