Making cross-racial therapy work: A phenomenological study of clients' experiences of cross-racial therapy

Broaching body size and sizeism: Input from specialized clinicians

Broaching issues of identity and power with clients in the context of their mental health care is affirmed as an effective multicultural and social justice counseling skill by a growing evidence base. Considerations for broaching body size, including size difference and sizeism, with clients has not yet been studied, thus clinicians lack guidelines for facilitating these conversations. In this consensual qualitative research study, we present themes involved in broaching body topics based on our interviews with nine clinicians specialized in treating clients with eating disorders and body-related counseling concerns. Themes addressed counselor development, conceptualization of broaching, clinical-decision-making, practice, and impact of broaching body topics in session. Clinicians identified professional and personal developments they pursued and would advocate for training future clinicians to better serve clients. Descriptions of unique and shared aspects of broaching clients' intersectionality and body-size specifically depict avenues for tailoring broaching conversations. Specific examples of effective and ineffective broaching conversations, including language used and psychoeducational components, provide recommendations for practice and connect to observed impacts on the client, counselor, and counseling process.

Deaf perceptions about treatment for alcohol use and mental health

INTRODUCTION

Recent research suggests that alcohol use disorder may be more prevalent in the Deaf community, a diverse sociolinguistic minority group. However, rates of treatment-seeking among Deaf individuals are even lower than in the general society. This study used the Theory of Planned Behavior to identify Deaf adults' beliefs about treatment that may prevent their treatment-seeking behaviors.

METHODS

This study conducted elicitation interviews with 16 Deaf adults. The study team recruited participants from across the U.S. and conducted interviews on Zoom. Participant ages ranged from 27 to 67 years (M = 40, SD =10.8). Seventy-five percent of the sample was male, 75 % were White, and 12.5 % were Hispanic/Latine. The study conducted interviews in American Sign Language, subsequently interpreted into English by a nationally certified interpreter, and transcribed for data analyses. The study analyzed transcripts using the Framework Method. The study team coded the interviews in groups and assessed for saturation (≤ 5 % new themes) of themes throughout the analysis. This study reached saturation in the third group (six total groups).

RESULTS

Identified themes followed the Theory of Planned Behavior constructs. The study identified nine Behavioral Beliefs with four advantages and five disadvantages of seeking treatment, four Normative Beliefs with one support and three oppositions to seeking treatment, and thirteen Control Beliefs with five facilitators and eight barriers to seeking treatment. Overall, the Deaf participants reported several unique beliefs based on their cultural and linguistic perspectives, including a concern about unqualified providers, experiencing stress in treatment with hearing providers, stigma within the Deaf community, less access to cultural information about alcohol and mental health, less encouragement of traditional treatment in marginalized communities, and additional barriers (e.g., communication, limited Deaf treatment options, discrimination, etc.).

CONCLUSIONS

A thorough understanding of individual beliefs about treatment is necessary to develop interventions that may increase treatment-seeking behaviors. Previous research has demonstrated that individual beliefs may be modified using Cognitive Behavioral Therapy techniques to increase treatment-seeking behaviors among hearing individuals. Similar interventions may be useful with Deaf individuals; however, they must consider the unique cultural and linguistic perspectives of the community.

Coping with Community Violence: Perspectives of African American Young Adult Men and Hispanic/Latino Young Adult Men

Further study is needed regarding the intersection of community violence exposure, coping strategies, and health behaviors among young adult African American men and Hispanic/Latino men. This study did so in Lake County, Indiana, which contains multiple areas with disproportionate prevalence of violence relative to population size. Approximately 22 miles from Chicago, Lake County includes noteworthy mid-sized cities such as Gary, Hammond, and East Chicago. This study explored the perceptions of African American men and Hispanic/Latino men ages 18 to 25 regarding coping strategies and both healthy and health risk behaviors after directly witnessing or indirectly experiencing a violent act or event. We used aspects of social cognitive theory to design this community-based participatory research study. Thirteen males who self-identified as African American, Hispanic/Latino, or both, completed 34- to 80-minute, audio-recorded phone interviews. Audio recordings were transcribed, and NVivo 12 Windows was used by the research team (primary researchers and two coders) to complete transcript analysis. Findings from this study provided insight around African American men and Hispanic/Latino men regarding (a) witnessing violence directly or indirectly experiencing violence; (b) changes in everyday life experiences; (c) coping strategies that involved socio-emotional health, spiritual health, social health, and risky health behaviors; (d) rationales for not asking for help; (e) observations of significant others' coping; (f) what to do differently in the future; (g) beliefs about mentors; and (h) beliefs about mental health providers. Delving into participants' experiences revealed that African American men and Hispanic/Latino men in Lake County, Indiana chose to adopt a range of health risk and health positive strategies after directly witnessing or indirectly experiencing violence. Becoming knowledgeable about African American men's and Hispanic/Latino men's diverse coping strategies and health behaviors may help inform the community about how best to cocreate spaces that aim to alleviate the traumatic experience of having directly or indirectly experienced community violence.

