Session Quality and Impact in Psychotherapy With American Indian Clients

The quality and impact of psychotherapy sessions are primary concerns in service delivery. However, no published investigations of quality or impact of psychotherapy sessions with American Indian (AI) patients could be found in the scientific literature. We sought to demonstrate that collecting such data is feasible as well as to inform the development of evidence-based practices and cultural adaptations. To this end, we asked psychotherapists treating AIs in outpatient psychotherapy within an urban community clinic to rate the quality and impact of sessions delivered to their clients. Eight psychotherapists self-reported session quality and impact with the Session Evaluation Questionnaire, Form 5 (SEQ-5; Stiles, 1980, 1984) immediately following service delivery to 112 separate, consecutive clients. Session quality was assessed with measures of depth and smoothness. Post-session impact was assessed with measures of positivity and emotional arousal. Overall, sessions were rated as equally deep, but smoother, more positive, and less emotionally arousing in comparison to a sample of experienced university-based psychotherapists (Cummings et al., 1993). However, sessions provided by AI psychotherapists were rated as deeper, less positive, and more emotionally arousing than sessions provided by White psychotherapists. Replicating this study in a larger sample and including client as well as observer ratings will help to move this nascent line of research forward. Impact Statement Given the absence of studies reporting on session quality and impact with American Indian psychotherapy clients, we wondered about the quality and impact of psychotherapy with this group. Overall, sessions were rated by therapists as equally deep, but smoother, more positive, and less emotionally arousing in comparison to a sample of experienced university-based psychotherapists. However, sessions provided by AI psychotherapists were rated as deeper, less positive, and more emotionally arousing than sessions provided by White psychotherapists. The findings show that measuring session quality and impact is feasible and that measuring these constructs can provide important quality assessment information for stakeholders. Session quality and impact ratings in this study compare favorably to a sample of experienced university-based therapists, suggesting high quality service provision. Researchers and clinic directors working in American Indian healthcare settings are encouraged to measur