Social support and psychotherapy outcomes for international students in university/college counseling centers.

Objective: To explore the relationship between international students' social support at intake and international student distress at end of treatment. Participants: Data was collected from participants (n = 40,085) from 90 United States universities using the Center for Collegiate Mental Health (CCMH) database. Methods: Participants completed measures of psychological distress and perceived social support. Using multilevel modeling, we predicted participants' distress at end of treatment by international student status, social support, race, and length of therapy. Results: We found that international students who reported lower social support at intake ended treatment with higher levels of psychological distress when distress at intake was controlled compared to United States peers. Conclusions: Understanding the significance of social support for international students can help to inform mental healthcare professionals' approach to psychotherapy.

Psychosociocultural correlates of mental health among Mexican American students in a Hispanic-serving institution: A conditional process analysis.

In this study, we used a psychosociocultural framework to examine whether cultural congruity was related to mental health indirectly via a sense of university belonging in a sample of 322 Mexican American undergraduates attending a Hispanic-serving institution (HSI). In line with literature on biculturalism and cultural values, we also examined whether Mexican American HSI students' adherence to the ethnic value of familismo and to White ethnoracial values jointly moderated this indirect association. Results of conditional process modeling indicated that greater cultural congruity was partially indirectly associated with greater university belonging, which, in turn, was associated with better mental health. This partial indirect effect was more pronounced among Mexican American students with higher levels of White ethnoracial values and weaker or nonsignificant among students with average or lower levels of these values, a moderation effect that persisted even at varying levels of familismo. Overall, our findings highlight the importance of examining the complex and interlocking associations among cultural congruity, university belonging, cultural values, and mental health for Mexican American students in an HSI context. Implications for theory, research, and practice are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Psychotherapy outcomes with Latinx clients attending Hispanic-serving institutions and predominantly White institutions.

In the present study, we used a large, national data set to examine psychotherapy outcomes from 9,515 Latinx clients seeking treatment in 71 college or university counseling centers in the United States, 13 of which were in Hispanic-serving institutions (HSIs) and 58 in predominantly White institutions (PWIs). We examined the hypothesis that Latinx clients in HSIs, compared to Latinx clients in PWIs, would experience greater relief in symptoms of depression, generalized anxiety, and academic distress over the course of psychotherapy. Results of multilevel modeling offered partial support for our hypothesis. Compared to their counterparts in PWIs, Latinx clients in HSIs were found to experience significantly greater relief in academic distress over the course of psychotherapy, but there were no significant differences between Latinx clients in HSIs and PWIs in terms of changes in depression or generalized anxiety over time. We offer recommendations for future research and discuss the practical implications of these findings. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Introduction to special section: Addressing racism, anti-blackness, and racial trauma in psychotherapy.

This article introduces the special section on "Addressing Racism, Anti-Blackness, and Racial Trauma in Psychotherapy." The special section was organized to highlight research and clinical practices on addressing racism, anti-Blackness, and racial trauma in psychotherapy. We provide an overview of the special section with attention to future research to continue to advance practice and scholarship on addressing racism, anti-Blackness, and racial trauma in psychotherapy. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Measurement invariance and psychometric properties of the CCAPS-62 and -34 for international student clients.

OBJECTIVES: International students attending universities in the United States may encounter psychological distress related to their adjustment and experiences studying in a new context and seek services from university counseling centers. Many centers use the Counseling Center Assessment of Psychological Symptoms (CCAPS) to measure psychological distress in college counseling centers. However, this scale has not been tested for measurement invariance with international students. Our purpose was to explore the measurement invariance of the CCAPS-62 and -34 for international students. METHODS: We tested measurement invariance for both versions of the scale using data from over 107,000 university students in psychotherapy at university counseling centers. We also examined construct validity and internal consistency. RESULTS: Invariance testing indicated the measurement models of the CCAPS-62 and -34 are equivalent between both groups. CONCLUSION: These findings are discussed in light of utilizing this widely-used scale in United States university/college counseling centers with international student clients.

"How could I not bring it up?": A multiple case study of therapists' comfort when Black clients discuss anti-Black racism in sessions.

