Automating the assessment of multicultural orientation through machine learning and natural language processing.

Recent scholarship has highlighted the value of therapists adopting a multicultural orientation (MCO) within psychotherapy. A newly developed performance-based measure of MCO capacities exists (MCO-performance task [MCO-PT]) in which therapists respond to video-based vignettes of clients sharing culturally relevant information in therapy. The MCO-PT provides scores related to the three aspects of MCO: cultural humility (i.e., adoption of a nonsuperior and other-oriented stance toward clients), cultural opportunities (i.e., seizing or making moments in session to ask about clients' cultural identities), and cultural comfort (i.e., therapists' comfort in cultural conversations). Although a promising measure, the MCO-PT relies on labor-intensive human coding. The present study evaluated the ability to automate the scoring of the MCO-PT transcripts using modern machine learning and natural language processing methods. We included a sample of 100 participants (n = 613 MCO-PT responses). Results indicated that machine learning models were able to achieve near-human reliability on the average across all domains (Spearman's ρ = .75, p < .0001) and opportunity (ρ = .81, p < .0001). Performance was less robust for cultural humility (ρ = .46, p < .001) and was poorest for cultural comfort (ρ = .41, p < .001). This suggests that we may be on the cusp of being able to develop machine learning-based training paradigms that could allow therapists opportunities for feedback and deliberate practice of some key therapist behaviors, including aspects of MCO. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The association of sleep duration and feeling rested with health in U.S. Hispanic women.

This study aims to understand the health correlates of sleep deficiencies in non-elderly U.S. Hispanic1 women. Data from a sample of U.S. Hispanic women (n = 1531; ages 18-65 [M = 39.98; SD = 12.85]) who completed the 2017 National Health Interview Survey were analyzed to understand (1) sleep duration and quality; (2) the association of sleep patterns with key health indicators; and (3) whether these relationships are mediated by health behaviors (ie, healthy eating and physical activity). Shorter sleep duration was associated with a higher likelihood of often feeling anxious and having hypertension. Worse sleep quality was associated with a higher likelihood of being overweight, having fair or poor health status, often feeling depressed, often feeling anxious, having high cholesterol, and having asthma. Doctor's recommendation to engage in physical activity and to decrease calorie intake served as mediators in some of these relationships. Results indicate that among Hispanic women: (1) sleep is an important determinant of a variety of health outcomes and (2) the association of sleep and many health outcomes are mediated by healthy eating and physical activity. Further research on the association of sleep and risk of chronic disease among Hispanic women is needed.

Psychotherapy racial/ethnic disparities in treatment outcomes: The role of university racial/ethnic composition.

OBJECTIVE: Mental health disparities between racial/ethnic minorities (REM) and White individuals are well documented. These disparities extend into psychotherapy and have been observed among clients receiving care at university/college counseling centers. However, less is known about if campus RE composition affects outcomes from psychotherapy for REM and White clients. METHOD: This study examined psychotherapy outcomes from 16,011 clients who engaged in services at 33 university/college counseling centers. Each of these clients completed the Behavioral Health Measure as a of part routine practice. Campus RE composition was coded from publicly available data. RESULTS: The results demonstrated that White clients had better therapy outcomes than REM clients when they were at campuses where there were more White students. For universities 1 SD below the mean percentage of White students, the average difference in therapy outcomes for White and REM clients was Cohen's d = .21 (with White students experiencing more improvement); however, for universities 1 SD above the mean, the between group outcome disparity was greater (Cohen's d = .38). CONCLUSION: Therapists and higher education professionals should consider environmental impacts on counseling services. Implications for higher education, counseling centers, and mental health disparities are provided. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Addressing racial equity in health psychology research: An application of the multicultural orientation framework.

Health psychology research emphasizes biological and positivist methods, giving less attention to the multifaceted sociocultural and political forces at play in health processes and outcomes. In this article, we present a new sociostructural approach for working toward racial equity in health psychology research, consistent with public psychology goals. This new approach uses the multicultural orientation framework (MCO) to guide health psychologists to consider the sociocultural and political history of their work, systems of oppression and privilege embedded in health research, and a path toward using research to achieve social change, antiracism, and health equity. We identify MCO as a tool for health psychology researchers to engage in ongoing self-reflection, cultivate cultural humility, and act upon opportunities to examine cultural factors at each step of the research process. After describing the MCO's components of cultural humility, cultural opportunities, and cultural comfort, we introduce questions that researchers can use to guide self-reflexivity and the implementation of MCO into health psychology research focused on racial equity. Specifically, we present the issue of Black women's perinatal health to embody the importance of applying MCO to health disparities research. We then walk through how to apply MCO in health research study development, data collection, and data dissemination. As we outline how to apply MCO to promote antiracist health research, we aim to enact social change consistent with the public psychology goals of building and fostering strong community relationships that inform social policy. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Dissemination of computer-assisted cognitive-behavior therapy for depression in primary care.

