Impacts of Racial and Gender Identities on Individuals' Intentions to Seek a Counselor

To understand the theoretical impact of racial and gender identities on counselor selection, an online experiment was conducted with 527 participants in which both the race and gender of a perspective counselor's online profile were manipulated. Results showed that participants had a higher intention to seek counseling when the counselor was from the same racial and/or gender group. These preferences existed above and beyond other identity-based evaluative metrics, such as those tied to group stereotypes (e.g., warmth and competence). The results advocate for the development and evaluation of culturally tailored digital health interventions and underscore the importance of further formative research in this area to enhance the accessibility and effectiveness of healthcare resources for all.

Instability and Uncertainty Are Critical for Psychotherapy: How the Therapeutic Alliance Opens Us Up

Tschacher and Haken have recently applied a systems-based approach to modeling psychotherapy process in terms of potentially beneficial tendencies toward deterministic as well as chaotic forms of change in the client's behavioral, cognitive and affective experience during the course of therapy. A chaotic change process refers to a greater exploration of the states that a client can be in, and it may have a potential positive role to play in their development. A distinction is made between on the one hand, specific instances of instability which are due to techniques employed by the therapist, and on the other, a more general instability which is due to the therapeutic relationship, and a key, necessary result of a successful therapeutic alliance. Drawing on Friston's systems-based model of free energy minimization and predictive coding, it is proposed here that the increase in the instability of a client's functioning due to therapy can be conceptualized as a reduction in the precisions (certainty) with which the client's prior beliefs about themselves and their world, are held. It is shown how a good therapeutic alliance (characterized by successful interpersonal synchrony of the sort described by Friston and Frith) results in the emergence of a new hierarchical level in the client's generative model of themselves and their relationship with the world. The emergence of this new level of functioning permits the reduction of the precisions of the client's priors, which allows the client to 'open up': to experience thoughts, emotions and experiences they did not have before. It is proposed that this process is a necessary precursor to change due to psychotherapy. A good consilience can be found between this approach to understanding the role of the therapeutic alliance, and the role of epistemic trust in psychotherapy as described by Fonagy and Allison. It is suggested that beneficial forms of instability in clients are an underappreciated influence on psychotherapy process, and thoughts about the implications, as well as situations in which instability may not be beneficial (or potentially harmful) for therapy, are considered.

Racial dynamics among clients in a residential substance use disorder treatment program in South Los Angeles and its impact on clients' treatment experiences

This study seeks to investigate racial dynamics among clients in a female-only residential substance use disorder treatment facility in South Los Angeles and its effects on treatment experiences. Clients were interviewed about their interracial interactions, perceptions of clients of races and ethnicities different from their own and how racial dynamics might affect their experiences in treatment. Nine interviews were conducted and analyzed using thematic analysis. Participants recounted that racial differences do not play a significant role in their treatment experiences, although racial identities shape social group formation. Motivation to recover from addiction and other shared lived experiences facilitate interracial harmony.

Caregiver Voices: Cross-Cultural Input on Improving Access to Autism Services

Decades of research have established that racial ethnic minority, low-income, and/or non-English speaking children with autism spectrum disorder (ASD) are diagnosed later than white children, and their families experience greater difficulty accessing services in the USA. Delayed access to timely diagnosis and early intervention may impact child outcomes and family quality of life. Despite their cognition of these disparities and their significant impact on the lives of those affected, explanations for the barriers experienced by underserved families are elusive, likely due to the complex interaction between structural and family factors. This study used qualitative methods to gather family and provider perspectives of perceived barriers and facilitators to obtaining an ASD diagnosis and accessing ASD-related services for underserved families. Themes from focus groups and interviews with families from three cultural groups (black, Hispanic/Latino, and Korean) and three primary languages (English, Korean, and Spanish) highlight specific barriers related to family, community, and systemic challenges as well as facilitators to accessing care for these populations. Family experiences are expanded upon with viewpoints from the providers who work with them. Recommendations are made for reducing disparities in the existing ASD service system including increasing professional, family, and community education; increasing culturally responsive care; improving provider-family partnerships; and addressing practical challenges to service access.