The development of the Broaching Assessment Scale: A client-rated measure of therapists' broaching behaviour in clinical counselling

Objective: Addressing ethnic-cultural topics during the process of psychotherapy, i.e. broaching, is considered highly important for ethnic minority clients who consult mental health care services. Surprisingly little is known, however, about clients' perception of a therapist's broaching qualities, and how clients' mental construction of broaching translates into behavioural broaching acts a therapist may display.

Method: Based on previous work and nine in-depth interviews with ethnic minority clients, a client-rated measure of therapists' broaching behaviour was developed and psychometrically evaluated in two samples. Sample 1 (N = 252 UK ethnic minority clients) was used to empirically delineate the factor structure of an initial item set. Participants were then resolicited to complete a revised item pool.

Results: The empirical structure resulted in a final 25-item broaching instrument with five subscales probing into therapists' broaching behaviour. This Broaching Assessment Scale (BrAS) was validated in Sample 2 (N = 239 US ethnic minority clients). Strict measurement invariance of the factor structure was observed across the two samples and distinctive correlational patterns with therapeutic process measures were found.

Conclusion: The BrAS provides new insights on how sensitivity to ethnic-cultural topics can be targeted along its concrete features, and is a promising tool for conceptualizing culturally sensitive mental healthcare assessment.

The differential impact of COVID-19 across health service psychology students of color: An embedded mixed-methods study

OBJECTIVES

Communities of color in the United States systematically experience inequities in physical and mental health care compared to individuals who identify as non-Hispanic White. The coronavirus disease 2019 (COVID-19) pandemic exacerbated these structural drivers of inequity to disproportionate and devastating effects for persons of color. In addition to managing the direct effects of COVID-19 risk, persons of color were also navigating increased racial prejudice and discrimination. For mental health professionals and trainees of color, the effects of COVID-19 racial health disparities and the increase in acts of racism may have been compounded by their work responsibilities. The current study used an embedded mixed-methods approach to examine the differential impact of COVID-19 on health service psychology (HSP) students of color as compared to their non-Hispanic White peers.

METHOD

Using quantitative and qualitative data from the Epidemic-Pandemic Impacts Inventory, measures of perceived support and of discrimination, and open-ended questions about students' experiences with racism and microaggressions, we examined the extent to which different racial/ethnic HSP student groups experienced COVID-19-related discrimination, the impacts of COVID-19 felt by students of color, and how these experiences differed from those of their non-Hispanic White peers.

RESULTS

HSP students of color endorsed greater impacts of the pandemic on both self and others in the home, perceived themselves as less supported by others, and reported more experiences of racial discrimination than non-Hispanic White HSP students.

CONCLUSION

Throughout the graduate experience, HSP students of color and their experiences of discrimination need to be addressed. We provided recommendations to HSP training program directors and students both during and after the COVID-19 pandemic.

BIPOC Experiences of Racial Trauma on TikTok: A Qualitative Content Analysis

Racial trauma has long been an issue in American society. Recent incidents of racial violence, including the attack and murder of George Floyd and the rise of anti-Asian hate have garnered significant media attention. People often use social media to express their emotions and perspectives on national events, and it has become a popular forum for posting and commenting on content related to timely social issues. In effort to understand individual perspectives, and experiences of racial trauma discussed on social media, we analyzed content labeled with the hashtag "racial trauma" on TikTok during significant racial incidents from March 2020 to May 2022. Results of content analysis showed six themes, (1) encountering racism, (2) traumatic experiences, (3) consequences of experiencing racial trauma, (4) expressing difficult feelings, (5) questioning and challenging oppression, denial, and privilege, and (6) a call to action: raising awareness. Findings inform clinicians' understanding of how their clients experience racial trauma. Clinical implications for incorporating a nuanced understanding of racial trauma in mental health treatment are discussed.

