Appropriate validation standards for licensure examinations: Comment on Callahan et al. (2020).

Callahan et al. (2020) asserted that the Examination for Professional Practice in Psychology (Part 2-Skills) has not undergone appropriate validation. Although they recognized that content validity is the foundation of licensure examinations, they suggested additional validational strategies that are not recommended for licensure examination development. This response clarifies the appropriate validation standards for the examination. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Challenges to psychology education and training in the culture of competence.

The culture of competence is upon the profession of psychology. Although that culture has resulted in numerous changes in the profession over the past few decades, we continue to face challenges. These challenges include issues such as the profession's competency models, training models, accreditation models, specific competencies (e.g., research, diversity, supervision), training sequence concerns (e.g., the internship match imbalance, postdoctoral experience requirements), and scope of competent practice issues. This article describes these challenges with the hope that the profession of psychology will be able to work together to resolve them, in spite of some critical differences in viewpoints. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A Competency Framework for the Practice of Psychology: Procedures and Implications.

OBJECTIVE: Several competency models for training and practice in professional psychology have been proposed in the United States and Canada. Typically, the procedures used in developing and finalizing these models have involved both expert working groups and opportunities for input from interested parties. What has been missing, however, are empirical data to determine the degree to which the model reflects the views of members of the profession as a whole. METHOD: Using survey data from 466 licensed or registered psychologists (approximately half of whom completed one of two versions of the survey), we examined the degree to which psychologists, both those engaged primarily in practice and those involved in doctoral training, agreed with the competency framework developed by the Association of State and Provincial Psychology Boards' Practice Analysis Task Force (Rodolfa et al., 2013). RESULTS: When distinct time points in training and licensure or registration were considered (i.e., entry-level supervised practice in practicum settings, advanced-level supervised practice during internship, entry level independent practice, and advanced practice), there was limited agreement by survey respondents with the competency framework's proposal about when specific competencies should be attained. In contrast, greater agreement was evident by respondents with the competency framework when the reference point was focused on entry to independent practice (i.e., the competencies necessary for licensure or registration). CONCLUSION: We discuss the implications of these findings for the development of competency models, as well as for the implementation of competency requirements in both licensure or registration and training contexts.

Multicultural competencies: What are we measuring?

The current study examined the validity of the client-rated version of the Cross-Cultural Counseling Inventory-Revised (CCCI-R). The first phase of this study involved a content validation of the CCCI-R by experts who had publications in the fields of multicultural competencies (MCCs) and psychotherapy research. Of the 20 items on the CCCI-R, 7 were rated as appropriate for client use. The second phase of this study utilized confirmatory factor analysis to examine construct validity by testing whether clients' perceptions of their therapists' MCCs (via the seven items validated by experts) were distinct from client-rated working alliance scores. Model fit statistics supported a theoretically based model in which MCCs were measured distinctly from working alliance, but where the two factors were related. Implications for theory and practice are discussed.

Interaction among alliance, psychodynamic-interpersonal and cognitive-behavioural techniques in the prediction of post-session change.

UNLABELLED: The current study examined the interaction of clients' perceptions of the psychodynamic-interpersonal (PI) and cognitive-behavioural (CB) techniques that their therapist utilized in their most recent therapy session and working alliance in the prediction of post-session changes. Seventy-five clients were treated by 25 therapists at a counselling centre in the USA. We posited that alliance would interact with clients' perceptions of their therapists' use of PI and CB techniques in the prediction of post-session changes. The results revealed a three-way interaction between clients' perceptions of the alliance, PI techniques and CB techniques in the prediction of post-session changes. More PI and more CB techniques and more PI but fewer CB techniques were associated with better post-sessions changes in the context of higher alliances. More CB techniques but fewer PI techniques and fewer PI and fewer CB techniques were not significantly associated with post-session changes in the context of higher (or lower) alliances. KEY PRACTITIONER MESSAGE: Clients' perceptions of PI techniques in the context of stronger alliances were most beneficial for post-session outcomes. Thus, a high alliance will likely maximize the impact of PI techniques. Clients who rated their therapist as being relatively inactive reported fewer positive post-session outcomes, suggesting that an idle therapeutic approach is not advantageous. Therapist differences explained two to three times more variation in session outcomes than client ratings of alliance or techniques. Some therapists are better at facilitating positive session outcomes as compared with others, suggesting that a potential key barometer of therapists' effectiveness may be captured by session outcomes.

