Asian international psychotherapist's experiences of client's microaggression in therapy.

Much of the multicultural counseling literature focuses on how White or U.S.-born therapists can work effectively with clients of color. However, with the increasing number of racial minority and international therapists and trainees, there is a need to expand the multicultural counseling literature to acknowledge and center the experiences of therapists and trainees of color, particularly the experiences of Asian international therapists. Specifically, a greater understanding and guidelines are needed regarding how Asian international therapists handle clients' xenophobia, racism, and microaggressions in therapy. This qualitative study interviewed 11 licensed practicing Asian international psychotherapists within the United States about their experiences of client-initiated microaggressions in therapy. Consensual qualitative research was used to analyze interview data. Results indicated four domains pertaining to Asian international psychotherapists' experiences in therapy: xenophobia, microaggression, impact, and strategy. Participants reported complex negative impacts of xenophobia and microaggressions on their well-being as well as the therapeutic relationship and treatment outcomes. Additionally, participants identified the difficulty and complexity of addressing client-initiated microaggressions in session. Implications for training and practice as well as suggestions for future research are provided. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Identity salience: An intersectional approach to understanding multicultural processes and outcomes in psychotherapy.

A growing body of research has demonstrated the importance of therapists' multicultural orientation (MCO), namely, their cultural humility (CH), cultural comfort, and cultural missed opportunities, on treatment processes and outcomes (Davis et al., 2018). However, to date, few research has attempted to identify client factors that may moderate the relationship between therapists' MCO and therapeutic processes and outcomes. Informed by Yakushko et al.'s (2009) identity salience model, this study seeks to advance the MCO literature by examining the saliency of clients' cultural identities, therapists' MCO, and improvement in therapy. Data for this study consisted of 193 individuals who had received at least five sessions of psychotherapy in the last 6 months and responded to an online survey about their experience in therapy. Moderated polynomial regression and response surface analysis was used to examine if the relationship between therapists' MCO and clients' perceived improvement in psychotherapy differed as a function of the salience of clients' first and second most important cultural identities. The results indicated that when clients report only one highly salient cultural identity and perceive their therapist high in cultural humility, they report high levels of improvement. In contrast, when clients reported two highly salient identities, cultural humility and improvement in therapy were not significantly related. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Psychotherapy alone versus collaborative psychotherapy and psychiatric care in the treatment of depression and anxiety in patients with cancer: A naturalistic, observational study.

OBJECTIVE: At present, there is a paucity of naturalistic studies directly comparing the effectiveness of psychotherapy alone versus collaborative psychotherapy and psychiatric care in the management of depression and anxiety in patients with cancer. This study tested the hypothesis that collaborative psychiatric and psychological care would lead to greater reductions in depression and anxiety symptoms in patients with cancer compared with psychotherapy alone. METHODS: We analyzed treatment outcomes of 433 adult patients with cancer, of which 252 patients received psychotherapy alone and 181 patients received collaborative psychotherapy and psychiatric care. Longitudinal changes in depressive (i.e., PHQ-9) and anxiety symptoms (GAD-7) were examined between groups using latent growth curve modeling. RESULTS: After controlling for treatment length and psychotherapy provider effects, results indicated collaborative care was more effective than psychotherapy alone for depressive symptoms (γ12 = -0.13, p = 0.037). The simple slope for collaborative care was -0.25 (p = 0.022) and the simple slope for psychotherapy alone was -0.13 (p = 0.006), suggesting collaborative care resulted in greater reductions in depressive symptoms compared with psychotherapy alone. In contrast, there were no significant differences between psychotherapy alone and collaborative psychotherapy and psychiatric care in reducing anxiety symptoms (γ12 = -0.08, p = 0.158). CONCLUSIONS: Collaborative psychotherapy and psychiatric care may individually address unique aspects of mental health conditions in patients with cancer, namely depressive symptoms. Mental healthcare efforts may benefit from implementing collaborative care models where patients receive psychiatric services and psychotherapy to effectively address depressive symptoms in the treatment of this patient population.

Meditation, mindfulness, and acceptance methods in psychotherapy: A systematic review.