The Patient and Carer Race Equality Framework: a model to reduce mental health inequity in England and Wales

The Patient and Carer Race Equality Framework (PCREF) is an Organisational Competence Framework (OCF), recommended by the Independent Review of the Mental Health Act as a means to improve mental health access, experience and outcomes for people from ethnic minority backgrounds, particularly Black people. This is a practical framework that should be co-produced with and tailored to the needs of service users, based on quality improvement and place-based approaches. We aim to use the PCREF to address the longstanding epistemic justices experienced by people with mental health problems, particularly those from minoritised ethnic groups. We will outline the work that led to the proposal, the research on racial inequalities in mental health in the UK, and how the PCREF will build on previous interventions to address these. By taking these into account, the PCREF should support a high minimum standard of mental health care for all.

Development of Antimicrobial Cellulose Nanofiber-Based Films Activated with Nisin for Food Packaging Applications

The cellulose nanofiber (CNF) is characterized by the nano-sized (fibers with a diameter between 5 and 20 nm and a length between 2 and 10 μm), flexible and cross-linked structure that confer enhanced mechanical and gas barrier properties to cellulosic fiber-based packaging materials. The purpose of this work was to develop an antimicrobial packaging film by direct mixing nisin with CNF, followed by coating it onto polyethylene (PE), polypropylene (PP), and polylactic acid (PLA) films. The antimicrobial effectiveness of CNF-Nis+PE, CNF-Nis+PP, and CNF-Nis+PLA was investigated both in vitro end in ex vivo tests. In the latter case, challenge test experiments were carried out to investigate the antimicrobial activity of the coupled films of CNF-Nisin+PLA to inhibit the growth of Listeria innocua 1770 during the storage of a meat product. The films were active against the indicator microorganisms Brochothrix thermosphacta and Listeria innocua in in vitro test. Moreover, a reduction in the Listeria population of about 1.3 log cycles was observed immediately after the contact (T0) of the active films with hamburgers. Moreover, when the hamburgers were stored in active films, a further reduction of the Listeria population of about 1.4 log cycles was registered after 2 days of storage. After this time, even though an increase in Listeria load was observed, the trend of the Listeria population in hamburgers packed with active films was maintained significantly lower than the meat samples packed with control films during the whole storage period.

Adapting behavioral activation for perinatal depression and anxiety in response to the COVID-19 pandemic and racial injustice

BACKGROUND

We examined the implementation of a brief, behavioural activation (BA) model, via telemedicine, for perinatal populations during a confluence of significant global events in 2020. We conducted a rigorous qualitative study to identify relevant barriers and facilitators from the perspectives of both perinatal participants and treatment providers. We also present two case studies where BA was used and adapted to provide patient-centered care.

METHODS

Within the ongoing SUMMIT non-inferiority randomized controlled trial in Canada and USA, we interviewed a random selection of perinatal participants (n = 23) and all treatment providers (n = 28). A content analysis framework was developed to identify relevant barriers and facilitators and frequencies were calculated for each emergent theme within and across respondent groups.

RESULTS

Key facilitators reported by participants receiving BA were that BA helped with support and social connection (73.9%), creative problem solving (26.1%) and attending to pandemic-related symptoms (21.7%). Key facilitators endorsed by providers delivering BA were the use of telemedicine (35.7%) and loosening of government restrictions (21.4%). Both participant groups reported similar barriers to BA during the pandemic such as a lack of privacy and limited activities due to pandemic restrictions. However, providers were more likely to endorse pandemic-related life stressors as a barrier to treatment delivery compared to participants (64.3% vs. 34.8%). Both participant groups experienced explicit discussion of race and the racial justice movements during sessions as beneficial and reported harms of not doing so to the therapeutic alliance.

CONCLUSIONS

BA offers a person-centered model to facilitate social connection through creative problem-solving for women with perinatal depressive and anxiety symptoms within the context of the COVID-19 pandemic. Explicit discussion of race and racial injustice during sessions is an important and helpful aspect in psychological treatments.

