Cultural humility and racial microaggressions in cross-racial clinical supervision: A moderated mediation model.

Cultural humility is important in supervision; however, studies have primarily sampled White supervisees. Racially and ethnically minoritized trainees experience microaggressions during their training, yet cross-racial supervision is less often studied. We examined a moderated mediation model to test whether the supervisory working alliance mediated the relationship between frequency of racial microaggressions and satisfaction with supervision, and whether the impact of racial microaggressions on the supervisee and supervisor cultural humility moderated the relationship between racial microaggression frequency and the supervisory working alliance. In a sample of supervisees of color (N = 102; majority cisgender women, 86.2%, and heterosexual, 59.8%; 35.3% Black/African American, 28.4% Asian/Pacific Islander, 18.6% Hispanic/Latine) receiving clinical supervision from White supervisors, we found that racial microaggression frequency was negatively associated with satisfaction with supervision, and this relationship was fully accounted for by the supervisory working alliance. Racial microaggressions in supervision were found to be detrimental to the supervisory working alliance, which was then related to lower satisfaction with supervision. Further, racial microaggression impact and cultural humility moderated the relationship between racial microaggression frequency and the supervisory working alliance; this relationship was strongest when racial microaggression impact was high and cultural humility was average or high. The social bond hypothesis suggests we are more likely to allow ourselves to be vulnerable when we assess cultural humility to be high. We posit that the observed moderation effect may be due to supervisees experiencing greater shock when experiencing racial microaggressions from supervisors whom they perceived to be culturally humble. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Exploring User Perceptions of a Mobile App for Religious Practices.

The purpose of this study was to explore the usage patterns of USA subscribers of an online religious/spiritual application (i.e., app; Pray.com) and the associations of app usage with physical health, mental health, spiritual health, and well-being outcomes. A total of 1031 subscribers participated in the survey about their engagement with the Pray.com app. Most of the respondents had been using the app between one and two years, and more than half were high-frequency users. Although many individuals engaged with the app experienced spiritual growth, many also reported retrospective improvement in mental and physical health. This research serves as an initial examination of how religious-based apps may be associated with self-reported improvements in physical, mental, and spiritual health outcomes.

Development and Validation of the Forbearance Scale.

The character strength of forbearance contributes to peace in broader society, as well as familial harmony. Although forbearance is essential to healthy interpersonal relationships, no psychometrically sound measure has been developed to assess the multi-dimensional nature of forbearance. The present set of studies describes the development and initial validation of the Forbearance Scale (FS). In Study 1, items were generated from focus group interviews with college students (n = 43) to establish the content validity of the scale. In Study 2, the factor structure of the FS was determined using exploratory factor analysis of data from college students (n = 466). In Study 3, the factor structure of the FS was cross-validated with a community sample (n = 579) by means of confirmatory factor analysis. The final scale, the FS-16, consists of 16 items with four factors: (1) emotional calmness, (2) overlook others' misdeeds, (3) tolerance and acceptance, and (4) self-restraint. Hierarchical multiple regression analyses provided evidence of convergent and concurrent validity. The FS-16 demonstrates potential as a new personality assessment tool for measuring forbearance.

Multicultural Streaming in Group Psychotherapy Supervision: Orientation to and Preparation for Culturally Humble Practice.

How do psychotherapy supervisors most effectively integrate issues and concerns about multiculturalism and social justice (MSJ) into the supervisory experience? Concrete examples of how to best address this integration are needed, and this article provides one such example. The authors propose multicultural streaming as one approach to orient supervisees about, and prepare them for, incorporation of MSJ matters into group supervision and to foster their evolving sense of culturally humble practice. This article defines multicultural streaming, presents a plan for its implementation at the group's outset, and identifies implementation guideposts for consideration. A set of cultural humility guidelines adapted for group supervision is also proposed for group facilitation. This perspective is presented with the hope of generating further discussion about integrating MSJ issues into the group supervisory experience.

