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).