Anti-Black racism is often overlooked in predominantly White spaces such as psychotherapy. This pervasive disregard and dehumanization reflects the perpetuation of ongoing racial trauma that can influence the psychological health of Black people seeking psychotherapy. Therapists, therefore, ought to be equipped and comfortable to have conversations about anti-Blackness and anti-Black racism in sessions, though evidence suggests they are often uncomfortable discussing race and racism in practice. To understand therapists' comfort when clients discuss anti-Black racism, we used a multiple case study approach to interview five practicing clinicians (two White, two Black, one biracial Asian and White). Within-case analysis elicited a sense of participants' personal experiences of being comfortable, and at times less so, when clients discussed having endured anti-Black racism. Cross-case analysis led to the identification of four themes: (a) Beyond Acknowledgment, (b) Drawing Personal Awareness into the Moment, (c) Engaging with One's Own Emotional Responses, and (d) I Am versus I Should: Proactive and Reactive Comfort. These findings are discussed within the scope of multicultural competence, multicultural orientation, and the value of cultural comfort when clients' discuss anti-Black racism. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

"Where have you been in this world?" a qualitative study of clients' curiosity about their psychotherapists.

Curiosity is widely seen as a basic human drive, important to the development of relationships as well as to the process of change in psychotherapy. Less attention, however, has been directed toward examining curiosity in the client-therapist relationship. In particular, we lack a comprehensive understanding of what occurs for clients when they become curious about their therapists. As a result, we aimed to explore clients' experiences of curiosity about their therapists. Using a consensual qualitative research approach, we analyzed data from ten current and former adult psychotherapy clients. Results were organized in six domains that captured different facets of participants' experiences of curiosity about their therapists: the content of the curiosity, motivation(s) for the curiosity, triggers of the curiosity, expressions of curiosity, influences on the curiosity, and consequences of the curiosity. More specifically, results revealed participants experienced curiosity that (a) concerned the therapist's professional and personal life, (b) was motivated by concerns over the therapist's ability to understand or relate, and (c) was triggered by therapist behavior (e.g., disclosures). For some participants, having a positive therapeutic relationship led to greater curiosity; by the same token, participants' desire for professional boundaries at times quelled this curiosity. Moreover, although some participants described positive relational outcomes, others disclosed feelings of shame or discomfort resulting from their curiosity. Several cultural factors were also found to influence participants' curiosity. Implications for research and practice are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Therapist and counseling center effects on international students' counseling outcome: A mixed methods study.

We employed a convergent mixed methods design to examine therapist and counseling center effects on international student clients' (ISCs) counseling outcomes. Using the Center for Collegiate Mental Health (CCMH) data set (2015-2017), we conducted a three-level hierarchical linear model with clients (N = 85,110) nested in therapists (N = 1,267), and therapists nested in counseling centers (N = 111), with clients' international status predicting distress (DI) in their last sessions while controlling for initial DI. Compared to domestic students, the average last session DI was significantly higher among ISCs. Random effects were significant, suggesting that some therapists and centers were more effective in their work with ISCs than others. When the proportion of ISCs seen was accounted into the model, we found a cross-level interaction in which the last session DI differences between ISCs and domestic students were significant for centers seeing a small percentage of ISCs but not for centers with large percentages of ISCs in the caseload. Grounded theory analysis of qualitative data from 11 therapists with international backgrounds revealed therapist and center factors that converged with our quantitative findings. Participants reported adhering to general clinical frameworks when working with ISCs given the lack of training on international competence (which may help explain the effectiveness gap), but also noted nuanced culturally-informed components that likely contribute to more effectively working with ISCs. Findings around center effects were complemented by qualitative results emphasizing systemic representation and engagement with diversity, creative outreach efforts, and administrative/leadership support. Implications for practice and research are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Center effects, therapist effects, and international student clients' drop out from psychotherapy.

In 2019-2020, 1,075,496 international students pursued higher education in the United States. Many of these students endure unique experiences of psychological distress that accompanies their shared experience of studying abroad in the United States. Researchers have explored clinical experiences within this diverse group, with some suggesting that international students are at greater risk than students from the United States for dropping out of psychotherapy. This issue is underexplored in the extant psychotherapy literature. Therefore, we used a large, national data set and multilevel analyses to test if international students are more likely than students from the United States to drop out of psychotherapy, defined in this study as failure to attend one's last scheduled session. Data from 65,293 clients (n = 3,970 international students), 2,735 therapists, and 131 university/college counseling centers were included in the analysis. Results revealed that (a) international students are no more likely to drop out than United States domestic students, (b) on average, centers (ICC = 0.045) and therapists (ICC = 0.071) are differentially effective at preventing drop out, and (c) therapist effects on drop out differ for international students. We discuss these findings with respect to therapist and center roles in international students' drop out from treatment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Do birds of a feather flock together? Clients' perceived personality similarity, real relationship, and treatment progress.

