Journal of Counseling Psychology

Perceived racism and mental health among Black American adults: A meta-analytic review.
The literature indicates that perceived racism tends to be associated with adverse psychological and physiological outcomes; however, findings in this area are not yet conclusive. In this meta-analysis, we systematically reviewed 66 studies (total sample size of 18,140 across studies), published between January 1996 and April 2011, on the associations between racism and mental health among Black Americans. Using a random-effects model, we found a positive association between perceived racism and psychological distress (r = .20). We found a moderation effect for psychological outcomes, with anxiety, depression, and other psychiatric symptoms having a significantly stronger association than quality of life indicators. We did not detect moderation effects for type of racism scale, measurement precision, sample type, or type of publication. Implications for research and practice are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
How central is the alliance in psychotherapy? A multilevel longitudinal meta-analysis.
Prior meta-analyses have found a moderate but robust relationship between alliance and outcome across a broad spectrum of treatments, presenting concerns, contexts, and measurements. However, there continues to be a lively debate about the therapeutic role of the alliance, particularly in treatments that are tested using randomized clinical trial (RCT) designs. The purpose of this present study was to examine whether research design, type of treatment, or author's allegiance variables, alone or in combination, moderate the relationship between alliance and outcome. Multilevel longitudinal analysis was used to investigate the following moderators of the alliance–outcome correlation: (a) research design (RCT or other), (b) use of disorder-specific manuals, (c) specificity of outcomes, (d) cognitive and/or behavioral therapy (CBT) or other types of treatments, (e) researcher allegiance, and (f) time of alliance assessment. RCT, disorder-specific manual use, specificity of primary and secondary outcomes, and CBT did not moderate the alliance–outcome correlation. Early alliance–outcome correlations were slightly higher in studies conducted by investigators with specific interest in alliance than were those in studies conducted by researchers without such an allegiance. Over the course of therapy, these initial differences disappeared. Apart from this trend, none of the variables previously proposed as potential moderators or mediators of the alliance–outcome relation, alone or in combination, were found to have a mediating impact. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Valuing clients' perspective and the effects on the therapeutic alliance: A randomized controlled study of an adjunctive instruction.
The patterns of growth and development of the therapeutic alliance over the course of therapy have been of continued interest to psychotherapy researchers. The purpose of this study was to investigate whether a simple institutional metacommunication intervention with clients had an effect on the development of the alliance. This adjunctive instruction involved inviting therapy clients to take a proactive role in their treatment by encouraging feedback to their therapist about various aspects of the therapy process. In this randomized controlled study (N = 94), clients were assigned to 1 of 2 conditions: (a) an institutional adjunctive instruction condition in which patients were contacted by clinic personnel at the beginning of the remediation phase (Session 5) and encouraged to take a proactive role in their treatment and (b) a control condition that contained no institutional adjunctive instruction. Between-condition differences in the alliance were tested, controlling for baseline influences and the early therapeutic alliance. Clients' postsession reports from Sessions 1 to 24 indicated that the adjunctive instruction increased the alliance over the course of therapy vis-à-vis the control condition. The adjunctive instruction appeared to have fostered clients' evaluation of their therapists' interest in their welfare. The results indicate that interventions, even brief or subtle, can produce lasting benefits in the alliance when targeted at specific psychological processes. Systematic metacommunication from the institutional level appeared to reinforce clients' therapeutic alliance with their therapists in individual treatment. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Therapeutic immediacy across long-term psychodynamic psychotherapy: An evidence-based case study.
C. E. Hill (2004) recently developed the concept of therapist immediacy to capture discussion by the therapist about the therapeutic relationship that occurs in the here-and-now of a therapy session. This concept has been expanded to include discussion about the therapeutic relationship by both the client and therapist, captured by the term therapeutic immediacy (K. Kuutmann & M. Hilsenroth, 2011). Although prior research has examined the use of therapeutic immediacy across short-term treatment, the present study is the first to examine the use of immediacy across a long-term (4 years) psychotherapy. Also, this is the first study to assess the interrater reliability of therapeutic immediacy, which was found to achieve good to excellent levels across raters. The most frequently used categories of client and therapist immediacy are presented. Finally, the authors provide an in-depth qualitative examination of 5 therapeutic immediacy segments across the treatment judged by the raters to have high levels of depth/intensity (4.5 or higher out of 5) to examine the role of therapeutic immediacy in exploring meaningful treatment issues. Clinical utility, potential limitations, and future research on therapeutic immediacy are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The group's absence norm and commitment to the group as predictors of group member absence in the next session: An actor–partner analysis.