In Their Own Words: How Black Teens Define Trauma

Trauma is a subjective phenomenon. However, when examining trauma among low-income, Black teens, it is common to use established clinical criteria as the metric for identifying and evaluating its presence and impact. Little attention has been devoted to exploring how Black youth characterize trauma in their own terms. This qualitative study explored the concept of trauma from the perspectives of 12 low-income, Black teens. Participants' descriptions included death and loss; violence exposure; police harassment, racism, and discrimination; poverty; being stuck in the hood; and being bullied. While some of their descriptions were compatible with traumatic stressors outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM), participants also highlighted factors that are not explicitly enumerated in the DSM. Findings present important implications for the development of more culturally and developmentally inclusive discussions of trauma and for clinical practice with low-income, Black youth who are impacted by trauma and adversity.

Bridging the Gap: Racial concordance as a strategy to increase African American participation in breast cancer research

Lack of African American females in breast cancer research has been receiving substantial attention. This study seeks to identify research perceptions and motivating factors needed to increase racial/ethnic minority participation in breast cancer research. A total of 57 African American women (Σ = 47.8 years), from Rhode Island and Texas, completed a questionnaire and focus group. While many participants were not breast cancer survivors, they reported knowledge of their racial group’s risk for breast cancer. One major finding that could be seen as both a facilitator and barrier is racial concordance between participant and researcher. Cultural sensitivity and trust building is recommended to increase minority participation.

Investigating the Perceptions of Care Coordinators on Using Behavior Theory-Based Mobile Health Technology With Medicaid Populations: A Grounded Theory Study

BACKGROUND

Medicaid populations are less engaged in their health care than the rest of the population, translating to worse health outcomes and increased health care costs. Since theory-based mobile health (mHealth) interventions have been shown to increase patient engagement, mobile phones may be an optimal strategy to reach this population. With increased development of theory-based mHealth technology, these interventions must now be evaluated with these medically underserved populations in a real-world setting.

OBJECTIVE

The aim of our study was to investigate care coordinators' perceived value of using a health behavior theory-based mHealth platform with Medicaid clients. In particular, attention was paid to the perceived impact on patient engagement. This research was conducted using the patient-provider text messaging (short message service, SMS) platform, Sense Health (now Wellpass), which integrates the transtheoretical model (TTM), also called the stages of change model; social cognitive theory (SCT); supportive accountability; and motivational interviewing (MI).

METHODS

Interviews based in grounded theory methodology were conducted with 10 care managers to understand perceptions of the relationship between mHealth and patient engagement.

RESULTS

The interviews with care managers yielded a foundation for a grounded theory model, presenting themes that suggested 4 intertwined correlative relationships revolving around patient engagement: (1) A text messaging (short message service, SMS) platform supplements the client-care manager dynamic, which is grounded in high quality, reciprocal-communication to increase patient engagement; (2) Texting enhances the relationship between literacy and access to care for Medicaid patients, increasing low-literacy patients' agency to access services; (3) Texting enhances communication, providing care managers with a new means to support their clients; and (4) Reminders augment client accountability, leading to both increased motivation and readiness to change behaviors, as well as an improved client-care manager relationship.

CONCLUSIONS

Messaging platform features tied to health behavior theory appear to be effective in improving patient engagement. Two-way communication (supportive accountability), trusted relationships (supportive accountability, SCT), personalized messages (TTM), and patient input (TTM, SCT, MI) appeared as the most relevant components in achieving desired outcomes. Additionally, reminder messages were noted as especially useful in making Medicaid patients accountable and in turn engaging them in their health and health care. These findings convey suggested elements for inclusion in other mHealth interventions aiming to improve patient engagement in Medicaid populations.

“Ain’t I a Woman?”