OBJECTIVE: : Meditation, mindfulness, and acceptance (MMA) methods have gained popularity among psychotherapists and the public. The impact of these strategies as implemented in treatment packages (e.g., mindfulness-based interventions) has been studied extensively. However, the impact of integrating MMA strategies into individual psychotherapy has not been established. METHODS: : To address this gap in the literature, we conducted a systematic review of empirical (quantitative or qualitative) studies investigating the use of MMA methods during individual psychotherapy in adult samples. RESULTS: : After reviewing 4671 references, only three studies (one quantitative, two qualitative) met our inclusion criteria. The one experimental study (n = 162) provided no evidence that including mindfulness meditation improved outcomes beyond other active interventions (ds = 0.00-0.12 for effects on general clinical symptoms vs. progressive muscle relaxation and treatment-as-usual, respectively). Two qualitative studies (n = 5 therapist-patient dyads in one study, n = 9 adults in one study) provided preliminary evidence that patients may find MMA methods helpful. CONCLUSIONS: : We highlight future directions for work in this area, including clarifying optimal dosage and timing, identifying patient characteristics associated with beneficial or adverse effects, investigating cultural adaptations, and clarifying how MMA constructs can be measured within individual psychotherapy. We conclude by highlighting training recommendations and therapeutic practices.

Decentering the use of police: An abolitionist approach to safety planning in psychotherapy.

The dominant narrative in much of the world, but especially the West, is that public safety and security are provided by policing. Psychotherapy invests in this dominant narrative via its reliance on emergency services provided by the state, such as 911 and police, to pursue the safety of clients and the larger society. However, the long-documented history of oppressive systems of policing suggest that these dominant narratives operate to protect powerful groups while surveilling and policing marginalized people, but particularly Black and Brown communities. As such, critical and abolitionist movements have rejected the idea that policing provides safety and have sought out alternative methods for ensuring community wellness and safety. Although the field of psychology has broadly expressed interest in growing its critical lens and interrupting systems of power, very little has directly addressed how carceral logics influence psychotherapy practice, and how this influences the client's sense of safety in therapy. This manuscript argues for an abolitionist approach to informed consent and safety planning in psychotherapy to address the disparate ways that clients, and especially marginalized clients such as Black and Brown people, experience psychotherapy's traditional use of systems of policing and state authority. Clinical illustrations are provided and future directions are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Changes in group counseling engagement and conflict and growth in emotional cultivation for children and adolescents.

Group climate is an important factor in group counseling and psychotherapy process and outcome research. The current investigation examined group climate changes (from early to late sessions) at the within-group (i.e., group members) and between-group (i.e., group-as-a-whole) levels in predicting changes in group members' emotional cultivation in group counseling. A total of 236 Taiwanese children and adolescents across 41 groups participated in this study. Members' ratings of group climate (i.e., engagement and conflict) were partitioned into within-group and between-group components, and polynomial regression with response surface analysis was used to examine the association between changes in group engagement and conflict (at the member- and group-level) from early to late group sessions on changes in emotional cultivation. Results supported the theoretical hypothesis that when a group-as-a-whole reported increasing engagement from early to late group sessions, relative to other groups (i.e., between-group effect), members of that group experienced greater growth in emotional cultivation. Results also indicated that group members reported greater growth in emotional cultivation when there was consistent and high engagement or consistent and low conflict from early to late group sessions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The relationship between clients' expectation of therapist support and challenge and treatment outcome: A response surface analysis.