Exploring the therapeutic alliance and race from sports psychologists' and athletes' lived experiences: A pilot study

The therapeutic alliance has been explored widely within therapy literature but more research is necessary on the sport and exercise psychology client dyad. The racial/cultural identity development model and Rogers's (1957) six core conditions provide the conceptual and theoretical framework for this pilot qualitative study, which seeks to explore the building process in therapeutic relationships within cross-racial sport and exercise psychology. The perspectives of four black athletes of mixed descent and seven sport and exercise psychologists from diverse backgrounds (Arab = 1, Black British = 3, White British = 3) were considered. One-hour semi-structured interviews were analysed using an inductive thematic analysis. This yielded the following themes for athletes: lack of disclosure, racial impact on alliance, desired characteristics and experience. For sport and exercise psychologists these themes included therapeutic alliance building blocks, creating safe spaces and the racial impact of disclosure. Recommendations for building the process in cross-racial dyads are explored based on the participants' comments. The findings are discussed and areas for future research are explored based on these main themes.

Racial Justice Activist Burnout of Women of Color in the United States: Practical Tools for Counselor Intervention

The pervasive racially hostile climate in society can bring severe mental health ramifications, such as burnout, to racial justice activists. For women of color (WOC), intersecting identities presents additional challenges. Due to the significant psychological impact burnout can have on WOC activists, counselors need the knowledge and tools to address this mental health issue. This article aims to provide counselors with a guide to working with WOC racial justice activists in the United States by outlining challenges faced by this population, health and mental health effects of burnout, and counseling interventions.

A Knowledge Synthesis of Cross-Cultural Psychotherapy Research: A Critical Review

This article presents a current knowledge synthesis of empirical studies on cross-cultural psychotherapy since 1980. Guided by a critical review framework, our search in seven relevant databases generated 80 studies published in English. Main themes are organized into (1) therapists’ cultural competence ( n = 46); (2) therapy process in cross-cultural dyads ( n = 22); and (3) cross-cultural differences in gender, sexual orientation, or social class ( n = 12). Compared to previous reviews on cross-cultural psychotherapy, the findings of this review highlight a broad range of methodological rigor in both quantitative and qualitative studies. Most studies examined actual therapy participants rather than participants in analog studies, thus emulating more therapy-near experiences in cross-cultural psychotherapy research. Also, several studies explored cross-cultural compositions beyond racial and ethnic majority therapist-minority client dyads, and included therapists of color as the participants, exploring reverse power dynamics in therapy and giving voices to foreign-born therapists. The therapy process research provides rich and full descriptions around the dynamic and interactional therapy process in cross-cultural dyads, which can be used to foster cultural sensitivities among therapists in their practice and training. We discuss the limitations of the studies included in the review and its implications for psychotherapy practice, training, and future research.

Engaging South Asian youth and families: A clinical review

OBJECTIVE

South Asians (SAs), a rapidly growing minority group in the United States are underrepresented in mental health research. They represent a unique sub-group of Asian immigrants in that their journey to the United States in the last 50 years was driven by the pursuit of academic and career opportunities. Our goal is to provide a topical overview of factors contributing to the mental health challenges of South Asian American (SAA) youth and to describe culturally sensitive approaches that would provide effective treatment for SAA youth and their families.

METHODS

We conducted a review of published literature in PubMed and PsycInfo search engines using the key words South Asian immigrants, South Asian Americans, psychological, psychiatric, mental health treatment, therapy and interventions.

RESULTS

The challenges faced by these highly educated families are distinctive in that there is a struggle to maintain ethnic identity based on collectivism while embracing American ideals of individualism. These opposing values along with model minority expectations put SAs at high risk for mental health concerns and acculturative family distancing. Furthermore, mental health stigma impedes help-seeking. Mental health practitioners must navigate the different value systems of the parent-child dyad without ostracizing either generation and deliver effective care. Hence, culturally adapted family therapy and community-based approaches may be particularly relevant in SA youth.

CONCLUSION

Our article outlines common family attitudes and issues pertinent to mental health in youth and discusses useful clinical approaches to dealing with SAA youth and their families.