The group's absence norm, a construct from the applied psychology literature, was used to examine session absences in personal growth groups. Rather than examining the absence norm statically, we modeled it dynamically as a time-varying covariate (Tasca et al., 2010). We also examined moderation by modeling the interaction of the absence norm and the group member's commitment to the group in predicting the group member's absence in the next group session. Session absences in 1,722 group sessions for 66 group members in 9 interpersonal growth groups were modeled using Kenny, Mannetti, Pierro, Livi, and Kashy's (2002) adaptation of the Actor–Partner Interdependence model. Specifically, a 3-level model (sessions within group members within groups) examined the relationship of the group's absence norm (average previous absences of the other group members), commitment to the group (previous absences of the group member), and the interaction of the group's absence norm and commitment to the group on absence in the next session. As we hypothesized, (a) a greater number of previous individual absences (low commitment) increased the probability of a member being absent the next session, (b) the higher the group's absences norm, the greater the probability that an individual group member would be absent the next session, and (c) individual group members who were more committed to the group were more influenced by the group's absences norm than were group members less committed to the group. Implications for research and practice are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Perceiving a calling, living a calling, and job satisfaction: Testing a moderated, multiple mediator model.
The current study examined the relation between perceiving a calling, living a calling, and job satisfaction among a diverse group of employed adults who completed an online survey (N = 201). Perceiving a calling and living a calling were positively correlated with career commitment, work meaning, and job satisfaction. Living a calling moderated the relations of perceiving a calling with career commitment and work meaning, such that these relations were more robust for those with a stronger sense they were living their calling. Additionally, a moderated, multiple mediator model was run to examine the mediating role of career commitment and work meaning in the relation of perceiving a calling and job satisfaction, while accounting for the moderating role of living a calling. Results indicated that work meaning and career commitment fully mediated the relation between perceiving a calling and job satisfaction. However, the indirect effects of work meaning and career commitment were only significant for individuals with high levels of living a calling, indicating the importance of living a calling in the link between perceiving a calling and job satisfaction. Implications for research and practice are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Transgender individuals' workplace experiences: The applicability of sexual minority measures and models.
The present study explored whether 3 existing measures of workplace constructs germane to the experiences of sexual minority people could be modified to improve their applicability with transgender individuals. To this end, the Workplace Heterosexist Experiences Questionnaire (WHEQ; C. R. Waldo, 1999); the Lesbian, Gay, Bisexual, and Transgendered Climate Inventory (LGBTCI; B. J. Liddle, D. A. Luzzo, A. L. Hauenstein, & K. Schuck, 2004); and the Workplace Sexual Identity Management Measure (WSIMM; M. Z. Anderson, J. M. Croteau, Y. B. Chung, & T. M. DiStefano, 2001) were modified to explicitly address the experiences of transgender individuals. Data from a sample of 263 transgender individuals were used to evaluate the psychometric properties of the modified measures. Analyses of the structures of the modified measures (Transgender Forms [TF]) suggested an alternative 2-factor structure for the WHEQ-TF, but provided support for the previously observed unidimensional structure for the LGBTCI-TF, and a slightly modified 3-factor structure for the WSIMM-TF. Cronbach's alpha reliability coefficients for scale or subscale items across the 3 measures were acceptable. Criterion-related validity was evident in theoretically consistent patterns of correlations between scores on the 3 modified measures and scores on indicators of job satisfaction and outness. These data provide preliminary support for transgender-specific versions of measures of 3 key constructs in the sexual minority vocational behavior research. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
On the border: Young adults with LGBQ parents navigate LGBTQ communities.
Little research has examined the perspectives of young adults with lesbian, gay, bisexual, transgender, and queer (LGBTQ) parents, particularly in relation to their identification with the LGBTQ community. To address this gap, we conducted a qualitative study of 42 young adults (ages 18–29) who were raised by LGBQ parents. We found that participants often described their sense of belonging to the LGBTQ community as shifting over the life course. Some participants, particularly those whose parents had always been out, felt connected to the LGBTQ community as children. Of these, most maintained those connections over time. However, some increasingly deidentified with the LGBTQ community, which they sometimes attributed to their own heterosexual identification. Others, particularly those whose parents came out later in life, described a lack of connection to the LGBTQ community as children. Of these, most became increasingly identified with the community, which they often attributed to their own and their parents' increasing sense of comfort with their parents' sexuality. Heterosexual participants who sought out LGBTQ-oriented groups in young adulthood sometimes encountered resistance from these groups, whereby participants' reasons for wanting to become involved were not readily apparent or appreciated. Our findings highlight the need for practitioners to understand the complex and often changing role of the LGBTQ community in the lives of young adults with LGBQ parents. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Social connectedness, discrimination, and social status as mediators of acculturation/enculturation and well-being.