Resource loss and mental health during COVID-19: Psychosocial protective factors among U.S. older adults and those with chronic disease.

Across the globe, COVID-19 has disproportionately affected the physical and mental health of several vulnerable groups. In a series of two cross-sectional studies conducted April to July 2020, we examined its acute mental health effects on two vulnerable U.S. community samples-home-bound older adults who were at or below the poverty line (Study 1, N = 293, Mage  = 76.94, SD = 8.64; 75.1% female, 67.9% Black) and adults with chronic disease (Study 2, N = 322, Mage  = 62.20, SD = 12.22; 46.3% female, 28.3% racial/ethnic minorities). Based on the conservation of resources theory, we hypothesised that pandemic-related resource loss would be associated with greater mental distress, but perceived social support and positive psychological characteristics (trait resilience and optimism) would buffer against this adverse effect. Across both samples of vulnerable adults, pandemic-related resource loss was related to mental distress. Perceived social support was related to lower mental distress but did not consistently buffer the effect of resource loss on mental health. However, in Study 2, both trait resilience and optimism buffered this relationship. Findings are discussed in terms of their implications for the conservation of resources theory.

Perceived and actual posttraumatic growth in religiousness and spirituality following disasters.

OBJECTIVE: Religious/spiritual (R/S) growth is a core domain of posttraumatic growth (PTG). However, research on R/S growth following disasters has over-relied on retrospective self-reports of growth. We therefore examined longitudinal change in religiousness/spirituality following two disasters. METHOD: Religious survivors of Hurricanes Harvey (Study 1) and Irma (Study 2) completed measures of perceived R/S PTG, general religiousness/spirituality ("current standing"-R/S PTG), and subfacets of religiousness/spirituality (spiritual fortitude, religious motivations, and benevolent theodicies). In Study 1, 451 participants responded at 1-month and 2-month postdisaster. In Study 2, participants responded within 5-days predisaster and at 1-month (N = 1,144) and 6-months postdisaster (N = 684). RESULTS: In both studies, perceived R/S PTG was weakly related to longitudinal increases in general religiousness/spirituality and in most of its subfacets, but reliable growth in any R/S outcome was rare. Additionally, Study 2 revealed evidence that actual change in psychological well-being is associated with actual (but not perceived) R/S PTG, but disaster survivors tend to exhibit declines in their religiousness/spirituality, spiritual fortitude, and religious motivations. CONCLUSIONS: Results suggest disaster survivors are only modestly accurate in perceiving how much positive R/S change they experience following a disaster. We discuss implications for clinical practice, scientific research, and empirical and conceptual work on PTG more broadly.

The Enneagram: A systematic review of the literature and directions for future research.

The Enneagram is a typology that many clients use to understand their personality and interpersonal patterns, despite some concerns about its validity. Thus, the purpose of this review is to provide a comprehensive and clinician-friendly review of the extant empirical work on the Enneagram. After reviewing 104 independent samples, we found mixed evidence of reliability and validity. In terms of strengths, some factor analytic work has shown partial alignment with prior theorizing, and subscales show theory-consistent relationships with other constructs such as the Big 5. Also, several studies found the Enneagram was helpful for personal/spiritual growth. However, factor analytic work has typically found fewer than nine factors, and no work has used clustering techniques to derive the nine types. Also, there is little research supporting secondary aspects of Enneagram theory, such as wings and intertype movement. We conclude by highlighting directions for future research and implications for clinical practice.

Inquiry-based stress reduction: A systematic review of the empirical literature.