Cinematherapy with African American couples

Cinematherapy is the use of movies as an intervention with clients. When done well, it is used to evoke and process emotion, psychoeducate, increase empathy, and problem-solve. However, there is no literature on utilizing movies as an intervention with African American couples. Based on literature and research about culture-informed interventions and media literacy, cinematherapy with African American couples would be more meaningful and effective if clinicians utilize Black-oriented movies.

Qualitative accounts from Syrian mental health professionals: shared realities in the context of conflict and forced displacement

OBJECTIVES

To explore the impact of the provision of care of forcibly displaced Syrian mental health professionals (MHPs) to Syrian clients in the community given shared experiences and backgrounds with clients.

DESIGN

A qualitative study using thematic analysis of in-depth semistructured interviews to explore shared realities, self-disclosure and the impact of providing therapy.

SETTING

Syrian MHPs operating in Gaziantep and Istanbul, Turkey, were interviewed.

PARTICIPANTS

Sixteen forcibly displaced Syrian MHPs (eight male, eight female) aged between 24 and 54 years (M=35, SD=8.3) who provided care to the displaced Syrian community in Turkey.

RESULTS

All workers described having a shared reality with their clients as helpful in therapy and a smaller proportion described it as a vulnerability. All described their work with Syrian clients as fulfilling and most described it as distressing. Participants referred to self-care,supervision, peer-support and personal therapy as a means to cope.

CONCLUSIONS

This study provides the first insight into the shared experiences of the ongoing trauma, loss and violations resulting from the ongoing Syrian conflict from the perspective of Syrian MHPs, adding to the literature of the professional issues and ethical duty to protect health workers in conflict settings.

Más allá de las barreras: Competency and practice considerations in language, cultural, and social issues when delivering group CPT to Hispanic immigrants

High rates of under-assessed trauma and psychiatric disorders, particularly posttraumatic stress disorder (PTSD) have been reported among Hispanic immigrants, especially as related to immigration trauma. Multiple studies have shown group cognitive processing therapy (CPT) to be an effective evidence-based practice (EBP) for treatment of PTSD across a number of clinical populations. To date, however, no studies have examined important competency and practice issues in linguistic, cultural, and ethical areas that group CPT providers should consider when delivering group CPT to Hispanic immigrants. This paper aims to outline these and provide future directions for research.

Experiences of Racism and Racial Tensions Among African American Women Impacted by Commercial Sexual Exploitation in Practice: A Qualitative Study

Barriers faced by Black women when navigating commercial sexual exploitation (CSE)-related services remain understudied. This qualitative study explores (a) Black women's experiences of racism when accessing services in CSE-related organizations and (b) the existence and manifestation of racial tensions in practice. In-depth interviews were conducted with 30 adult women who traded sex as adults and 20 CSE-related service providers. Findings suggest that Black women perceive preferential treatment given to White women. Racial tensions between women accessing programs were identified, as well as a promising practice of intergroup dialogue groups addressing racism, privilege, and oppression. Implications are discussed.

The Process of Change in Ethnic Minority Males Undergoing Psychodynamic Psychotherapy: A detailed comparison of two cases

Objective

Better understanding of the connection between therapeutic processes and outcomes in minority groups can help design and use culturally-adapted treatments.

Method

To explore the active ingredient in the therapeutic process, the present case study compared two ethnic minority male clients, recruited as part of a randomized controlled trial (RCT), one with a good outcome, the other with a poor one. The 12-item Working Alliance Inventory-Observer (S-WAI-O) coding system was used to capture the process of change, alongside a qualitative analysis of content. The cases were identified based on their change in pre- to post-treatment scores on the Beck Depression Inventory (BDI) and the Hamilton Rating Scale for Depression (HRSD).

Results

The findings suggest a rupture-resolution process in the good outcome case, including a process of negotiation of the alliance and work on issues of trust. In contrast, the poor outcome case showed strong and steady alliance, but context analysis pointed to withdrawal ruptures.

Conclusions

Although it is difficult to generalize from a two-case study analysis, the present work suggests that building and negotiating alliance with minority clients has a potential for treatment success.

