Impact of racial microaggressions in psychotherapy vignettes with african american clients: An experimental analogue design.

Mental health researchers have focused on promoting culturally sensitive clinical care (Herman et al., 2007; Whaley & Davis, 2007), emphasizing the need to understand how biases may impact client well-being. Clients report that their therapists commit racial microaggressions-subtle, sometimes unintentional, racial slights-during treatment (Owen et al., 2014). Yet, existing studies often rely on retrospective evaluations of clients and cannot establish the causal impact of varying ambiguity of microaggressions on clients. This study uses an experimental analogue design to examine offensiveness, emotional reactions, and evaluations of the interaction across three distinct levels of microaggression statements: subtle, moderate, and overt. We recruited 158 adult African American participants and randomly assigned them to watch a brief counseling vignette. We found significant differences between the control and three microaggression statements on all outcome variables. We did not find significant differences between the microaggression conditions. This study, in conjunction with previous correlational research, highlights the detrimental impact of microaggressions within psychotherapy, regardless of racially explicit content. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

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).

Determining the therapist's contribution in therapist multicultural competence process and outcome.

Efforts to help therapists improve their multicultural competence (MCC) rely on measures that can distinguish between different levels of competence. MCC is often assessed by asking clients to rate their experiences with their therapists. However, differences in client ratings of therapist MCC do not necessarily provide information about the relative performance of therapists and can be influenced by other factors including the client's own characteristics. In this study, we used a repeated measures design of 8,497 observations from 1,458 clients across 35 therapists to clarify the proportion of variability in MCC ratings attributed to the therapist versus the client and better understand the extent that an MCC measure detects therapist differences. Overall, we found that a small amount of variability in MCC ratings was attributed to the therapist (2%) and substantial amount attributed to the client (70%). These findings suggest that our measure of MCC primarily detected differences at the client level versus therapist level, indicating that therapist MCC scores were largely dependent on the client. Clinical implications and recommendations for future MCC research and measurement are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Construction and validation of the Multicultural Orientation Inventory-Group Version.

Given the continued racial/ethnic diversification of the United States, it is not uncommon for therapy groups to consist of members with diverse racial/ethnic backgrounds and various cultural identities. Scholars have underscored how this cultural diversity can directly impact many processes and outcomes of group-based interventions (Chen, Kakkad, & Balzano, 2008). However, there is presently a paucity of empirical research testing the relationship between cultural processes of therapy groups and members' outcomes. Moreover, no psychometrically sound measure of the cultural process that unfolds in group therapy currently exists. As such, this study sought to adapt the Multicultural Orientation Inventory to develop and validate the Multicultural Orientation Inventory-Group Version (MCO-G), a measure assessing the cultural humility, cultural comfort, and cultural missed opportunities in therapy groups. Data for this validation study consisted of 208 members of 49 therapy groups across 10 university counseling centers. Confirmatory factor analyses supported a 3-factor structure of the MCO-G Inventory, wherein the 3 factors corresponded with the underlying constructs of cultural humility, cultural comfort, and cultural missed opportunities. This study provides initial evidence for the estimated internal and convergent validity of the MCO-G, as measured by clients' perceptions of a higher-order group therapeutic factor and improvement in therapy. Results provide initial support for the psychometric properties of the MCO-G. Moreover, groups' cultural humility and cultural missed opportunities were related to members' improvement in therapy. Clinical implications and future research are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The detrimental effect of fragile groups: Examining the role of cultural comfort for group therapy members of color.

Scholars have underscored the importance of cultural processes within therapy groups, but there is a paucity of empirical research on this topic. Recently, the multicultural orientation framework was applied to group therapy to address this limitation and empirically test the role of cultural comfort, cultural humility, and cultural opportunities in a group context. Despite this advancement, a more nuanced understanding of the differential effects of cultural processes based on group members' race/ethnicity status is needed. Informed by theory and research on White fragility, this study sought to test the differential relationship between cultural comfort and cultural concealment, as well as cultural comfort and improvement, for 97 Racial-Ethnic Minority (REM) and 109 White members of 49 therapy groups. As hypothesized, REM status significantly moderated the association between cultural comfort and clients' cultural concealment and improvement, such that cultural comfort was negatively associated with cultural concealment and positively associated with improvement in group therapy for REM clients but not White clients. Results and implications are discussed within a fragility framework. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Cultural concealment and therapy outcomes.

Therapy is predicated on the need for clients to share intimate details about their lives, including their cultural values, attitudes, and beliefs. Previous studies have found that clients conceal certain aspects of their lives including, but not limited to their symptoms and their feelings about the therapy process. To date, there has not been an investigation focused on whether clients conceal aspects of their cultural identities, whether some therapists are more likely to have clients conceal aspects of their cultural identities, and if cultural concealment is associated with therapy outcomes. The present study attempted to do so utilizing the caseloads of 37 therapists who treated a total of 233 clients in a university counseling center setting. Client data were collected at the end of treatment utilizing the Patient's Estimate of Improvement (PEI; Hatcher & Barends, 1996), a measure that assesses client change on domains including general functioning, symptom related distress, intimate and social relationships, work or school, feelings about oneself, behavior, control of life, and tolerance for and ability to share painful feelings. Cultural concealment was assessed via 5 items regarding the amount and circumstances under which clients withheld cultural identity based information in therapy. Results indicated that within therapists' caseloads, client's ratings of cultural concealment were negatively associated with therapy outcomes. Additionally, therapists whose clients rated more cultural concealment on average had clients with worse therapy outcomes. Lastly, there was a significant contextual effect indicating that within and between therapist cultural concealment were statistically different from one another. (PsycINFO Database Record

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.