Alliance in action: a new measure of clients' perceptions of therapists' alliance activity.

We developed a new measure, Alliance in Action (AiA), which assesses clients' perceptions of therapist behavior related to fostering and maintaining the alliance. Clients (N=170) were treated by 42 therapists. All clients were currently in therapy. The results of a factor analysis revealed four subscales to the AiA, which reflected clients' perceptions of their therapists' behavior to monitor the therapeutic relationship, the goals for therapy, and progress towards client goals. A fourth subscale emerged that reflected clients' perceptions of therapist avoidance of eliciting feedback. The AiA subscales demonstrated alphas above .70 and they were associated with client-rated alliance and session outcomes in univariate correlation tests. In multilevel models, three of the four subscales were associated with alliance and session outcomes. The AiA may be helpful in understanding how the therapeutic alliance functions in therapy.

'No-show': therapist racial/ethnic disparities in client unilateral termination.

In the present study, the authors examined the source of racial/ethnic minority (REM) disparities in unilateral termination (i.e., the client ending therapy without informing the therapist)--a form of dropout that is associated with poor alliance and outcome. First, the authors tested whether some therapists were more likely to have clients who reported unilaterally terminating as compared with other therapists. Next, the authors examined 2 competing hypotheses regarding the therapists role in termination disparities: (a) that racial/ethnic disparities in unilateral termination are similar across therapists and thus due to other components of the treatment process or (b) that racial/ethnic disparities in unilateral termination are specific to therapists, where some therapists are more likely, on average, to have higher rates of unilateral termination with REM clients as compared with White clients. The sample included 155 REM clients and 177 White clients who were treated by 44 therapists at a university counseling center. The results showed that therapists accounted for a significant proportion of the variation in clients' unilateral termination, and REM clients were more likely to report they unilaterally terminated from therapy as compared with White clients. Furthermore, racial/ethnic disparities in clients' report of unilateral termination varied across therapists' caseloads. These results suggest that therapists have a central role in their clients' unilateral termination and have implications for understanding racial/ethnic mental health disparities.

Working through: in-session processes that promote between-session thoughts and activities.

This study examined whether clients' ratings of the working alliance as well as their perception of cognitive-behavioral (CB) and psychodynamic-interpersonal (PI) techniques (delivered by therapists who used both) were associated with clients' intersession processes (i.e., their thoughts about therapy and therapeutic activity between sessions). Seventy-five clients who were currently in therapy at a large university counseling center participated in the current study. Multilevel regression analyses demonstrated that alliance and clients' perceptions of their therapists' use of PI techniques were positively associated with clients' general thoughts about therapy between sessions. Also, stronger alliances were associated with more therapeutic activities between sessions and more positive (and less negative) thoughts about therapy between sessions. In addition, clients at later sessions who described their therapists as using more PI techniques also reported engaging in more therapeutic activities between sessions (after controlling for the variance in the other variables, such as use of CB techniques). Clients' perceptions of their therapists' use of CB techniques in the most recent session were not related to thinking about therapy or therapeutic activities after controlling for the variance in the other variables.

Clients' perceptions of their psychotherapists' multicultural orientation.

The current retrospective study examined whether clients' (N = 176) perceptions of their psychotherapists' multicultural orientation (MCO) were associated with their psychological functioning, working alliance, and real relationship scores. Moreover, we tested whether clients' perceptions of the working alliance and the real relationship mediated the relationship between clients' perceptions of their psychotherapists' MCO and psychological functioning. The results showed that clients' perceptions of their psychotherapists' MCO were positively related to working alliance, real relationship, and psychological functioning. Only clients' ratings of the working alliance mediated the relationship between clients' perceptions of their psychotherapists' MCO and psychological functioning. Thus, because clients perceive their psychotherapists as being more oriented toward cultural issues, they may view the therapist as being more credible and may gain a sense of comfort in the therapeutic process. In turn, clients' strong alliance facilitates improvement in psychological well-being.

Client and therapist variability in clients' perceptions of their therapists' multicultural competencies.