Conceptualizing Culturally Infused Engagement and Its Measurement for Ethnic Minority and Immigrant Children and Families

Despite the central role culture plays in racial and ethnic disparities in mental health among ethnic minority and immigrant children and families, existing measures of engagement in mental health services have failed to integrate culturally specific factors that shape these families' engagement with mental health services. To illustrate this gap, the authors systematically review 119 existing instruments that measure the multi-dimensional and developmental process of engagement for ethnic minority and immigrant children and families. The review is anchored in a new integrated conceptualization of engagement, the culturally infused engagement model. The review assesses culturally relevant cognitive, attitudinal, and behavioral mechanisms of engagement from the stages of problem recognition and help seeking to treatment participation that can help illuminate the gaps. Existing measures examined four central domains pertinent to the process of engagement for ethnic minority and immigrant children and families: (a) expressions of mental distress and illness, (b) causal explanations of mental distress and illness, (c) beliefs about mental distress and illness, and (d) beliefs and experiences of seeking help. The findings highlight the variety of tools that are used to measure behavioral and attitudinal dimensions of engagement, showing the limitations of their application for ethnic minority and immigrant children and families. The review proposes directions for promising research methodologies to help intervention scientists and clinicians improve engagement and service delivery and reduce disparities among ethnic minority and immigrant children and families at large, and recommends practical applications for training, program planning, and policymaking.

Culturally Adapted Behavioral Activation

The scarcity of accessible culturally competent service providers and a general sense of mistrust in Eurocentric-based mental health settings exacerbate the lack of help seeking and effective therapeutic engagement for Latinos. Thus, clinical interventions that account for diverse values and worldviews may be an important step in the helpful treatment of U.S. Latino populations. Behavioral activation (BA), an evidence-based intervention for the treatment of depression, was recently evaluated through a preliminary clinical trial study in a community clinic primarily serving Spanish-speaking Latinos, and the results were promising. A culturally adapted version of BA was developed for Latinos, which took into consideration the cultural value of familismo (a collectivist worldview and preference for maintaining close connections to family); however, BA has not been previously applied to Latino families. The current case study presents the clinical treatment of a Mexican American family living in the southwest of the United States experiencing numerous stressors resulting in depressive symptoms. Specifically, this family sought therapy having experienced many negative life events, including stressors associated with institutionalized racism, their financial situation, and acculturation process. This led to a disruption of the family hierarchy, anger, unhappiness, fear, and isolation among family members. Outcomes of the intervention include a decrease in depressive symptoms and improved family communication and relationships by their involvement in activities such as attending cultural events in their community, family outings, and the children’s participation in extracurricular activities.

International Education and Service Learning

The field of counseling psychology continues to see a perpetual underutilization of mental health resources by many cultural groups, including international populations. Underutilization of services is due, in part, to psychologists’ deficiency in cultural and international competency. International education—an experiential learning technique that involves cultural contact—has been proposed as an alternative method for training students to work effectively cross-culturally. The current article examines the effects of service learning embedded in a study abroad diversity course in Singapore. The course was designed for graduate counseling psychology students as an experiential vehicle for developing cultural competency and awareness of social justice issues through direct contact with diverse groups. Qualitative data are reviewed, and implications for training, such as integration of cross-cultural and social justice issues in counseling training programs, are discussed.

Racial/ethnic match and treatment outcomes for women with PTSD and substance use disorders receiving community-based treatment

This study examined the relationship between racial/ethnic match and treatment outcomes for 224 women who participated in a clinical trial of group treatments for posttraumatic stress disorder (PTSD) and substance use disorders. Generalized estimating equations were used to examine the effect of client-therapist racial/ethnic match on outcomes. Results revealed racial/ethnic match was not significantly associated with session attendance. There was a significant three-way interaction between client race/ethnicity, baseline level of PTSD symptoms, and racial/ethnic match on PTSD outcomes. White clients, with severe PTSD symptoms at baseline, who attended treatment groups where they were matched with their therapist, had greater reductions in PTSD symptoms at follow-up than their counterparts who were racially/ethnically mismatched with their group therapist. Racial/ethnic match did not confer additional benefits for Black clients in terms of PTSD outcomes. Racial/ethnic match interacted with baseline substance use to differentially influence substance use outcomes at follow-up for all women. Clinical implications are discussed.