Computer-assisted cognitive-behavior therapy (CCBT) for depression in primary care will be evaluated in a trial with 240 patients randomly assigned to CCBT or treatment as usual (TAU). The study will disseminate a therapy method found to be effective in psychiatric settings into primary care - a setting in which there have been significant problems in the delivery of adequate, evidence-based treatment for depression. The study will include a high percentage of disadvantaged (low-income) patients - a population that has been largely ignored in previous research in CCBT. There have been no previous studies of CCBT for depression in primary care that have enrolled large numbers of disadvantaged patients. The form of CCBT used in this study is designed to increase access to effective therapy, provide a cost-effective method, and be a sustainable model for wide-spread use in primary care. In order to deliver therapy in a practical manner that can be replicated in other primary care practices, patients with significant symptoms of depression will receive treatment with an empirically supported computer program that builds cognitive-behavior therapy skills. Support for CCBT will be provided by telephone and/or e-mail contact with a care coordinator (CC) instead of face-to-face treatment with a cognitive-behavior therapist. Outcome will be assessed by measuring CCBT completion rate, comprehension of CBT concepts, and satisfaction with treatment, in addition to ratings of depressive symptoms, negative thoughts, and quality of life. The cost-effectiveness analysis and exploration of possible predictors of outcome should help clinicians, health care organizations, and others plan further dissemination of CCBT in primary care.

Racial/ethnic disparities in client unilateral termination: The role of therapists' cultural comfort.

OBJECTIVE: There is growing evidence highlighting the existence of inequities in mental health treatments that occur on the basis of client race and ethnicity for some therapists. In particular, therapists vary in the degree to which their racial/ethnic minority clients unilaterally terminate as compared to White clients. Although therapists have been shown to be a key source of racial/ethnic mental health treatment disparities, less is known about what predicts which therapists will have larger disparities among their clients. METHOD: With this in mind, the current study examined client unilateral termination within therapist caseloads, and then examined therapists' racial/ethnic comfort and general comfort as predictors of client unilateral termination. The sample included 23 counselors who treated 177 clients at a large university counseling center. RESULTS: The results indicated that therapists' racial/ethnic comfort was significantly associated with racial/ethnic disparities within their caseloads; however, therapists' general comfort was not. Implications for research and practice are offered. CONCLUSIONS: Therapists' racial/ethnic comfort may help explain disparities in unilateral termination.

Cultural Humility in Psychotherapy Supervision.

As a core component of multicultural orientation, cultural humility can be considered an important attitude for clinical supervisees to adopt and practically implement. How can cultural humility be most meaningfully incorporated in supervision? In what ways can supervisors stimulate the development of a culturally humble attitude in our supervisees? We consider those questions in this paper and present a model for addressing cultural humility in clinical supervision. The primary focus is given to two areas: (a) modeling and teaching of cultural humility through interpersonal interactions in supervision, and (b) teaching cultural humility through outside activities and experiences. Two case studies illustrating the model are presented, and a research agenda for work in this area is outlined.

Multicultural competencies: What are we measuring?

The current study examined the validity of the client-rated version of the Cross-Cultural Counseling Inventory-Revised (CCCI-R). The first phase of this study involved a content validation of the CCCI-R by experts who had publications in the fields of multicultural competencies (MCCs) and psychotherapy research. Of the 20 items on the CCCI-R, 7 were rated as appropriate for client use. The second phase of this study utilized confirmatory factor analysis to examine construct validity by testing whether clients' perceptions of their therapists' MCCs (via the seven items validated by experts) were distinct from client-rated working alliance scores. Model fit statistics supported a theoretically based model in which MCCs were measured distinctly from working alliance, but where the two factors were related. Implications for theory and practice are discussed.

A meta-analysis of multicultural competencies and psychotherapy process and outcome.

For decades, psychologists have emphasized the provision of multiculturally competent psychotherapy to reduce racial and ethnic disparities in mental health treatment. However, the relationship between multicultural competencies (MC) and other measures of clinical process and treatment outcome has shown heterogeneity in effect sizes. This meta-analysis tested the association of client ratings of therapist MC with measures of therapeutic processes and outcome, including: (a) working alliance, (b) client satisfaction, (c) general counseling competence, (d) session impact, and (e) symptom improvement. Among 18 studies (20 independent samples) included in the analysis, the correlation between therapist MC and outcome (r = .29) was much smaller than the association with process measures (r = .75), but there were no significant differences in correlations across different types of MC or clinical process measures. Providing some evidence of publication bias, effect sizes from published studies (r = .67) were larger than those from unpublished dissertations (r = .28). Moderator analyses indicated that client age, gender, the representation of racial-ethnic minority (R-EM) clients, and clinical setting were not associated with effect size variability. Based on these findings, we discuss implications and recommendations for future research that might lead to a better understanding of the effects of therapist MC on treatment process and outcome. Primary needs in future research include the development and evaluation of observer ratings of therapist MC and the implementation of longitudinal research designs.

