Culturally Sensitive Psychotherapy for Perinatal Women: A Mixed Methods Study

Objective: There is a critical need to better understand psychological treatments from a culturally sensitive lens. Using a process-oriented model, we examined treatment satisfaction among perinatal patients who received behavioral activation (BA) within a large psychotherapy trial for perinatal depression and anxiety, and explored how to optimize culturally sensitive delivery through a multistakeholder perspective. Method: In this mixed methods study, we estimated treatment satisfaction through mean client satisfaction scores (Client Satisfaction Questionnaire [CSQ]-8) among perinatal participants (N = 417) using one-way analysis of variance. We also conducted semistructured interviews with 20 ethnically diverse perinatal participants, 19 treatment providers, and five clinical leads. We employed content analysis to identify barriers, facilitators, and strategies for delivering culturally sensitive treatment. Results: CSQ-8 scores were similar across ethnic groups, F(7, 409) = 0.70, p = .67. Most participant interviewees reported that topics of race, ethnicity, and culture were raised during treatment sessions and that providers were able to address these topics in a culturally sensitive way. Despite this, almost all providers and clinical leads reported insufficient training to deliver culturally sensitive psychotherapy. The most-endorsed challenge for participants and providers was apprehension to bring up issues of race and ethnicity during treatment. Key facilitators included provider style, previous training, ongoing training resources, and supervision. Conclusion: BA offers one psychotherapeutic model that uses an idiosyncratic and process-oriented approach that fosters intersectional humility and benefits from cultural humility, comfort, and opportunities. We identify key recommendations to inform culturally sensitive, evidence-based psychological treatments that include explicitly acknowledging and eliciting topics of race, ethnicity, and culture during sessions and supervision and ongoing training and supervision. What is the public health significance of this article? This study highlights the importance of idiosyncratic and process-oriented psychotherapies to facilitate treatment satisfaction and inform culturally sensitive care. This individualized approach is ultimately guided by a patient-centered lens that promotes partnership and collaboration between patient and provider. Key recommendations include the use of cultural humility and cultura