Potentially Harmful Therapy and Multicultural Counseling: Bridging Two Disciplinary Discourses

In recent years psychologists have been increasingly concerned about potentially harmful therapy, yet this recent discourse has not addressed issues that have long been voiced by the multicultural counseling and psychotherapy movement. We aim to begin to bring these seemingly disparate discourses of harm into greater conversation with one another, in the service of placing the discipline on a firmer foothold in its considerations of potentially harmful therapy. After reviewing the two discourses and exploring reasons for their divergence, we argue that they operate according to differing assumptions pertaining to the sources, objects, and scope of harm. We then argue that these differences reveal the discipline's need to better appreciate that harm is a social construct, that psychotherapy may be inherently ethnocentric, and that strategies for collecting evidence of harm should be integrated with a social justice agenda.

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.

Confronting a "big huge gaping wound": emotion and anxiety in a cultural sensitivity course for psychiatry residents

In his seminal volume From anxiety to method in the behavioral sciences, George Devereux suggests that any therapeutic or scientific engagement with another human being inevitably will be shaped by one's own expectations, assumptions, and reactions. If left unacknowledged, such unspoken and unconscious influences have the capacity to torpedo the interaction; if subjected to critical reflection, however, they can yield insights of great interpretive value and practical significance. Taking these reflections on counter-transference as point of departure, this article explores how a range of unacknowledged assumptions can torpedo good faith efforts to engender "cultural sensitivity" in a required course for American psychiatry residents. The course examined in this paper has been taught for seven successive years by a pair of attending psychiatrists at a longstanding New England residency training program. Despite the instructors' good intentions and ongoing experimentation with content and format, the course has failed repeatedly to meet either residents' expectations or, as the instructors bravely acknowledged, their own. The paper draws upon a year-long ethnographic study, conducted in the late 2000s during the most recent iteration of the course, which involved observation of course sessions, a series of interviews with course instructors, and pre- and post-course interviews with the majority of participating residents. By examining the dynamics of the course from the perspectives of both clinician-instructors and resident-students, the paper illuminates how classroom-based engagement with the clinical implications of culture and difference can run awry when the emotional potency of these issues is not adequately taken into account.

A Framework for Bridging Cultural Barriers in Suicide Risk Assessment

The incidence and prevalence of death by suicide and nonlethal suicidal behaviors such as suicide attempts, thoughts, and feelings are increasing in the United States and throughout the world. Efforts to prevent suicide deaths and suicide attempts, and reduce the likelihood that suicidal thoughts and feelings will lead to those outcomes, rest on the accuracy of suicide risk assessments primarily conducted in the context of clinical interviews. Despite being armed with lists of empirically derived “correlates” of suicide (i.e., risk factors), suicide risk assessment continues to be a challenging task faced by counseling psychologists and other mental health professionals on a daily basis. As Shea (1999) has suggested, this challenge in a large part is a function of differing values and beliefs regarding suicide between the clinician and the client that create barriers to accurate assessment. The thesis of this contribution to the Major Contribution is that the barriers to suicide risk assessment are much broader than values and beliefs when in the context of cultural differences between the clinician and client. Thus, we present an argument for the adoption of a set of compatibility heuristics as a framework for suicide risk assessment in the cross-cultural suicide risk assessment environment.

"Just be straight with me:" an exploration of Black patient experiences in initial mental health encounters

It is advantageous for a clinician to understand how patients feel about their initial encounters, but it can be difficult to discern what is and what is not working. This qualitative, exploratory study is guided by the question, "What happens during an initial mental health encounter between a Black patient and a non-Black provider that leads the patient to describe it as a good or poor experience?" The findings are based on face-to-face, postintake interviews with 14 Black patients seen by 11 non-Black providers as part of the Patient-Provider Encounter Study. The objective is to explore the initial interpersonal interactions between Black patients and their non-Black mental health providers and to better understand how patients come to describe the encounter as good (favorable) or poor (unfavorable). A framework inclusive of 5 specific elements is introduced that maps the patient's conceptualization process about how judgments are made about the encounter. Owing to the naturalistic and exploratory nature of the study, a research hypothesis was not established. Instead, we observed how patients scanned the interaction with the provider, made assessments about their provider, and determined whether their experience was positive or negative. The implications of these findings will help to improve the interactions in mental health settings between minority patients and their providers.