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.

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).

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).

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).

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).