Clients' expectations of treatment have long been posited as an important therapeutic factor in treatment success. Decades of research and meta-analytic findings have supported the notion that client expectations about what will happen over the course of therapy and how beneficial therapy will be are directly related to treatment factors, such as the working alliance and treatment outcome. Client expectations can be categorized into two broad categories, outcome expectations (i.e., how beneficial treatment will be) and treatment expectations (i.e., what will happen in treatment). This study sought to examine clients' treatment expectations, specifically, their role expectations, which represent their beliefs of how their therapists will act in session. Data for this study included 1,233 clients participating in individual counseling with 49 therapists at a university counseling center. Multilevel polynomial regression and response surface analysis were used to test congruent and discrepant effects of clients' pretreatment support and challenge expectancy on reductions in their psychological distress over the course of treatment. Results indicated that reductions in clients' psychological distress were the greatest when their support and challenge expectancy scores were congruent and high. In other words, clients who expected both high challenge and high support from their therapist, prior to the start of counseling, reported the greatest improvement in counseling. Clients similarly reported reductions in their psychological distress when their support and challenge expectations were congruent and low, although this effect was smaller than when they expected high levels of both support and challenge. Together, these findings suggest that when clients' expectations of support and challenge are similar, they fare better in treatment, as opposed to when they expect a greater amount of support than challenge or vice versa. (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).

Does person-group fit matter? A further examination of hope and belongingness in academic enhancement groups.

Efforts have been made to support the academic success and address the retention of low academically performing college students; however, little is known about how these interventions are effective. This study builds upon recent findings that the hope and belongingness of college students in a group-based academic enhancement intervention were important factors in their academic success. Applying person-environment fit theory, this study assessed changes in an individual's hope and belongingness, changes in the group's hope and belongingness, and the interaction between changes in both an individual's hope and belongingness and the group's hope and belongingness (i.e., person-group fit) on the academic outcomes of 145 college students participating in 11 academic enhancement seminars. Results indicated that changes in a student's hope and belongingness were positively associated with changes in their academic self-efficacy, but not their academic performance, as measured by grade point average (GPA). However, the changes in the group's hope and belongingness moderated the relationship between students' changes in hope and belongingness and their academic performance, such that these relationships were stronger when the student fit with their group in regard to their perceived changes in hope and belongingness (i.e., high individual-high group change). This study provides further support for the importance of instilling hope and a sense of belongingness in students within academic enhancement groups, and the complex influence of group-level processes within these interventions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The role of mental health counseling in college students' academic success: An interrupted time series analysis.

Retention remains a problem for postsecondary institutions and college students. To address these issues, researchers have sought to identify factors of college success and retention. Findings have consistently shown the importance of psychosocial factors and mental health on college students' academic success. As such, university and college counseling centers are well positioned to enhance students' academic success by addressing psychosocial distress. However, existing literature on the effect of counseling on college students' academic success is mixed, and limitations exist. To address previous limitations of the literature, this study utilized an interrupted time series design to examine differences in students' postcounseling academic success compared to their precounseling academic success. Additionally, we examined the association between changes in students' psychological distress and academic distress for students who endorsed clinical distress at the onset of counseling and changes in their grade point average (GPA) over time. Data for this study consisted of 1,231 clients seen by 49 therapists at a university counseling center. As hypothesized, students' GPAs increased at a greater rate postcounseling compared to precounseling. Additionally, for students who were clinically distressed at the onset of counseling, reductions in their psychological distress were associated with positive changes in their GPA over time, but the relationship between changes in their academic distress and changes in their GPA was not significant. This study suggests that counseling can be beneficial for college students' academic success, in part due to changes in students' psychological distress, but not their academic distress, specifically for clinically distressed students. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Examining racial microaggressions in group therapy and the buffering role of members' perceptions of their group's multicultural orientation.

Microaggressions have been found to occur at high rates within individual therapeutic dyads, and negatively impact therapeutic processes and outcomes for clients. However, there has been limited attention to the occurrence and impact of racial microaggressions in a group therapy context. Therefore, this study sought to examine the occurrence and impact of racial microaggressions on clients' perceptions of group cohesion and improvement in group therapy, as well as the buffering role of members' perceptions of their group's multicultural orientation (MCO) on the impact of racial microaggressions. Data for this study consisted of 71 racial/ethnic minority (REM) clients across 38 interpersonal process therapy groups. Results indicated that 72% of participants reported experiencing at least 1 racial microaggression over the course of their group therapy experience. Contrary to our hypothesis, racial microaggressions were not associated with member's perceptions of group cohesion or improvement. However, results indicated that REM members' experiences of racial microaggressions had a stronger negative effect on their perceptions of group cohesion in groups with perceived low cultural comfort. This study documents the high prevalence of racial microaggressions in group therapy and the effect of the group's MCO on the relationship between racial microaggressions and REM members' perceptions of group cohesion. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Attending to the intersectionality and saliency of clients' identities: A further investigation of therapists' multicultural orientation.

