First do no harm: Principles of care for clients with sexual identity confusion and/or conflict.

Individuals who experience sexual identity confusion and/or conflict face unique stressors and life circumstances for which they may seek psychotherapy; however, little specific guidance exists for therapists working with clients who experience sexual identity confusion and/or conflict. To meet this need, we present a framework for therapists whose clients experience distress related to sexual identity confusion and/or conflict. We first define and describe sexual identity confusion and conflict, situating both in developmental theories of sexual identity. We then review clinical approaches that have been used historically to inform treatment with clients experiencing sexual identity confusion and/or conflict. Next, we discuss guiding ethical and clinical principles to inform such a clinical approach. Then, we provide assessment and treatment recommendations. We conclude by discussing considerations for working with clients who are diverse in gender identity, race/ethnicity, age, sexual orientation, and religious affiliation. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A culturally specific mental health and spirituality approach for African Americans facing the COVID-19 pandemic.

A series of 15-min videos were produced to provide resources to pastors in African-American communities to aid them in conveying accurate public and mental health information about COVID-19. Video presenters included trusted experts in public and mental health and pastors with considerable experience responding to the needs of the African-American community during the COVID-19 pandemic. Four culturally specific core themes to consider when providing care to African Americans who are at increased risk during the pandemic were identified: ritual disruption, negative reactions for not following public health guidelines, trauma, and culture and trust. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Cultural pathways for suicidal ideation and behaviors.

OBJECTIVE: Goals were to empirically examine cultural suicide pathways initially theorized by the cultural theory and model of suicide, by examining relationships between cultural (family conflict, minority stress, cultural suicide sanctions), general distress (depression, hopelessness), and cultural idioms of distress factors as predictors of suicidal ideation and attempts. METHOD: Path analysis examined a moderated mediation model with a community sample of 1,077 ethnic minority and/or LGBTQ adults (average age of 24.32 (SD = 10.23) ranging from 18 to 88, 299 LGBTQ, 447 Asian American, 196 Latino/a, 60 Black or African American, 8 Hawaiian or Pacific Islander, 6 Arab American, 2 Native American, 187 mixed race). RESULTS: Multiple pathways of statistical significance emerged. First, cultural life events (family conflict and minority stress) showed direct paths to ideation and attempts and indirect paths through general (depression and hopelessness) and cultural idioms of distress to ideation and attempts. The path from minority stress to ideation was entirely explained by general/cultural distress. Second, cultural suicide sanctions moderated the relationship between family conflict and ideation. Third, cultural idioms of distress was an important component of overall distress, alongside depression and hopelessness, predicting attempts and ideation. CONCLUSIONS: Findings elucidated pathways involving both general distress and cultural factors, and pathways from cultural life events to suicide constructs independent of mental illness-related factors. Findings question utilizing mental illness as a primary suicide driver, make theoretical contributions in refining the cultural theory and model of suicide, and advance understandings of roles of cultural factors in suicide research and practice. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Cultural versus classic risk and protective factors for suicide.

The current study examined the predictive value of cultural versus classic risk and protective factors for suicide in a community sample of 322 ethnic, sexual, and gender minority adults. Cultural factors played a significant and substantial role in predicting suicide attempts (explained 8% of variance in attempts and correctly classified 8.5% of attempters) over and above the classic factors of hopelessness, depression, and reason for living (which explained 17% of variance in attempts and correctly classified 14.1% of attempters). Findings suggest that cultural factors are important to include in standard suicide practice.

Relations of religion with depression and loneliness in older sexual and gender minority adults.