OBJECTIVE: This paper reviewed the empirical research on inquiry-based stress reduction (IBSR; also called "The Work"), which has similarities to third-wave cognitive behavioral approaches such as Acceptance and Commitment Therapy (ACT). Widely used as a self-help intervention, IBSR has only recently been subjected to empirical research. METHOD: We reviewed empirical studies (published and unpublished) that examined IBSR. RESULTS: We found 17 empirical studies (15 independent samples) that examined IBSR. Several studies reported positive changes on variables such as stress, anxiety, and well-being. However, only three studies evaluated IBSR using randomized clinical trials (RCTs). Concerns related to treatment feasibility and cost-effectiveness of IBSR are noted. CONCLUSIONS: There are some promising initial findings on IBSR. However, additional research employing high-quality research designs is necessary to explore the efficacy and effectiveness of IBSR in various contexts.

Development of the Collectivist-Sensitive Trait Forgivingness Scale.

Mounting evidence suggests that experiences of forgiveness vary across cultures. However, culturally sensitive conceptualizations of forgiveness lack empirical support, in part because psychometrically sound instruments designed to capture unique aspects of forgiveness in non-Western cultures are rare. For this reason, we developed the Collectivist-Sensitive Trait Forgivingness Scale (TFS-CS), which is designed to measure trait forgivingness within societies characterized by a blend of individualistic and collectivistic worldviews. In Study 1 (N = 597), exploratory factor analysis revealed a 16-item three-factor structure of third-party forgiveness, collectivistic forgiveness, and interpersonal resentment among South Africans. In Study 2 (N = 897), the three-factor model replicated in an independent South African sample. Findings also offered preliminary evidence supporting the construct validity of the TFS-CS. Overall, these studies support a conceptualization of trait forgivingness with similarities and differences relative to Western models and highlight the importance of appreciating the influence of culture when measuring forgiveness.

Multicultural Orientation in Psychotherapy Supervision: Cultural Humility, Cultural Comfort, and Cultural Opportunities.

As a complement to multicultural competence, the multicultural orientation (MCO) perspective has been proposed as a pragmatic way to enhance cultural understandings about psychotherapeutic dynamics, processes, and outcomes. Consisting of three core components-cultural humility, cultural comfort, and cultural opportunities-the MCO is considered relevant for both individual and group treatment. However, the MCO perspective has yet to be specifically applied to psychotherapy supervision. Because supervision often provides multicultural oversight for individual and group psychotherapy services, considering the ramifications of MCO for psychotherapy supervision (MCO-S) is important. In this article, the implications of MCO-S are reviewed, with attention given to the impacts of cultural humility, cultural comfort, and cultural opportunities on the supervisor-supervisee relationship. Case examples are provided to illustrate the ways in which MCO can affect the psychotherapy supervision process and outcome. Supervision research possibilities are also proposed.

Creating and Elaborating the Cultural Third: A Doers-Doing with Perspective on Psychoanalytic Supervision.

Although recognized as highly crucial to supervision practice (e.g., Tummala-Narra, 2004), culture has been addressed minimally in the psychoanalytic supervision literature. Calls to remedy that limitation have been made and making culture matter has been identified as a most pressing need for psychoanalytic supervision. But how then do we as supervisors go about doing that? How might we better position culture in, and make culture central to, our psychoanalytic supervisory conceptualization and conduct? We subsequently take up those questions, expanding upon our earlier proposals about cultural humility and the Cultural Third (Watkins and Hook, 2016) by (a) proposing a tripartite multicultural perspective (i.e., cultural humility-cultural comfort-cultural opportunities) as supervision sine qua non; (b) using recognition theory as a way to better understand that very process of Third creation and elaboration; and (c) providing a rupture/repair case example that shows efforts to create and build the Cultural Third in supervision. The Cultural Third is conceptualized as a product of doers-doing with so as to culturally learn together through "not knowing".

Development of the Self-Forgiveness Dual-Process Scale.