The present study proposed and tested a conceptual model of acculturation/enculturation and subjective well-being (SWB) by including social connectedness in mainstream society, social connectedness in the ethnic community, perceived discrimination, and expected social status as mediators. Survey data from 273 Asian American college students in the midwest were analyzed by using structural equation modeling. Results indicated that the effect of acculturation on SWB was mediated by social connectedness in mainstream and ethnic communities and expected social status, whereas the effect of enculturation on SWB was mediated by social connectedness in the ethnic community and expected social status. Contrary to the authors' hypothesis, perceived discrimination did not mediate the relation of acculturation and SWB, but indirectly influenced SWB via a lowered sense of connectedness to mainstream society. Approximately 46% of the variance in SWB was accounted for by the variables included in this model. Implications for theory, research, and practice are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Forbearance coping, identification with heritage culture, acculturative stress, and psychological distress among Chinese international students.
Based on Berry's (1997) theoretical framework for acculturation, our goal in this study was to examine whether the use of a culturally relevant coping strategy (i.e., forbearance coping, a predictor) would be associated with a lower level of psychological distress (a psychological outcome), for whom (i.e., those with weaker vs. stronger identification with heritage culture, a moderator), and under what situations (i.e., lower vs. higher acculturative stress, a moderator). A total of 188 Chinese international students completed an online survey. Results from a hierarchical regression indicated a significant 3-way interaction of forbearance coping, identification with heritage culture, and acculturative stress on psychological distress. For those with a weaker identification with their heritage culture, when acculturative stress was higher, the use of forbearance coping was positively associated with psychological distress. However, this was not the case when acculturative stress was lower. In other words, the use of forbearance coping was not significantly associated with psychological distress when acculturative stress was lower. Moreover, for those with a stronger cultural heritage identification, the use of forbearance coping was not significantly associated with psychological distress regardless of whether acculturative stress was high or low. Future research and implications are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The Concerns about Counseling Racial Minority Clients Scale.
The purpose of this study was to develop and validate the Concerns about Counseling Racial Minority Clients (CCRMC) scale among counselor trainees. Sample 1 was used for an exploratory factor analysis and confirmatory factor analysis. Four factors were identified, Managing Cultural Differences (α = .82), Offending or Hurting Clients (α = .87), Biased Thoughts and Behaviors (α = .81), and Client Perceptions (α = .77). The coefficient alpha for the CCRMC was .90. The results support the validity of the scale. The scores on the CCRMC and its subscales have positive associations with fear of negative evaluation from others (r = .19 to .40) and negative associations with general counseling self-efficacy (r = −.30 to −.46) and multicultural intervention self-efficacy (r = −.30 to −.64). The CCRMC significantly predicted fear of negative evaluation, session management self-efficacy, and multicultural intervention self-efficacy over and above multicultural social desirability. The validity evidence was not different between White and minority graduate trainees. In Sample 2, the estimated 1-week test–retest reliabilities ranged from .75 to .96 for the CCRMC and its four subscales. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Counseling psychology trainees' perceptions of training and commitments to social justice.
This mixed methods study examined social justice commitments of counseling psychology graduate trainees. In the quantitative portion of the study, a national sample of trainees (n = 260) completed a web-based survey assessing their commitments to social justice and related personal and training variables. Results suggested that students desired greater social justice training than what they experienced in their programs. In the qualitative portion, we used a phenomenological approach to expand and elaborate upon quantitative results. A subsample (n = 7) of trainees who identified as strong social justice activists were interviewed regarding their personal, professional, and training experiences. Eleven themes related to participants' meanings of and experiences with social justice emerged within 4 broad categories: nature of social justice, motivation for activism, role of training, and personal and professional integration. Thematic findings as well as descriptive statistics informed the selection and ordering of variables in a hierarchical regression analysis that examined predictors of social justice commitment. Results indicated that trainees' perceptions of training environment significantly predicted their social justice commitment over and above their general activist orientation and spirituality. Findings are discussed collectively, and implications for training and future research are provided. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The Distress Disclosure Index: A research review and multitrait–multimethod examination.