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.

Centering and decentering client disclosures: A qualitative study of therapists' responses to clients' experiences of discrimination.

Clients who are societally marginalized because of their identities may seek support from therapists to process experiences of discrimination and oppression. Therapist navigation of these cultural conversations is a crucial skill. However, there is limited research examining how therapists immediately respond to clients when they disclose experiences of discrimination. In this study, 66 participants watched two brief videos of fictitious clients disclosing experiences of covert and overt discrimination. Participants watched one of two video vignettes, with one focusing on a White lesbian woman client and another focusing on a Black woman client. After watching each video, participants were asked to respond to clients as if they were the clients' therapist. We used reflexive thematic analysis to code participant responses, which spanned three themes: (a) invalidation and decentering of client's emotions, appraisals, and experiences; (b) incongruence and avoidance of client's language around identities; and (c) empathic attunement and centering of client emotions, appraisals, and experiences. While some participant responses were interpreted as emotionally aligning with the client, other participant responses were coded as minimizing or questioning client experiences of discrimination or using language incongruent with how the client self-identified. We discuss implications for research, training, and practice in navigating conversations about discrimination with psychotherapy clients. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Windows of cultural opportunity: A thematic analysis of how cultural conversations occur in psychotherapy.

A cultural opportunity is 1 of 3 pillars within multicultural orientation framework; it is defined as a moment in therapy when aspects of a client's background emerge, which can be deeply explored to better understand the salient aspects of a client's cultural identities. Research on cultural opportunities provides evidence that clients desire cultural conversations. However, no study to date has examined what cultural opportunities sound like in therapy and how therapists and clients utilize these opportunities. Accordingly, the purpose of this study was to examine the ways in which cultural conversations emerge during the first psychotherapy session and how clients and therapists engage in these cultural conversations. Psychotherapy sessions from diverse therapist-client pairings at a university counseling center (n = 22) were analyzed using (reflexive) thematic analysis. Qualitative findings revealed 4 themes around how cultural opportunities emerge (e.g., windowpane of feeling) and 3 themes in how they are responded to (e.g., look out the same window: using client's language to explore culture). Implications for therapist training and supervision are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Susan L. Morrow (1942-2018).

Presents an obituary for Susan L. Morrow (1942-2018) Morrow was Professor Emerita in Counseling Psychology at the University of Utah, a licensed psychologist, an American Psychological Association (APA) fellow, a feminist and social justice activist, and a mentor, colleague, and friend. Born in Baton Rouge, Louisiana, on November 18, 1942, she received her Bachelor of Arts in elementary education from Concordia Teachers College before pursuing a master's degree in counseling and a doctoral degree in counseling psychology (1992) at Arizona State University. On December 22, 2018, in Salt Lake City, Utah, when Sue left this world, it stood still for many of us fortunate enough to have been in her bright, shining orbit. That orbit, especially the loving, intentional, accountable, and inclusive community that Sue and her partner, Donna Hawxhurst, built over many years, is an experience that leaves a profound impact in our field. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Toward a psychotherapy science for all: Conducting ethical and socially just research.

Much has been written in recent years regarding the integration of social justice values with psychology and psychotherapy; however, the discourse surrounding social justice perspectives related to conducting psychotherapy research is scant. Psychotherapy researchers are beholden to various professional ethical standards, laws, and policies; however, adhering to these rules and guidelines may make research ethical, but not necessarily socially or politically just. In this article, the authors build on previous work from community, feminist, positive, and multicultural psychology perspectives as well as their own experiences as psychotherapy researchers, to propose a framework for approaching psychotherapy research from an ethical and socially just position. Examples from the authors' experiences conducting psychotherapy research with incarcerated individuals, community- and school-based research with youth, and research with sexual/gender minorities are provided to illustrate theoretical principles and provide practical recommendations. Barriers to implementing such a framework to psychotherapy research, as well as strategies to manage these challenges are also discussed. In addition, the authors propose a model that can be used to develop and evaluate the social justice process and content dimensions of a research study. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Too close and too far: counseling emerging adults in a technological age.

Individuals increasingly connect with others via social media (e.g., blogs, social networking, chatrooms), a phenomenon that is likely to impact psychological well-being and development. As such, therapists play an important role in assisting their clients to identify how virtual and in-person relationships influence their sense of self, interpersonal communication, and how they engage in meaningful relationships. In this article, I describe 3 examples related to working with emerging adults that take into consideration how this population "does relationships" in this technological era. Specifically, 3 clinical exchanges illustrate ways to (a) enhance interpersonal skills, (b) develop self-awareness about emotions, and (c) gain a clearer understanding of the intersections of social identity.