Alliance and Outcomes in Counseling Canadian Aboriginal Peoples

This study evaluated predictors of outcome in counseling with Canadian Aboriginal peoples. Participants in the study included 373 Canadian Aboriginal clients receiving outpatient counseling at Calgary Counselling Centre in Alberta, Canada between October 2004 and November 2011. Outcome in this study was measured using the Outcome Questionnaire 45 (OQ-45) and predictor variables consisted of client demographics, counselor training level, and client ratings of the therapeutic alliance. The alliance was measured using the Session Rating Scale (SRS). Outcome variables, as measured by the OQ-45, were most often analyzed categorically and consisted of four different possible categories of change as measured from first to last session. Client OQ-45 scores were also analyzed as a continuous variable to examine the relationship between therapeutic change and therapeutic alliance. The researcher found significant results in the following areas: 1) primary presenting problem predicted client level of distress at intake; 2) education level of the client was predictive of number of sessions attended; 3) client ratings of the alliance at the second and third sessions were predictive of therapeutic change. As hypothesized, there was no significant difference in outcome based on counselor training level. The results are discussed in the context of improving clinical practice in real-world clinical settings, considerations in working with Native peoples, and the need for ongoing outcome monitoring. Limitations of the study, implications of the findings, and recommendations for future research are discussed.