In the present study, we examined whether clients' perceptions of similarity to their therapists in terms of the Big Five personality traits were associated with the real relationship and, indirectly through the real relationship, to treatment progress. Data collected through an online crowdsource platform from 212 adult clients in individual psychotherapy were analyzed using polynomial regression and response surface analysis. Results indicated that clients who perceived greater similarity to their therapists at higher (vs. lower) levels of Conscientiousness and Openness to Experience reported stronger real relationships, as did clients who perceived greater similarity at lower (vs. higher) levels of Neuroticism. Similarly, clients reported a stronger real relationship when they perceived their therapists as similarly high in Extraversion, but the real relationship decreased slightly when the similarity was perceived at higher (vs. moderate) levels of this trait. Perceived similarity at high and low levels of Agreeableness was also associated with stronger real relationships. There was no evidence of an indirect association between client-perceived similarity and treatment progress via the real relationship. However, clients who perceived greater similarity to their therapists at higher (vs. lower) levels of Openness to Experiences and Conscientiousness reported more progress in treatment. Implications for theory, research, and practice are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Therapists' cultural comfort and clients' distress: An initial exploration.

The extent to which therapists are comfortable discussing clients' cultural identities in psychotherapy has been considered a valuable component of how therapists integrate clients' cultures into treatment. Cultural comfort specifically reflects a therapist's way of being at ease, relaxed, and open when discussing clients' cultural identities in treatment. Some initial research has demonstrated the relationships between cultural comfort and clinical outcomes, yet this work has relied largely on cross-sectional designs. The purpose of this preliminary study was to use longitudinal psychotherapy data to explore the relationships between clients' perceptions of their therapists' cultural comfort and clients' distress over the course of psychotherapy. Data were collected from 48 clients who attended 476 sessions in a doctoral training clinic. Multilevel modeling was used to account for the nested nature of the data. Results showed that, when session number was held constant, within-client increases in their perceptions of their therapists' cultural comfort were predictive of decreases in psychological distress. We discuss these findings in light of the multicultural orientation literature and with respect to the implications for therapists striving to be comfortable with culture in sessions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

"Alguien abrió la puerta:" The phenomenology of bilingual Latinx clients' use of Spanish and English in psychotherapy.

There has been a growing recognition of the role that various aspects of culture play in the theory and practice of psychotherapy. One aspect of culture that has received little attention, however, is language. Specifically, we lack comprehensive understanding of the value bilingual clients find in expressing thoughts, feelings, and experiences in two languages. Research that enhances understanding of the role that bilingualism plays in psychotherapy may thus help improve the quality of services that bilingual clients receive. To this end, we interviewed eight bilingual Latinx people (seven of Mexican descent and one Puerto Rican) between the ages of 20 and 37 about their experience using Spanish and English in psychotherapy. Using descriptive phenomenological analysis, we identified and interpreted 250 meaning units that were grouped into five overarching themes: (a) Enhancing Expression and Understanding, (b) An Affirming Experience, (c) Facilitating Therapeutic Processes, (d) Utility of a Therapist Bilingual Orientation, and (e) Strengthening the Therapeutic Relationship. Findings speak to the value for bilingual Latinx clients of being able to use both of their languages in psychotherapy. Implications for multicultural psychotherapy research and practice are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Development and initial validation of the Therapist Cultural Comfort Scale.

The development and initial validation of a client-rated measure of therapist cultural comfort (the Therapist Cultural Comfort Scale [TCCS]) is reported. The first phase of the study involved content validation of the initial pool of items via consultation with (a) focus groups of doctoral student therapists and (b) experts in the field of multicultural counseling and psychotherapy. A 56-item pool generated during this phase, together with instruments used to gauge convergent and incremental validity, were administered to a community adult sample of current psychotherapy clients (N = 889). Exploratory factor analysis suggested 2 subscales representing negative and positive indicators of therapist cultural comfort. Item response theory principles guided final selection of subscale items. Analyses suggested good factor stability and reliability of the 13-item TCCS as well as strong measurement invariance across racial/ethnic minority status and gender. Total and subscale scores related as expected with other measures of multicultural constructs (cultural humility, missed cultural opportunities, and multicultural competencies). Generally, TCCS total and subscale scores also predicted working alliance and treatment progress above and beyond the effects of therapist general comfort. There were few differences in clients' perceptions of therapist cultural comfort based on client demographic characteristics. Implications for research and practice are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Pretreatment counseling experiences, stressors, and support differences between transgender and cisgender university students seeking mental healthcare.