Progress in the scientific study of self-forgiveness reveals a need for (a) integration of the extant self-forgiveness literature with general psychological theory, (b) development of measures that reflect nuanced conceptualizations of self-forgiveness, (c) better understanding of the impact of self-forgiveness on personal and interpersonal functioning, and (d) development of evidence-based clinical applications of self-forgiveness. Accordingly, we conceptualized self-forgiveness within the framework of Social Cognitive Theory and developed the Self-Forgiveness Dual-Process Scale to assess value reorientation (VRO) and esteem restoration (ERS) following perceived interpersonal offense. In Study 1, we identified the hypothesized 2-factor structure in a sample of university students (N = 191). For Study 2, we used an independent sample (N = 100) to replicate the factor structure and provide initial evidence of construct validity by exploring associations of value reorientation and esteem restoration with established measures of self-forgiveness, self-punishment, and self-exoneration. In Study 3, we recruited a third sample (N = 66) to assess contributions of value reorientation and esteem restoration to explain variance in offense-related rumination beyond that explained by an existing measure of state self-forgiveness. Overall, findings supported conceptualization of self-forgiveness according to processes of value reorientation and esteem restoration, distinguished self-forgiveness from other responses to wrongdoing, and revealed the unique impacts of value reorientation and esteem restoration on functioning. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Integrating clients' religion and spirituality within psychotherapy: A comprehensive meta-analysis.

Some religious or spiritual (R/S) clients seek psychotherapy that integrates R/S values, while others may be reticent to disclose R/S-related aspects of struggles in a presumably secular setting. We meta-analyzed 97 outcome studies (N = 7,181) examining the efficacy of tailoring treatment to patients' R/S beliefs and values. We compared the effectiveness of R/S-tailored psychotherapy with no-treatment controls, alternate secular treatments, and additive secular treatments. R/S-adapted psychotherapy resulted in greater improvement in clients' psychological (g = 0.74, p < 0.000) and spiritual (g = 0.74, p < 0.000) functioning compared with no treatment and non R/S psychotherapies (psychological: g = 0.33, p < 0.001; spiritual: g = 0.43, p < 0.001). In more rigorous additive studies, R/S-accommodated psychotherapies were equally effective to standard approaches in reducing psychological distress (g = 0.13, p = 0.258), but resulted in greater spiritual well-being (g = 0.34, p < 0.000). We feature several clinical examples and conclude with evidence-based therapeutic practices.

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 and racial microaggressions in counseling.

Racial microaggressions may contribute to poor counseling outcomes in racial/ethnic minority clients. The present study examined the occurrence of racial microaggressions in counseling using a large and diverse sample and explored the association between perceived cultural humility of the counselor and racial microaggressions. Racial/ethnic minority participants (N = 2,212) answered questions about the frequency and impact of racial microaggressions in counseling and the characteristics of their counselor. The majority of clients (81%) reported experiencing at least 1 racial microaggression in counseling. Participants most commonly reported racial microaggressions involving denial or lack of awareness of stereotypes and bias and avoidance of discussing cultural issues. There were few differences in racial microaggression frequency or impact based on client race/ethnicity and counselor race/ethnicity. Racially matched clients viewed racial microaggressions as more impactful than did clients who were not racially matched. Client-perceived cultural humility of the counselor was associated with fewer microaggressions experienced in counseling. We conclude by discussing limitations, areas for future research, and implications for counseling.

Thankful for the little things: A meta-analysis of gratitude interventions.