OBJECTIVES: High levels of religious involvement have been associated with positive mental health outcomes in older adults. This study investigated whether the effects of religion on healthy aging could generalize to older LGBTQ adults. METHODS: This study examined religious affiliation in childhood versus at present, as well as the relationships of outness to religious community and religious engagement with depression and loneliness in 102 lesbian, gay, and bisexual cisgender, transgender, and questioning adults (LGBTQ) over the age of 55. As part of a larger study, participants completed several questions and measures including: one outness to religious community item, 4 religious engagement questions, the Center for Epidemiological Studies Depression Scale, and the 8-item UCLA Loneliness Scale. RESULTS: Many older LGBTQ adults reported changes in religious affiliation from childhood to adulthood. Greater levels of outness to religious communities and lower religious engagement were related to lower levels of depression and loneliness. CONCLUSIONS: Findings suggest that outness to religious communities may be beneficial to the mental health of older LGBTQ adults. Higher levels of distress may lead to higher levels of religious engagement. CLINICAL IMPLICATIONS: Religion, especially those that are supportive of sexual minorities, may help to improve the well-being of older LGBTQ adults.

A Shortened Screener Version of the Cultural Assessment of Risk for Suicide.

The current study aimed to establish a shortened version of the Cultural Assessment of Risk for Suicide (CARS) measure that can be more widely utilized under time constraints in clinical and applied settings. Based on a sample of 485 adults, confirmatory factor analysis, bivariate correlations, and Receiver-Operating Characteristic analyses were employed to determine the most psychometrically valid shortened version. The 14-item, 8-factor CARS screener (CARS-S) evidenced high reliability, high correlation with the original full version of the CARS questionnaire, and high convergent validity with measures of other suicide-related constructs of depression, hopelessness, suicidal ideation, and lifetime suicide attempts. The suggested clinical cut-off is 38.5. The shortened CARS-S offers a time-efficient assessment of cultural suicide risk factors.

An Empirical Model and Ethnic Differences in Cultural Meanings Via Motives for Suicide.

OBJECTIVE: The importance of cultural meanings via motives for suicide - what is considered acceptable to motivate suicide - has been advocated as a key step in understanding and preventing development of suicidal behaviors. There have been limited systematic empirical attempts to establish different cultural motives ascribed to suicide across ethnic groups. METHOD: We used a mixed methods approach and grounded theory methodology to guide the analysis of qualitative data querying for meanings via motives for suicide among 232 Caucasians, Asian Americans, and Latino/a Americans with a history of suicide attempts, ideation, intent, or plan. We used subsequent logistic regression analyses to examine ethnic differences in suicide motive themes. RESULTS: This inductive approach of generating theory from data yielded an empirical model of 6 cultural meanings via motives for suicide themes: intrapersonal perceptions, intrapersonal emotions, intrapersonal behavior, interpersonal, mental health/medical, and external environment. Logistic regressions showed ethnic differences in intrapersonal perceptions (low endorsement by Latino/a Americans) and external environment (high endorsement by Latino/a Americans) categories. CONCLUSION: Results advance suicide research and practice by establishing 6 empirically based cultural motives for suicide themes that may represent a key intermediary step in the pathway toward suicidal behaviors. Clinicians can use these suicide meanings via motives to guide their assessment and determination of suicide risk. Emphasis on environmental stressors rather than negative perceptions like hopelessness should be considered with Latino/a clients.

Evidence-based supervision: Tracking outcome and teaching principles of change in clinical supervision to bring science to integrative practice.

Supervision is the primary way in which psychotherapy trainees develop the skills of applying interventions, conceptualizing cases, and practicing self-reflection. Although critical to professional development, the nature and objectives of supervision can vary widely among supervisors, depending on idiosyncratic differences and the orientation used. As clinical psychology moves toward integrating science and practice, the need to teach students evidence-based principles of therapeutic change and how to use outcome measures to enhance progress is paramount. Furthermore, with hundreds of "evidence-based" interventions and widely diverse supervisors, the fact that cross-cutting interventions and common factors carry the burden of most therapeutic change is frequently lost. In this article, we outline an experimental training system that is being tested as a means to teach student-therapists to use empirically established moderators (treatment factors) and mediators of change to tailor their interventions to client differences. This experimental approach is derived from Systematic Treatment Selection (Beutler, Clarkin, & Bongar, 2000), a cross-cutting system that can be used to aid individualized treatment planning as well as to track and use client outcomes in clinical supervision within a graduate-level training clinic.