This study explored the experience of gendered racial microaggressions (i.e., subtle and everyday verbal, behavioral, and environmental expressions of oppression based on the intersection of one’s race and gender) among Black women at a predominantly White university. A total of 17 undergraduate, graduate, and professional students participated in one of two semistructured focus group discussions. Using dimensional analysis, three core gendered racial microaggression themes were uncovered, each with two subthemes: Projected Stereotypes (expectation of the Jezebel, expectation of the Angry Black Woman), Silenced and Marginalized (struggle for respect, invisibility), and Assumptions About Style and Beauty (assumptions about communication styles, assumptions about aesthetics). Results indicated that Black women experience microaggressions based on the stereotypes that exist about their gendered racial group. Findings support and extend the literature by developing a taxonomy of gendered racial microaggressions, which highlights intersecting forms of subtle oppression. Implications for research and practice in counseling psychology are discussed.

Paradigms, Purpose, and the Role of the Literature

The authors have identified three areas that are central to the rationale for conducting a qualitative research project, yet which produce confusion and uncertainty for some psychologists trained in traditional research methods. In this article, they consider how philosophy of science paradigms relate to the foundational rationale for qualitative inquiry and present suggestions for how researchers can formulate a statement of purpose and research questions that are congruent with an identified paradigm. They examine the role of scholarly literature in two areas: those of developing a rationale and in enhancing the impact of qualitative research. Examples from contemporary counseling psychology research are used to illustrate core concepts.

Clinical Experiences With Clients Who Are Low-Income: Mental Health Practitioners' Perspectives

The experiences of nine licensed mental health practitioners regarding their work with clients from low-income backgrounds were examined utilizing grounded theory methodology. Themes that emerged from the semi-structured interviews highlighted a rich narrative that portrayed the work as both deeply satisfying and inherently complex. Participants described the personal nature of this work, including countertransference elicited because of their own personal economic contexts and emotional reactions experienced within and outside the therapy room. Their stories acknowledged systematic challenges that act as barriers to treatment. Some participants noted that this has contributed to feelings of disillusionment toward the field as well as fears about the future of the mental health care. Based on these findings, we discuss implications for training, future research, and clinical practice.

Critical Secret Disclosure in Psychotherapy With Korean Clients

Korean clients who had completed counseling in Korea and viewed the therapy as successful were interviewed about critical secret disclosure during their therapy. In-depth interviews along with grounded theory-informed analyses in a methodological hermeneutic framework revealed that many Korean clients reported that despite initial fears and needing to test their counselors, sharing their secrets was a powerful experience that deepened their connection to their counselor, facilitated positive life changes, and enhanced their relationships with others. We present a hierarchy of categories that explains the meaning and process of critical secret disclosure in therapy. The results are discussed in the context of Korean culture and how these findings can inform therapy with Korean clients.

Therapist Ethnicity and Treatment Orientation Differences in Multicultural Counseling Competencies

This study examined the relationship between therapist characteristics, therapeutic orientations, person-level and agency-level practices with cultural competency among 221 Los Angeles County community mental health clinicians. Results from an online survey indicated that compared to White therapists, ethnic minority therapists were more personally involved in communities of color, more likely to use a cultural framework in clinical practice, and perceived their agencies to be more culturally sensitive. Ethnic minority therapists also reported greater multicultural (MC) awareness and better MC counseling relationships with their clients than White therapists. Personal involvement in communities of color accounted for ethnic differences in MC awareness and MC counseling relationships. Compared to therapists with a strictly non-behavioral (psychodynamic or humanistic) orientation, therapists with an eclectic (or integrative) therapy orientation reported having a higher level of community knowledge. Therapists with an eclectic orientation reported greater MC awareness than therapists with a non-behavioral orientation, while both eclectic and behavioral (cognitive behavioral or behavior modification) therapists recounted better MC counseling relationships with their clients than therapists with a non-behavioral orientation. Community knowledge mediated eclectic vs. non-behavioral therapeutic orientation differences in MC awareness. Agency resources/linkages and outreach both moderated the relationship between therapeutic orientation and MC skills. Results suggest that if therapists become more personally involved with diverse populations, they will feel more culturally aware and feel like they have a better relationship with ethnic minority clients.