A recent qualitative review by Wood, Froh, and Geraghty (2010) cast doubt on the efficacy of gratitude interventions, suggesting the need to carefully attend to the quality of comparison groups. Accordingly, in a series of meta-analyses, we evaluate the efficacy of gratitude interventions (ks = 4-18; Ns = 395-1,755) relative to a measurement-only control or an alternative-activity condition across 3 outcomes (i.e., gratitude, anxiety, psychological well-being). Gratitude interventions outperformed a measurement-only control on measures of psychological well-being (d = .31, 95% confidence interval [CI = .04, .58]; k = 5) but not gratitude (d = .20; 95% CI [-.04, .44]; k = 4). Gratitude interventions outperformed an alternative-activity condition on measures of gratitude (d = .46, 95% CI [.27, .64]; k = 15) and psychological well-being (d = .17, 95% CI [.09, .24]; k = 20) but not anxiety (d = .11, 95% CI [-.08, .31]; k = 5). More-detailed subdivision was possible on studies with outcomes assessing psychological well-being. Among these, gratitude interventions outperformed an activity-matched comparison (d = .14; 95% CI [.01, .27]; k = 18). Gratitude interventions performed as well as, but not better than, a psychologically active comparison (d = -.03, 95% CI [-.13, .07]; k = 9). On the basis of these findings, we summarize the current state of the literature and make suggestions for future applied research on gratitude. (PsycINFO Database Record

Cultural Humility and Hospital Safety Culture.

Hospital safety culture is an integral part of providing high quality care for patients, as well as promoting a safe and healthy environment for healthcare workers. In this article, we explore the extent to which cultural humility, which involves openness to cultural diverse individuals and groups, is related to hospital safety culture. A sample of 2011 hospital employees from four hospitals completed measures of organizational cultural humility and hospital safety culture. Higher perceptions of organizational cultural humility were associated with higher levels of general perceptions of hospital safety, as well as more positive ratings on non-punitive response to error (i.e., mistakes of staff are not held against them), handoffs and transitions, and organizational learning. The cultural humility of one's organization may be an important factor to help improve hospital safety culture. We conclude by discussing potential directions for future research.

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.

Transgression as addiction: religiosity and moral disapproval as predictors of perceived addiction to pornography.

Perceived addiction to Internet pornography is increasingly a focus of empirical attention. The present study examined the role that religious belief and moral disapproval of pornography use play in the experience of perceived addiction to Internet pornography. Results from two studies in undergraduate samples (Study 1, N = 331; Study 2, N = 97) indicated that there was a robust positive relationship between religiosity and perceived addiction to pornography and that this relationship was mediated by moral disapproval of pornography use. These results persisted even when actual use of pornography was controlled. Furthermore, although religiosity was negatively predictive of acknowledging any pornography use, among pornography users, religiosity was unrelated to actual levels of use. A structural equation model from a web-based sample of adults (Study 3, N = 208) revealed similar results. Specifically, religiosity was robustly predictive of perceived addiction, even when relevant covariates (e.g., trait self-control, socially desirable responding, neuroticism, use of pornography) were held constant. In sum, the present study indicated that religiosity and moral disapproval of pornography use were robust predictors of perceived addiction to Internet pornography while being unrelated to actual levels of use among pornography consumers.

Making a decision to forgive.

Prominent models and interventions designed to promote forgiveness have distinguished one's decision to forgive from achieving forgiveness as an end state, but because of a lack of a strong measure, there is a weak research base on making a decision to forgive. Thus, in three studies, the authors developed the Decision to Forgive Scale (DTFS) and examined evidence for its reliability and construct validity. The article focused on distinguishing making a decision to forgive from achieved level of forgiveness. Scores on the DTFS showed evidence of reliability, with Cronbach's alpha coefficients ranging from .92 to .94, and a 1-week temporal stability coefficient of .68. Using several strategies, the authors demonstrated that the DTFS is empirically distinct from the Transgression-Related Interpersonal Motivations scale (TRIM; McCullough et al., 1998). Namely, a 3-factor confirmatory factor analysis that included the DTFS and the 2 TRIM subscales showed excellent fit, suggesting these instruments assess 3 different constructs. The DTFS was only moderately related to the TRIM subscales, was more strongly related to stage of change than the TRIM, and predicted subsequent TRIM scores in a cross-lagged model. Finally, although decisions to forgive generally suggested greater forgiveness, these constructs interacted to predict existential distress. Namely, as decisional forgiveness increased, revenge was more strongly related to existential distress. Overall, the DTFS shows considerable promise for further clinical and basic research applications.