This study examined therapist differences in their clients' ratings of their therapists' multicultural competencies (MCCs) as well as tested whether therapists' who were rated as exhibiting more MCCs also had clients who had better therapy outcomes (N = 143 clients and 31 therapists). All clients completed at least 3 sessions. Results demonstrated that therapists accounted for less than 1% of the variance in their clients' Cross-Cultural Counseling Inventory­Revised (CCCI-R; T. D. LaFromboise, H. L. K. Coleman, & A. Hernandez, 1991) scores, suggesting that therapists did not differ in terms of how clients rated their MCCs. Therapists accounted for approximately 8.5% of the variance in therapy outcomes. For each therapist, their clients' CCCI-R scores were aggregated to provide an estimate of therapists' MCCs. Therapists' MCCs, based on aggregate CCCI-R scores, did not account for the variability in therapy outcomes that were attributed to them. Additionally, clients' race/ethnicity, therapists' race/ethnicity, or the interaction of clients'­therapists' race/ethnicity were not significantly associated with clients' perceptions of their therapists' MCCs.

The relationship between clients' conformity to masculine norms and their perceptions of helpful therapist actions.

T. J. G. Tracey et al.'s (2003) common factors model derived from therapists and psychotherapy researchers has provided a parsimonious structure to inform research and practice. Accordingly, the current authors used the 14 common factor categories identified in Tracey et al.'s model as a guide to code clients' perceptions of helpful therapist actions (e.g., intervention, way of being) in short-term psychotherapy. Next, they conducted a cluster analysis to establish meaningful subgroups of clients based on clients' perceptions of helpful therapist actions. Finally, they explored if clients in these subgroups differed in their report of conformity to masculine norms. Clients (N = 161) from a university counseling center were recruited for the current study. Results revealed 3 clusters of clients based on their perceptions of helpful therapist actions: Insight (44%), Relationship (30%), and Information (26%). In contrast, Tracey et al. found 3 clusters: Bond (which includes Insight and Relationship), Information, and Structure of therapy (not found in the current study). Clients in the Insight and Relationship clusters reported more conformity to masculine norms as compared with clients in the Information cluster. There were no sex differences across clusters.

Multicultural approaches in psychotherapy: A rejoinder.

In this rejoinder, the authors address several issues raised by R. L. Worthington and F. R. Dillon (2011) and C. R. Ridley and M. Shaw-Ridley (2011) regarding (a) the measurement of multicultural competencies (MCCs), (b) sampling considerations in multicultural research, and (c) the conceptual frame of multicultural psychotherapy research. The authors challenge the wisdom of exploring MCCs in psychotherapy research and provide a different framework to understand therapists' multicultural effectiveness with clients based on their cultural race/ethnicity. Additionally, the concept of therapists' multicultural orientation or approach is introduced to illuminate the process of aligning with clients about salient cultural issues in psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Empirical search for psychotherapists' gender competence in psychotherapy.

Over the past half century, psychotherapy research has demonstrated that psychotherapy outcomes do not vary based on clients' gender (Clarkin & Levy, 2004; Garfield, 1994; Wierzbicki & Pekarik, 1993). However, most studies assumed that all psychotherapists are equally competent to treat men and women, thus potentially missing essential information about variations in psychotherapy outcomes. In fact, there is a paucity of studies that have examined if psychotherapists' gender competence truly exists. We propose that psychotherapists' gender competence should be defined as the psychotherapist's ability to achieve positive psychotherapy outcomes with either female or male clients. This study examined the relationship between clients' gender and psychotherapy outcomes and if psychotherapists varied in their abilities to produce positive psychotherapy outcomes for female and male clients. The sample included 93 male and 229 female clients treated by 31 psychotherapists. Consistent with previous research, the results demonstrated that clients' gender was not related to psychotherapy outcomes. However, compared to other psychotherapists, some psychotherapists were better at treating men, whereas others were better at treating women. The results of this study demonstrate that psychotherapists' gender competence exists and relates directly to the psychotherapy outcomes (i.e., psychological well-being) of clients. Implications for psychotherapy practice, training, and research are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Overlap among clinical, counseling, and school psychology: implications for the profession and Combined-Integrated training.

Health care providers within psychology currently fall into three dominant practice areas: clinical, counseling, and school psychology. This article reviews data from four different sources-archival descriptions, training curricula, internship and employment outcomes, and professional activities-to examine the overlap among the three practice areas. Archival descriptions revealed substantial similarities, with smaller but interesting differences. A comparison of actual curricula from 10 programs accredited in each of the three practice areas yielded similar findings: Programs across the three practice areas were much more similar than different. Within-practice area variations among programs were nearly as large as across-practice area differences. We briefly review the professional activities of clinical, counseling, and school psychologists, again demonstrating considerable similarity. We conclude by explaining implications for doctoral training programs, internships settings, and professional credentialing.