Uncovering Patterns in Perceived Therapist Behaviour: A Latent Profile Analysis of Broaching Experiences Among Ethnic Minority Group Member Clients.

OBJECTIVE: Recent research shows that for clients who identify as ethnic minority group members, therapists' effort to include ethnic-cultural topics in therapy conversations-that is, broaching-is important for clients' evaluations of therapy and symptom improvement. However, little is known about how this is experienced by clients and how different patterns of broaching behaviours are related to the therapeutic process. This study aimed to identify meaningful combinations of therapist broaching behaviours in a sample of clients that identify as ethnic minority group members in outpatient psychotherapy (N = 452; 64.6% women, 33.6% men, 1.3% nonbinary; 0.4% preferred not to say; Mage = 33.8). METHODS: In the present research, we employed latent profile analysis to discern therapist profiles based on the similarity of their reported broaching behaviours. Group differences were analysed with Welch's analysis of variance. RESULTS: Five profiles were delineated, each revealing specific broaching patterns. The obtained profiles were named Pending, Neutral, Inappropriate, Uninvolved and Engaged. Reported cultural identity concealment was lower and client-estimated improvement higher in the Pending and Engaged profiles compared to the Inappropriate profile. Both the Neutral and Uninvolved profiles yielded scores in between. CONCLUSIONS: Pending and Engaged profiles are equally beneficial and the Inappropriate profile is the most harmful in terms of reported cultural concealment and client-estimated improvement. Implications of findings for practice, training and research are discussed.

The development of the Broaching Assessment Scale: A client-rated measure of therapists' broaching behaviour in clinical counselling.

Objective: Addressing ethnic-cultural topics during the process of psychotherapy, i.e. broaching, is considered highly important for ethnic minority clients who consult mental health care services. Surprisingly little is known, however, about clients' perception of a therapist's broaching qualities, and how clients' mental construction of broaching translates into behavioural broaching acts a therapist may display.Method: Based on previous work and nine in-depth interviews with ethnic minority clients, a client-rated measure of therapists' broaching behaviour was developed and psychometrically evaluated in two samples. Sample 1 (N = 252 UK ethnic minority clients) was used to empirically delineate the factor structure of an initial item set. Participants were then resolicited to complete a revised item pool.Results: The empirical structure resulted in a final 25-item broaching instrument with five subscales probing into therapists' broaching behaviour. This Broaching Assessment Scale (BrAS) was validated in Sample 2 (N = 239 US ethnic minority clients). Strict measurement invariance of the factor structure was observed across the two samples and distinctive correlational patterns with therapeutic process measures were found.Conclusion: The BrAS provides new insights on how sensitivity to ethnic-cultural topics can be targeted along its concrete features, and is a promising tool for conceptualizing culturally sensitive mental healthcare assessment.

Addressing cultural topics during psychotherapy: Evidence-based do's and don'ts from an ethnic minority perspective.

OBJECTIVE: Broaching-i.e., a counsellor's effort to install meaningful conversations in psychotherapy concerning one's cultural identity-is a strong predictor of positive treatment outcomes and client satisfaction, especially for minority-identified clients. Despite this understanding, the broaching literature has struggled to translate broaching principles into practical recommendations for specific behaviours and skills. The current study therefore explores the effects of broaching approaches by the therapist (i.e., direct, indirect and avoidant approach) about cultural topics including ethnicity, religion, gender expression and socioeconomic status on clients' perception of (1) the multicultural orientation of the therapist and (2) the frequency of microaggressions during therapy. METHOD: These research questions were investigated in a sample of ethnic minority clients (N = 231) who followed at least one session of mental healthcare counselling during the last 12 months. RESULTS: Findings show that indirect broaching is the overall most favourable approach, whilst avoidant broaching is consistently negatively associated with all therapy-related outcome measures. CONCLUSION: The results lay the basis for practical guidelines for broaching in psychotherapy, and provide counsellors with a foundation for having cultural conversations in an effective and respectful manner.