Katja Kuusisto , Ph.D. Institute for Advanced Social Research, IASR,

1. The female therapist and the client’s gender SSA, 10–11th Nov 2011 York, UK The Female Therapist and the Client’s Gender in Outpatient Substance Abuse Treatment: Effects on Outcome Katja Kuusisto, Ph.D. Institute for Advanced Social Research, IASR, FI-33014 University of Tampere, Finland katja.n.kuusisto@uta.fi Tytti Artkoski, M.Soc.Sc. School of Social Sciences and Humanities, FI-33014 University of Tampere, Finland tytti.artkoski@uta.fi Funding for this project was provided by the Academy of Finland, Research Programme on Substance Use and Addictions 2007-2010 to the research group headed by Prof. PekkaSaarnio on Effectiveness on Substance Abuse Treatment in Light of Common Factors, University of Tampere, Finland (grant 118327).

2. The female therapist and the client’s gender SSA, 10–11th Nov 2011 York, UK Background • Mostly male clients, female therapists • Gender-sensitivity - practices in substance abuse treatment which have not been specifically designed for representatives of a given gender but which nevertheless take special features of the client’s gender into consideration. • Same sex therapist-client dyad succeeds best • Gender differences in therapists: • Confrontational style in male therapists > more dropping out and increased drinking • Female therapists more empathetic, avoid excessive directiveness, less confrontational → Effects on the quality of co-operation and commitment to treatment

3. The female therapist and the client’s gender SSA, 10–11th Nov 2011 York, UK Aims • In this study we focus on whether female therapists are more successful in helping women or men as their clients in outpatient substance abuse treatment by studying whether there are gender differences in the therapeutic alliance, retention in treatment and outcomes. • In this context, we also try to ascertain the effect of matching gender to treatment outcome.

4. The female therapist and the client’s gender SSA, 10–11th Nov 2011 York, UK Researchquestions RQ1: To what extent are there differences in the estimations of the therapeutic alliance assessed by the female therapists by client’s gender or do corresponding estimations by the clients differ by gender? RQ2: What kind of differences are there between male and female clients as regards retention in treatment? RQ3: What kind of differences are there in treatment outcome between female and male clients? RQ4: To what extent can gender-matching of female therapists and their clients predict treatment results?

5. The female therapist and the client’s gender SSA, 10–11th Nov 2011 York, UK Principles in designing the study • Naturalistic approach • Non-selection of clients and therapists • Randomisation • Prospective follow-up study • Selection of materials

6. The female therapist and the client’s gender SSA, 10–11th Nov 2011 York, UK Implementation • Multi-centre study • 7 outpatient substance abuse treatment units, • 30 female therapists, • 296 clients (101 female, 195 male) • Treatment entry 1-6/2008 • Follow-up 6 months, five therapy sessions • The times of the therapy sessions arranged according to the clients’ needs and units’ everyday practices

7. The female therapist and the client’s gender SSA, 10–11th Nov 2011 York, UK Research Design and DataFigure 1. Research materials and number of clients at different stages in the research setup.

8. The female therapist and the client’s gender SSA, 10–11th Nov 2011 York, UK Results in short • According to the research findings: • Differences between genders in variables: marital status, experience of sexual violence, prior treatment involvement, participation at follow-up • Female clients were more likely to want a female therapist, whereas men did not voice such preferences regarding therapist’s gender. • The clients’ estimation of therapeutic alliance differed by gender at the first visit: female clients estimated the alliance to be slightly better than did men. • The therapists’ estimations were not connected to client’s gender. • In retention and outcome there were no differences between male and female clients. • Matching gender had no predictive power in treatment outcome in most multivariate analyses except in therapeutic alliance.

9. The female therapist and the client’s gender SSA, 10–11th Nov 2011 York, UK Discussion • The findings suggested that: • In Finnish outpatient substance abuse treatment clients of female therapists receive treatment of the same quality regardless of gender although the treatment may take client’s gender into consideration. • Qualitative research on the subject would be worthwhile, thereby enabling a more precise detailing of the treatment process. • There would also be reason to research male therapists and their clients.