The APA Guidelines for Psychological Practice With Sexual Minority Persons: An executive summary of the 2021 revision.

This article provides an executive summary of the American Psychological Association (APA)-approved Guidelines for Psychological Practice With Sexual Minority Persons (American Psychological Association, APA Task Force on Psychological Practice with Sexual Minority Persons, 2021). These Guidelines were produced at the request of the APA Society for the Psychology of Sexual Orientation and Gender Diversity (Division 44) and the APA Committee on Sexual Orientation and Gender Diversity (CSOGD) who, in 2018, jointly established a new task force to revise the 2010 Guidelines for Psychological Practice With Lesbian, Gay, and Bisexual Clients. This article provides a summary of the conceptual foundations that influenced these Guidelines, as well as an overview of the complete Guidelines. We highlight major changes in structure and new content areas. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Leverage, the treatment relationship, and treatment participation.

OBJECTIVE Although many psychiatric patients experience various forms of pressure or leverage to participate in community treatment, the association between such experiences and treatment participation is controversial. This study evaluated the hypothesis that aspects of the treatment relationship, such as the working alliance, psychological reactance, and perceived coercion, could be important in understanding treatment adherence and satisfaction in a group of patients at risk of experiencing leverage. METHODS A total of 198 outpatients at two community mental health centers completed structured interviews including measures of the treatment relationship, treatment participation, experience of leverage, and clinical functioning. Regression analyses were used to assess associations between the treatment relationship and treatment adherence and satisfaction while concomitantly considering experiences of leverage, demographic characteristics, and clinical functioning. RESULTS Approximately four in ten participants reported experiencing some form of leverage to adhere to treatment during the previous six months, such as pressures related to the criminal justice system, money, housing, and outpatient commitment. Patients who perceived greater coercion to participate in treatment were more likely to report taking their medications as prescribed. Higher satisfaction with treatment was associated with lower perceived coercion, a better working alliance, and lower levels of psychological reactance. CONCLUSIONS Benefits in medication adherence associated with interventions that patients perceive as coercive may come at a cost of decreased satisfaction with treatment. Aspects of the treatment relationship hold promise for individualizing treatment planning in a way that addresses satisfaction as well as adherence.

Client attachment orientations, working alliances, and responses to therapy: a psychology training clinic study.

The authors examined the associations between client attachment orientations, working alliance, and progress in therapy. Ninety-five clients at two university-based training clinics completed measures of adult attachment, attachment to therapist, and working alliance immediately preceding the third counseling session with therapists-in-training. A standardized measure of progress in therapy was administered at intake, third counseling session, and termination. Hierarchical linear modeling findings indicated that stronger working alliances and secure attachment to therapist were significantly associated with greater reductions in client distress over time. Higher levels of adult attachment anxiety were significantly associated with greater distress ratings at the outset of treatment. Directions for future research and suggestions for developing therapeutic relationships in the context of specific client attachment orientations are discussed.

Telling perfectionists about their perfectionism: Effects of providing feedback on emotional reactivity and psychological symptoms.

A randomized, controlled clinical trial was conducted to determine the efficacy of receiving feedback in a sample of maladaptive perfectionists. A total of 60 young adults were randomly assigned to a feedback intervention or control group. Hierarchical Linear Modeling was utilized to analyze the effects of perfectionism over time, as well as the effects of treatment condition on the relationship between perfectionism and outcomes. Measures of interest included emotional reactivity, self-esteem, and psychological distress. Findings revealed that providing feedback to maladaptive perfectionists reduced self-reported global symptomatic distress as well as emotional reactivity. The results are discussed in light of treatment implications, especially with regard to the manner in which perfectionists respond to therapeutic interventions. Overall, study findings suggest that a brief, low-cost feedback intervention is effective at decreasing psychological distress in maladaptive perfectionists and may serve as a beneficial precursor to individual therapy or counseling.

Authoritarian and homophobic attitudes: gender and adult attachment style differences.

This study explored the relations of gender and adult attachment styles to college students' scores on several measures of authoritarian attitudes (e.g., right-wing authoritarianism, ethnocentrism, homophobia, and religious fundamentalism). A multivariate analysis of authoritarian attitudes yielded significant main and interaction effects involving students' gender and their (categorical) attachment style scores. Relative to women, men reported higher levels of homophobia, ethnocentrism, and right-wing authoritarianism. Gender differences in homophobia were additionally conditioned by participants' adult attachment styles: Men with dismissing styles evidenced the highest levels of homophobia, whereas women with dismissing styles demonstrated the lowest levels; that is, a fear of intimacy seemed to contribute to homophobic attitudes found among heterosexual men. This was the first U.S. study of the relationship between adult attachment styles and right-wing authoritarianism, and further investigation is warranted.

Psychological abuse perpetration in college dating relationships: contributions of gender, stress, and adult attachment orientations.

This study investigated whether gender, stressful problems common among college students, and adult attachment orientations (anxiety and avoidance) contributed to self-reported perpetration of psychological abuse in dating relationships among 127 college students. College men's stress levels were the strongest predictor of perpetration of emotional abuse against their female romantic partners. Attachment avoidance among college men and women was associated with higher levels of emotional abuse perpetration when self-reported stress levels were high. Recommendations for research and practice are provided.

Respective contributions of therapist and client adult attachment orientations to the development of the early working alliance: a preliminary growth modeling study.

The authors investigated the temporal relationship between client and therapist attachment orientations and early working alliance. Attachment was measured by self-report after the 1st session of therapy. The working alliance ratings were completed after the 1st, 4th, and 7th therapy sessions. Hierarchical linear modeling results indicated that anxiously attached therapists had a significant positive effect on the client working alliances after the 1st session but significant negative effects over time. No other therapist or client attachment variables or related interactions had a significant effect on client working alliance ratings. Results also indicated that time was a significant positive predictor of client working alliance ratings.