The Distress Disclosure Index (DDI; J. H. Kahn & R. M. Hessling, 2001) is a brief self-report measure of one's tendency to disclose personally distressing information. The purpose of this article was to summarize what is known about the DDI, present new validity evidence, and make recommendations for use of the DDI. This article reviews research on the DDI from the past decade that indicates that distress disclosure is associated with well-being, professional help-seeking attitudes and intentions, and success in brief psychotherapy. On the basis of the reviewed literature, the authors report a reliability generalization study of DDI scores that strongly supports the internal consistency and test–retest reliability of DDI scores, and they review criterion-related and construct validity evidence. Next, the authors present a new multitrait–multimethod validity study of the DDI. Participants (N = 153) and peer informants (N = 153)—one per participant—completed paper-and-pencil questionnaire packets. Convergent validity of self-reported DDI scores was supported by a strong association with self-reports of emotional self-disclosure in response to a specific, unpleasant event, and self- and peer reports on the DDI were moderately correlated. DDI scores were not strongly associated with cognitive reappraisal and ambivalence over emotional expression, thus supporting discriminant validity. DDI scores were strongly associated with expressive suppression, and correlations between DDI scores and affect, depression symptoms, coping, and emotional expressivity were similar to those found with expressive suppression. The authors offer possible hypotheses explaining the overlap between distress disclosure and expressive suppression and present recommendations for future use of the DDI. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
A threshold model of social support, adjustment, and distress after breast cancer treatment.
This study examined a threshold model that proposes that social support exhibits a curvilinear association with adjustment and distress, such that support in excess of a critical threshold level has decreasing incremental benefits. Women diagnosed with a first occurrence of breast cancer (N = 154) completed survey measures of perceived support (Social Provisions Scale), quality of life (Functional Living Index—Cancer), adjustment (Psychological Adjustment to Illness Scale) and psychological distress (Brief Symptom Inventory) approximately 3 weeks after surgical treatment and 8–16 months later. Consistent with a threshold model, multiple regression analyses suggested a significant curvilinear relationship between social support and distress at Time 1 and Time 2 and between social support and adjustment at Time 2. Consistent with this model, the significant bivariate correlations between social support and outcomes were accounted for almost entirely by women in the lowest quartile of support. Social support among women in the highest 3 quartiles was unrelated or only marginally related to adjustment and distress. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Exploring actor–partner interdependence in family therapy: Whose view (parent or adolescent) best predicts treatment progress?
Predictions of family therapy outcome consistently vary depending on which client rates the alliance. We used the actor–partner interdependence model (Kenny, Kashy, & Cook, 2006) to test the interdependence of parents' and adolescents' ratings of alliance, session depth/value, and improvement-so-far after Sessions 3, 6, and 9. Initial analyses found trivial between-therapists variance; therefore, a 3-level hierarchical model partitioned the variance in these variables into between families, between family members, and between session components. For alliance and session depth, results showed a significant parent actor effect and a significant adolescent partner effect. Specifically, when parents saw a stronger alliance, they also saw the session as more valuable, but when adolescents saw a stronger alliance, their parents saw the session as less valuable. Both the parents' and the adolescents' improvement scores showed significant linear growth over time, and adolescents' alliance ratings were positively associated with their own and their parents' views of therapeutic progress. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
A latent class regression analysis of men's conformity to masculine norms and psychological distress.
How are specific dimensions of masculinity related to psychological distress in specific groups of men? To address this question, the authors used latent class regression to assess the optimal number of latent classes that explained differential relationships between conformity to masculine norms and psychological distress in a racially diverse sample of 223 men. The authors identified a 2-class solution. Both latent classes demonstrated very different associations between conformity to masculine norms and psychological distress. In Class 1 (labeled risk avoiders ; n = 133), conformity to the masculine norm of risk-taking was negatively related to psychological distress. In Class 2 (labeled detached risk-takers ; n = 90), conformity to the masculine norms of playboy, self-reliance, and risk-taking was positively related to psychological distress, whereas conformity to the masculine norm of violence was negatively related to psychological distress. A post hoc analysis revealed that younger men and Asian American men (compared with Latino and White American men) had significantly greater odds of being in Class 2 versus Class 1. The implications of these findings for future research and clinical practice are examined. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Journal of Counseling Psychology - Vol 59, Iss 1