OBJECTIVES: Our aim was to explore rates of prior counseling experiences as well as pretreatment stressors and supports among transgender university students seeking psychotherapy services in university counseling centers. METHODS: We used regression models to explore relationships between gender identity and prior mental health experiences, risk-related experiences, traumatic experiences, and support among clients (cisgender: n = 162,305; transgender: n = 545) seeking treatment at 136 university counseling centers. RESULTS: Results demonstrate more previous mental health service utilization and greater frequency of some prior stressors transgender clients. Findings indicate the odds of transgender clients reporting drug and alcohol concerns are lower than the reference group. Additionally, transgender clients report less familial support but more social support than cisgender clients. CONCLUSION: We discuss the importance of these findings through a more holistic lens that recognizes both stressors as well as positive factors that may more accurately characterize the experiences of transgender clients.

Presenting concerns in counseling centers: The view from clinicians on the ground.

Despite growing evidence that a greater number of students are seeking counseling in college and university counseling centers throughout the United States, there is a dearth of empirical information about (a) the presenting concerns for which students seek treatment and (b) how these concerns differ according to client demographic factors. The purpose of this descriptive and exploratory study was to explore how counseling center clinicians categorize client presenting concerns, and how these concerns vary according to client demographics. Given the importance of client suicide within the field of college counseling, the frequency of suicidality as an identified presenting concern was also explored. A sample of 1,308 clinicians from 84 counseling centers rated the presenting concerns of 53,194 clients using the Clinician Index of Client Concerns (CLICC) after an initial consultation. Results of descriptive and nonparametric analyses indicated that the most prevalent concerns were anxiety, depression, stress, family, and academic performance, and that clients who belong to different demographic groups frequently present to counseling with broadly similar types of concerns. Furthermore, suicidality represented an area of concern for 8.4% of all clients, and it ranked 20 of 44 as a clinician-rated concern. Comparable rates emerged across the range of client demographic groups examined, although rates were notably higher for a handful of groups. The findings offer one of the largest and most generalizable descriptions of why college students seek counseling services, as determined by clinicians' evaluations of presenting concerns. Implications for research and clinical applications of the findings are discussed. (PsycINFO Database Record

The development and initial validation of the Countertransference Management Scale.

Countertransference is an important aspect of the therapeutic relationship that exists in therapies of all theoretical orientations, and depending on how it is managed, it can either help or hinder treatment. Management of countertransference has been measured almost exclusively with the Countertransference Factors Inventory (Van Wagoner, Gelso, Hayes, & Diemer, 1991) and its variations, all of which focus on 5 therapist qualities theorized to facilitate management: self-insight, conceptualizing ability, empathy, self-integration, and anxiety management. Existing versions of the Countertransference Factors Inventory, however, possess certain psychometric limitations that appear to constrain how well they assess actual management of countertransference during a therapy session. We thus sought to develop a new measure that addressed these limitations and that captured the 5 therapist qualities as constituents (rather than correlates) of countertransference management that manifest in the treatment hour. The development and initial validation of the resulting 22-item Countertransference Management Scale (CMS) is described here. Exploratory factor analysis of ratings of 286 therapy supervisors of current supervisees indicated that the 5 constituents of countertransference management could be grouped into 2 correlated factors: "Understanding Self and Client" and "Self-Integration and Regulation." Evidence of convergent and criterion-related validity was supported by CMS total and subscale scores correlating as expected with measures of theoretically relevant constructs, namely, therapist countertransference behavior, theoretical framework, self-esteem, observing ego, empathic understanding, and tolerance of anxiety. Results also supported the internal consistency of the CMS and its subscales. Research, clinical, and training implications are discussed. (PsycINFO Database Record

Love and sexuality in the therapeutic relationship.

We examine sexual and loving feelings, on the part of both the therapist and patient, as they relate to their real relationship, patient transference, and therapist countertransference. Loving feelings (agape) often are part of a strong real relationship and they tend to have a positive effect. Sexual feelings, too, may be part of the real relationship, but they are also often more conflict-based, residing in the transference and countertransference experience. It is deeply important for the therapist to seek understanding of his or her own and the patient's loving and sexual feelings, and to tease apart, as much as possible, the extent to which they are real relationship versus transference-countertransference-based. The patient's loving and sexual feelings toward the therapist need to be explored and understood just as other feelings. Although it is crucial that the therapist seek understanding of his or her own loving and sexual feelings toward the patient, we express serious reservations about the therapeutic value of sharing these with the patient.