Psychotherapy clients often hold multiple and varied cultural identities, and it is important for therapists to attend to the intersectionality of clients' cultural identities, as well as the saliency of these identities. However, to date, few studies have considered the saliency of clients' multiple identities and how this may impact clients' perceptions of cultural processes in therapy. Therefore, this study utilized polynomial regression and response surface analysis to operationalize and examine congruent and discrepant effects between the saliency of clients' multiple identities and their perceptions of their therapists' cultural humility and cultural missed opportunities. Data for this study consisted of 87 clients who received individual counseling services at either a university counseling center or training clinic at two large universities in the United States. As hypothesized, results indicated significant discrepant effects between the saliency of clients' first and second most important cultural identities and perceptions of their therapists' cultural humility and cultural missed opportunities. Specifically, clients' ratings of their therapist's cultural missed opportunities were lowest when they reported either a) high saliency of cultural identity one and low saliency of cultural identity two, or b) low saliency of cultural identity one and high saliency of cultural identity two. Similarly, clients' ratings of their therapist's cultural humility were highest when they reported either a) high saliency of cultural identity one and low saliency of cultural identity two, or b) low saliency of cultural identity one and high saliency of cultural identity two. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Deliberate practice for the skill of immediacy: A multiple case study of doctoral student therapists and clients.

We examined the effects of deliberate practice training focused on immediacy (Im) for 7 doctoral student trainees. Training included an 8-hr workshop, 4 individual 50-min sessions, and 4 individual 30-min homework sessions. Qualitative results indicated that trainees found the deliberate practice training to be effective, especially in helping them become aware of and manage emotions and countertransference, which had inhibited them from using Im. In addition, there was a moderate and significant effect of training on the trainee's self-efficacy for using Im, a small and significant effect on therapist-rated working alliance, and no significant effect for client-rated working alliance. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Is there an optimal level of positive and negative feedback in group therapy? A response surface analysis.

Interpersonal feedback is an important process in group therapy. Feedback can be both positive and negative, and group researchers have noted the importance of both positive and negative feedback in fostering cohesive groups and evoking behavioral change (Yalom & Leszcz, 2005). However, there is a paucity of research examining the amount and valence (i.e., positive and negative) of interpersonal feedback on group therapy process and outcomes. Therefore, this study tested the proposition that congruent and high levels of members' perceptions of positive and negative feedback was optimal for member's perceptions of cohesion and improvement in group therapy. Data for this study consisted of 168 members across 43 interpersonal process therapy groups. Polynomial regression and response surface analysis revealed that members' perceptions of congruent and high levels of positive and negative interpersonal feedback were positively associated with members' perceptions of group cohesion and improvement. In addition, members' perceptions of discrepant high positive feedback and low negative feedback were positively associated with members' perceptions of group cohesion and improvement. These findings suggest that members' perceptions of balanced and high amounts of positive and negative feedback, as well as discrepant high positive feedback and low negative feedback, are optimal in group therapy. Group leaders should attend to the amount and proportion of positive and negative member-member feedback in therapy groups to enhance the clinical benefit of these services. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Does the group in group psychotherapy matter? A meta-analysis of the intraclass correlation coefficient in group treatment research.

OBJECTIVE: Over the last 3 decades, group treatment researchers have become increasingly knowledgeable of the impact of within-group dependency on analyses of group treatment data and of mutual influence processes that occur within therapy groups. Despite these advancements, there remains a lack of consensus on the magnitude of mutual influence, or group effects, in group treatment research. As such, this study sought to estimate the size of group effects on members' posttreatment outcomes by meta-analyzing the intraclass correlation coefficients (ICCs) in group treatment research. In addition, we tested several moderators of the ICC, including outcome type, outcome reactivity, outcome specificity, group format, treatment length, and group size. METHOD: Using robust variance estimations, we meta-analyzed 169 effect sizes from 37 group treatment studies. RESULTS: Findings indicated an average ICC of 0.06. Group size, group format, treatment length, outcome specificity, and outcome type did not significantly moderate the ICC; however, we did find evidence to suggest that the ICC varies as a function of outcome reactivity, with observer-rated outcome measures resulting in the largest ICC. CONCLUSION: These findings suggest that interdependence in group treatment research is an important concept both theoretically and statistically. (PsycINFO Database Record (c) 2020 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).