Race and Recognition

Building on the early work of Frantz Fanon, we explored the concept of recognition as an aspect of Black racial identity or the degree of being seen by others and ourselves as equal or morally worthy persons deserving respect. We collected 64 racial life narratives with self-identified Black adults in four contexts: Australia, Bermuda, South Africa, and the United States. We uncovered a core theme of Global Recognition or the desire to be seen as complex Black individuals with rich, diverse lives and innate value as human beings. Two main themes emerged that either promoted (i.e., Racial Recognition and Acceptance) or hindered this sense of Global Recognition (i.e., Lack of Racial Recognition and Acceptance). Each of these themes consisted of two subthemes. In addition, participants described four types of behaviors designed to achieve Global Recognition: Challenging Oppression, Competition, Self-Affirmation, and Racial Performance.

Older African American women's lived experiences with depression and coping behaviours

Little is known about older African American women's lived experiences with depression. What does depression mean to this group? What are they doing about their depression? Unfortunately, these questions are unanswered. This study examined older African American women's lived experiences with depression and coping behaviours. The common sense model provided the theoretical framework for present study. Thirteen community-dwelling African American women aged 60 and older (M = 71 years) participated. Using qualitative phenomenological data analysis, results showed the women held beliefs about factors that can cause depression including experiences of trauma, poverty and disempowerment. Results also indicated the women believed that depression is a normal reaction to life circumstances and did not see the need to seek professional treatment for depression. They coped by use of culturally sanctioned behaviours including religious practices and resilience. It appears these women's beliefs about depression and use of culturally sanctioned coping behaviours might potentially be a barrier to seeking professional mental healthcare, which could result in missed opportunities for early diagnosis and treatment of depression among this group. Implications for research, educational and clinical interventions are discussed.

THE INFLUENCE OF RACE AND ETHNICITY IN CLIENTS' EXPERIENCES OF MENTAL HEALTH TREATMENT

Clinicians and researchers have pointed to the need for culturally sensitive mental health interventions. Yet it has not been determined if the inclusion of cultural elements affects the way mental health clients experience services. This study examined 102 clients who had received mental health treatment from outpatient mental health clinics to investigate whether culturally related elements involving race and ethnicity were important to clients and whether they were related to client satisfaction and perceived treatment outcomes. Ethnic minority clients generally felt that issues regarding race and ethnicity were more important than did White clients. When these elements were considered important but were not included in their care, clients were less satisfied with treatment. Consistent with the notion of cultural responsiveness, these findings provide empirical evidence that culturally relevant aspects of the mental health service experience are salient to ethnic minority clients and can affect how they respond to services.

Exploring Clinicians Attitudes Toward the Incorporation of Racial Socialization in Psychotherapy

Racial socialization has been found to have a positive impact on the lives of African Americans. While most studies have focused on parental and caretaker racial socialization, none have examined this process in the context of the mental health practitioner-client relationship. Mental health practitioners may also serve as a socializing agent, providing African American clients with messages regarding race and racial barriers. The present exploratory study examined whether racial socialization messages are being incorporated in individual therapy by mental health practitioners who work with African American clients. Participants were 136 mental health providers solicited via electronic mailing lists from various divisions of the American Psychological Association, college counseling centers, and regional associations. Participants completed a survey on-line. Results indicated ethnicity was linked to the report of racial socialization focused on spiritual coping messages. Results also suggested an interaction between the ethnicity of the clinician and the age group of their clientele when examining messages focused on color-blind ideology.

African American Men’s Beliefs About Mental Illness, Perceptions of Stigma, and Help-Seeking Barriers

Little is known about African American men’s beliefs about mental illness. A descriptive qualitative study, using the common sense model (CSM), examined African American men’s beliefs about mental illness, perceptions of stigma associated with mental illness, and barriers to help-seeking. A total of 17 community-dwelling African American men participated in individual interviews. Dimensional analysis guided by the CSM showed most of the men identified mental illness causal factors consistent with the biopsychosocial model of mental disorders. They believed mental illness is a chronic disorder having negative consequences and reported experiencing barriers to help seeking. In contrast with previous studies, most men in the present study did not perceive stigma associated with mental illness and did not identify stigma as a barrier to help seeking. They were open to help seeking, were optimistic about professional treatment, encouraged others to seek treatment, and expressed strong interest in mental health research. Implications for counseling psychology research and practice are discussed.