A tool for the culturally competent assessment of suicide: the Cultural Assessment of Risk for Suicide (CARS) measure.

Despite important differences in suicide presentation and risk among ethnic and sexual minority groups, cultural variations have typically been left out of systematic risk assessment paradigms. A new self-report instrument for the culturally competent assessment of suicide, the Cultural Assessment of Risk for Suicide (CARS) measure, was administered to a diverse sample of 950 adults from the general population. Exploratory factor analysis yielded a 39-item, 8-factor structure subsumed under and consistent with the Cultural Theory and Model of Suicide (Chu, Goldblum, Floyd, & Bongar, 2010), which characterizes the vast majority of cultural variation in suicide risk among ethnic and sexual minority groups. Psychometric properties showed that the CARS total and subscale scores demonstrated good internal consistency, convergent validity with scores on other suicide-related measures (the Suicide Ideation Scale, the Beck Depression Inventory suicide item, and the Beck Hopelessness Scale), and an ability to discriminate between participants with versus without history of suicide attempts. Regression analyses indicated that the CARS measure can be used with a general population, providing information predictive of suicidal behavior beyond that of minority status alone. Minorities, however, reported experiencing the CARS cultural risk factors to a greater extent than nonminorities, though effect sizes were small. Overall, results show that the CARS items are reliable, and the instrument identifies cultural suicide risk factors not previously attended to in suicide assessment. The CARS is the first to operationalize a systematic model that accounts for cultural competency across multiple cultural identities in suicide risk assessment efforts.

Personal values and meaning in the use of methamphetamine among HIV-positive men who have sex with men.

Our aim with this qualitative study was to understand the role of personal values, meaning, and impact of drug use among HIV-positive men who have sex with men (MSM) who struggle with methamphetamine use. Participants were 22 MSM recruited from an ethnically diverse county in the San Francisco Bay area of California. Grounded theory was used to analyze the data collected in individual interviews. Emergent constructs of context, meaning, and perceived impact were identified and are described in a theoretical narrative format. The importance of broadening our understanding of HIV and methamphetamine addiction and their interaction is highlighted. This study contributes to the understanding of the complexity of methamphetamine use within the specific population of MSM living with HIV/ AIDS, and suggests possible directions for addressing important maintaining factors like adaptive use and enhancing factors that could contribute to an individual's ability to make better choices based on meaning and personal values.

Effects of time-limited dynamic psychotherapy on distress among HIV-seropositive men who have sex with men.

The current study seeks to examine changes in distress associated with receiving time-limited dynamic psychotherapy (TLDP) among men who have sex with men (MSM) who are also living with HIV and AIDS. Participants included 79 HIV-seropositive MSM who were seeking psychotherapy at a community mental health clinic between January 2000 and June 2005. Participants' had a mean age of 42 and were predominantly European American (77%), although Latinos (13%), African Americans (5%), and Asian Americans (4%) were also included. Each participant completed a pretest on a self-report measure of subjective distress, the Outcome Questionnaire 45.2 (OQ-45.2), received 20 sessions of TLDP over the course of 20 weeks, and then completed a posttest on the OQ-45.2 to examine changes associated with TLDP. Participants' self-reported distress showed statistically significant decreases after 20 sessions of TLDP. Furthermore, the overall effects were strong, suggesting that decreases in distress were clinically meaningful as well as statistically significant. These results are particularly significant in light of the AIDS Health Project's (AHP's) policy of assigning higher functioning clients to TLDP therapists at intake, indicating that the participants in this study began treatment with lower pretest scores than mental health clients in the general population. These results suggest that HIV-seropositive MSM who receive TLDP may experience significantly decreased distress. Future research using a randomized study design is needed to compare such benefits to those of more standard psychological interventions for this population. Strengths and limitations of the study are discussed in detail.