Relationship between interpretation, alliance, and outcome in psychodynamic psychotherapy: control of therapist effects and assessment of moderator variable impact.

The current study examines the relationship between therapist interpretations in the early stages of psychodynamic psychotherapy and subsequent outcomes for 76 outpatients. Pre-treatment characteristics of global symptomatology, personality pathology, insight, and level of object relations were examined as possible significant patient characteristics. Independent clinicians reliably rated therapist use of interpretations over two early treatment sessions (third and ninth). Patient-rated alliance was also examined as a possible psychotherapy process predictor of change. Therapy outcomes were measured based on patients' changes in global symptomatology and estimates of improvement across a broad range of functioning at the end of treatment. An examination of the study independent variables revealed significant relationships between pre-treatment personality disorder symptomatology with patient object relations (OR), patient OR with pre-treatment insight, and pre-treatment insight with use of therapist interpretation. Pre-treatment symptomatology and early treatment interpretations predicted reliable change in global symptomatology. Patients' estimates of improvement across a broad band of functioning were most significantly impacted by quality of alliance. Analysis of these outcome relationships controlled for therapist effects. Statistical implications of therapist effects are discussed in regard to this area of research and future directions for investigation are explored.

Therapist differences in symptom change with racial/ethnic minority clients.

Some psychotherapists produce better outcomes than others (Crits-Christoph & Mintz, 1991; Kraus, Castonguay, Boswell, Nordberg, & Hayes, 2011), although it has not been established whether therapists vary in their effectiveness with racial/ethnic minority (REM) clients. The importance of identifying therapist factors associated with successful outcomes for REM clients is underscored by imperatives regarding the provision of culturally competent psychotherapy (American Psychological Association, 2003; Smith, Rodriguez, & Bernal, 2011) and by research demonstrating the existence of ethnic disparities in mental health problems (Hayes, Chun-Kennedy, Edens, & Locke, 2011a) and their treatment (Harris, Edlund, & Larson, 2005). In this study, we investigated 36 therapists and 228 clients seen at a university training clinic to investigate whether differences in therapist effectiveness were a function of client ethnicity. Clients completed the Outcome Questionnaire-45 prior to each session. Multilevel modeling analyses indicated that (a) outcomes for REM and non-REM clients did not differ, (b) some therapists produced better outcomes than others, and (c) this variability was due in part to client REM status. Thus, it appears that therapists vary in their effectiveness at reducing symptoms with REM clients. Implications for training, multicultural theory, and future research are discussed.

Racial/ethnic disparities in therapist effectiveness: a conceptualization and initial study of cultural competence.

As a result of mental health disparities between White and racial/ethnic minority clients, researchers have argued that some therapists may be generally competent to provide effective services but lack cultural competence. This distinction assumes that client racial/ethnic background is a source of variability in therapist effectiveness. However, there have been no direct tests of the therapist as a source of health disparities. We provided an initial test of the distinction between general and cultural competence by examining client racial/ethnic background as a source of variability in therapist effectiveness. We analyzed cannabis use outcomes from a psychotherapy trial (N = 582) for adolescent cannabis abuse and dependence using Bayesian multilevel models for count outcomes. We first tested whether therapists differed in their effectiveness and then tested whether disparities in treatment outcomes varied across therapist caseloads. Results suggested that therapists differed in their effectiveness in general and that effectiveness varied according to client racial/ethnic background. Therapist effectiveness may depend partially on client racial/ethnic minority background, providing evidence that it is valid to distinguish between general and cultural competence.

"Hooking up" among college students: demographic and psychosocial correlates.

This study investigated 832 college students' experiences with hooking up, a term that refers to a range of physically intimate behavior (e.g., passionate kissing, oral sex, and intercourse) that occurs outside of a committed relationship. Specifically, we examined how five demographic variables (sex, ethnicity, parental income, parental divorce, and religiosity) and six psychosocial factors (e.g., attachment styles, alcohol use, psychological well-being, attitudes about hooking up, and perceptions of the family environment) related to whether individuals had hooked up in the past year. Results showed that similar proportions of men and women had hooked up but students of color were less likely to hook up than Caucasian students. More alcohol use, more favorable attitudes toward hooking up, and higher parental income were associated with a higher likelihood of having hooked up at least once in the past year. Positive, ambivalent, and negative emotional reactions to the hooking up experience(s) were also examined. Women were less likely to report that hooking up was a positive emotional experience than men. Young adults who reported negative and ambivalent emotional reactions to hooking up also reported lower psychological well-being and less favorable attitudes toward hooking up as compared to students who reported a positive hooking up experience. Based on these findings, suggestions for psychoeducational programming are offered. Additionally, directions for future research are provided.