Delivering Cognitive Processing Therapy to Spanish-Speaking Survivors: Lessons Learned from Rape Crisis Counselors

Background: Cognitive Processing Therapy (CPT) is a manualized, evidence-based treatment (EBT) with strong empirical support for treating post-traumatic stress disorder (PTSD) in individuals. However, no studies have been conducted to examine counselors’ experiences of delivering CPT to women from racial/ethnic minority groups at Rape Crisis Centers (RCCs), likely due to the underutilization of EBTs at RCCs (Edmond & Voth Schrag, 2017; Edmond, Voth Schrag, & Bender, 2019). Using mixed methods, this study explores bilingual counselors’ experiences of being trained in and delivering CPT and the subsequent effectiveness of CPT in addressing PTSD and depression with a sample of Spanish-speaking women who had experienced sexual violence and sought help from RCCs.

Methods: This study is part of a multi-year, randomized controlled trial examining the effectiveness of an implementation strategy (learning collaborative) for the adoption of CPT at 11 Texas RCCs in 2019. The qualitative data were collected through 13 focus group interviews conducted with 11 counselors working with Spanish-speaking women. Each counselor participated in at least one of two 90-minute focus groups conducted at two points in time within six months. Using a semi-structured guide, bilingual counselors were asked about experiences in being trained in and then implementing CPT with Spanish-speaking clients. The focus groups were audiotaped, transcribed, loaded into Nvivo and analyzed following an iterative process using the six-step thematic analysis proposed by Braun and Clarke (2006). The quantitative data of self-reported PTSD and depression were collected after each treatment session with 20 Spanish-speaking clients and analyzed using paired samples-t tests in Stata.

Results: Three overarching themes emerged from the qualitative analysis of focus groups with counselors: challenges of implementing CPT, counselors’ perceptions of the fitness and effectiveness of CPT with Spanish-speaking clients, and implementation strategies suggested by counselors. The challenges of implementing CPT identified included being trained in English but delivering CPT in Spanish, outdated or incomplete Spanish translations of CPT material, and structural barriers faced by low-income immigrant populations. Despite the challenges, counselors perceived CPT as effective and a good fit for Spanish-speaking women. Counselors also shared creative strategies they used to effectively deliver CPT and suggested strategies for future implementation, such as conducting training and regular consultation in Spanish. Analysis of quantitative data with Spanish-speaking clients indicated a decrease in the proportion of clients with severe PTSD symptoms (1^st session: 89%; 12^th session: 38%) and moderate or severe depression (1^st session: 56%; 12^thsession: 25%). The results of a paired samples-t test suggested that the differences were statistically significant.

Conclusion & Implications: This study contributes to the literature and field by presenting lessons learned from training RCC counselors to implement CPT in Spanish. This study also suggests that CPT is a good fit and an acceptable intervention for low-income, Spanish-speaking clients.