Date of Submission


Degree Type


Degree Name

Doctor of Psychology (PsyD)



Department Chair

Robert A DiTomasso, PhD, ABPP, Chair, Department of Psychology

First Advisor

Bruce S Zahn, EdD, ABPP, Chairperson

Second Advisor

Beverly White, PsyD

Third Advisor

Charmaine Chan, DO


Therapeutic alliance has been documented to have a significant impact on therapy. This study examined the impact that acknowledging visible cultural differences in the first session of treatment has on therapeutic alliance, perceived clinician cross-cultural competency, and potential attrition. A vignette study design was utilized with 26 subjects who were patients at the PCOM Center for Brief Therapy. The patients were randomly assigned one of four vignettes that consisted of a cross-cultural therapy situation, in which visible cultural differences were either addressed or not by a clinician. Following the reading of the vignette, the subjects were asked to complete the Working Alliance Inventory-Client Version, the client modified version of the Cross Cultural Counseling Inventory-Revised, and a Client Attrition Questionnaire. The results of the study indicated a significant difference in perceived clinician cultural competency in a situation where a clinician acknowledges multiple cultural differences rather than a single difference. A significant negative correlation was found between age and therapeutic alliance as a whole. Female subjects were also found to be significantly more likely than male subjects to make a higher rating of their potential to prematurely drop out of treatment. Future research should expand beyond the vignette model and utilize an intervention study to focus on the impact of broaching visible cultural differences in cross-cultural therapy during the first session of treatment.