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).

A further investigation of the good-enough level model across outcome domains and termination status.

Accurate estimations of progress in psychotherapy are necessary for therapists to identify clients at risk of deterioration and potentially reduce premature terminations. This need has resulted in a large body of literature examining the rate and trajectory of change in psychotherapy; however, few studies have tested these dose-response relationships outside of global measures of mental health. Moreover, there is a paucity of research examining the relationship between progress in treatment, treatment length, and premature termination. In this study, we conducted multivariate multilevel analyses to test the good-enough level model across the three domains of the phase model of psychotherapy: psychological symptoms, life functioning, and well-being. In addition, we tested changes in well-being, psychological symptoms, and life functioning, treatment length, and an interaction between treatment progress and treatment length as predictors of premature termination. Data for this study consisted of 438 clients who were treated by 57 therapists within a brief therapy model. Results failed to support the good-enough level model for changes in well-being, psychological symptoms, and life functioning, such that the rate of change across all three scales did not significantly vary as a function of treatment length. However, exploratory analyses revealed a significant interaction effect between changes in well-being, treatment length, and premature termination, indicating that clients who experienced high rates of change in well-being early in treatment were more likely to prematurely terminate treatment. Clinical implications and future research are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Different strokes for different folks: Examining additive and complimentary effects of the advisory working alliance and research team cohesion on trainees' research outcomes.

A primary task of scientific and scientist-practitioner training programs is to assist graduate students in acquiring research skills and, ultimately, developing research and scientific acumen. Informed by Gelso's (1979) model of effective research training environments (RTEs), we assessed the effect of the advisory working alliance and research team cohesion on trainees' research self-efficacy and research activity. With a sample of 76 counseling psychology doctoral trainees nested within 34 advisors, we examined the association between the advisory working alliance and research team cohesion and trainees' research self-efficacy and research activity. Next, we used polynomial regression and response surface analysis to test the additive and complementary effects between the advisory working alliance and research team cohesion on trainees' research self-efficacy and research activity. Univariate analyses indicated that the advisory working alliance and research team cohesion were positively associated with trainees' research self-efficacy and research activity. Moreover, polynomial regression models and response surface analyses indicated an additive effect between the advisory working alliance and research team cohesion on trainees' research self-efficacy and research activity, such that trainees' research self-efficacy and research activity were highest when the advisory working alliance and research team cohesion were consistent and high. Lastly, we found a complementary effect between the advisory working alliance and research team cohesion for trainees' research self-efficacy, meaning research self-efficacy was highest when students perceived either (a) high advisory working alliance and low research team cohesion or (b) low advisory working alliance and high research team cohesion. Training implications and future directions are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Examining therapist effects in relation to clients' race-ethnicity and gender: An intersectionality approach.

Women and Men of Color experience racism in unique and complex ways, just as White Women and Women of Color experience unique forms of sexism (i.e., gendered racism). Traditional analyses of therapists' cultural competence, broadly defined, have yet to examine the effect of intersectionality on the processes and outcomes of psychotherapy. Although previous research suggests that therapists differ in their effectiveness with Racial-Ethnic Minority (REM) clients, no study has examined therapist effects in terms of the intersectionality of clients' race-ethnicity and gender. This study applied an intersectionality framework to test therapist effects due to clients' race-ethnicity and gender. Data for this study consisted of 415 clients treated by 16 therapists. Results indicated that therapists differed in their ability to produce changes in symptom-defined psychological distress as a function of clients' intersecting identities of race-ethnicity and gender. Clinical implications and future research are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).