An Exploration of Boundaries and Solidarity in Counseling Relationships

This article explores the boundaries between clinicians and clients in light of the construct of solidarity. A universal conception of boundaries is critiqued and a culturally congruent view of boundaries is examined, rooted in the concept of solidarity. The article includes case illustrations of the connection between boundaries and solidarity and concludes with suggestions for mental health professionals.

Understanding the experience of Black clients in marriage and family therapy

Past research on Black clients' utilization of therapy focused on the barriers that prevent Black clients from attending therapy and the reasons for these barriers. However, few studies have been conducted that focus on how Black clients attending therapy actually experience these barriers. This study utilized both Likert and open-ended questions to examine the obstacles 16 Black clients face in their attempts to attend family therapy. The most frequently identified obstacles were related to concerns over family member response and cultural barriers to therapy. Participants also reported concerns about racial and/or cultural differences and a lack of understanding by non-Black therapists. The implications of this study addressed how to effectively meet the therapeutic needs of Black clients.

"The Chain Has to Be Broken": A Qualitative Investigation of the Experiences of Young Women Following Juvenile Court Involvement

Whereas the number of girls involved in the juvenile justice system is on the rise, little is known about female juvenile offenders after they reach adulthood. This study aims to explore the meaning that young adult women ascribe to their juvenile court experiences and assess their perceptions of facilitators and barriers to progress in their adult lives. Data on services and support are presented from nine semistructured interviews. Findings include the commonality of mental health issues, substance abuse, and problematic relationships with intimate partners. Implications for service provision and policy, as well as future research directions, are outlined.

Advanced relationships between categories analysis as a qualitative research tool

The authors propose an advanced relationships between categories (RBC) model as an expansion of Tutty, Rothery, and Grinnell's (1996) qualitative tool for classifying RBC patterns as contained, temporal, and causal relationships. It is assumed that identification of the relationships obtained among categories of qualitative data paves the way for construction of a theory, even though few tools have been developed for this purpose to date. The advanced RBC model points to three additional relationship patterns: bilateral, trilateral, and quadrilateral relationships. These relationships reveal how the text itself links among its various components. The model serves as an innovative tool for systematic derivation of explanations based on the qualitative raw data, contributing to grounded theory and other interpretive studies.

African American Women's beliefs, coping behaviors, and barriers to seeking mental health services

Little is known about African American women's beliefs about mental illness. In this qualitative study we employed the Common Sense Model (CSM) to examine African American women's beliefs about mental illness, coping behaviors, barriers to treatment seeking, and variations in beliefs, coping, and barriers associated with aging. Fifteen community-dwelling African American women participated in individual interviews. Dimensional analysis, guided by the CSM, showed that participants believed general, culturally specific, and age-related factors can cause mental illness. They believed mental illness is chronic, with negative health outcomes. Participants endorsed the use of prayer and counseling as coping strategies, but were ambivalent about the use of medications. Treatment-seeking barriers included poor access to care, stigma, and lack of awareness of mental illness. Few age differences were found in beliefs, coping behaviors, and barriers. Practice and research implications are discussed.

Developing a health screening questionnaire for women in welfare transition programs in the United States

Women in United States Welfare Transition Programs (WTPs) have high rates of chronic health problems that might present significant barriers to obtaining and/or maintaining employment. Inadequate, standardized health screening in WTPs across the United States contributes to the problem of achieving self-sufficiency for disadvantaged women. Using community-based participatory research as a framework, the study's purpose was to develop a culturally relevant and sensitive health screening questionnaire that would be acceptable for use with women enrolled in WTPs. Three rounds of focus groups (n = 10) were conducted with a total of 61 women. Analysis of focus group interviews revealed not only content areas identified as important to health, but critical process issues involved in administering the tool. The distinction between process and content was a critical finding because it stressed the importance of not only what women were asked, but how, when, and by whom they were asked.