Effect of older adult health and age on psychology doctoral trainees' expectations of clinical work with older adult clients

This experimental, repeated-measures study investigated the effects of client health and client age on doctoral psychology students' clinical expectations for their work with older adult clients. Doctoral clinical and counseling psychology trainees (N = 223) completed measures assessing clinical expectations for three older adult clients of varying health status (healthy, recent Alzheimer's Disease (AD) diagnosis, heart disease) who all presented with depressive symptoms. Trainees were randomly assigned to the 71-year-old or 81-year-old condition. Trainees perceived a depressed client with a recent AD diagnosis as a less appropriate candidate for therapy, less motivated and less responsible for therapy, and less able to develop a therapeutic relationship. Additional health-based differences in prognosis, comfort, and competence were moderated by client age. Although age did have a small effect, the health of the older adult client had a stronger influence on trainees' clinical expectations for work with older adults. Cognitive health concerns were perceived as a greater barrier to clinical work with older adults than were physical health concerns. Health biases for clinical work with older adults could impact the quality of mental healthcare provided.

Clinical and counseling psychology doctoral trainees' attitudes toward and interest in working with older adult clients

The small percentage of psychologists specializing in geropsychology will be increasingly insufficient to meet projected mental health needs of the growing older adult population in the United States. The current study examined contact with older adults, empathy, and multicultural competence as predictors of counseling and clinical psychology doctoral trainees' attitudes toward and interest in working with older adults. A sample of 311 doctoral trainees in clinical (n = 234) and counseling (n = 78) psychology were surveyed online. A structural equation model testing hypothesized interrelationships between study variables showed good fit. Greater contact with older adults was significantly related to less ageist attitudes, greater interest in work with older adults, and more empathy. Less ageist attitudes were significantly related to greater interest in clinical work with older adults. Greater empathy was significantly related to less ageist attitudes and greater multicultural competence, but to less interest in working with older adults. Empathy mediated the relation of contact to attitudes. Increasing positive contact with older adults as part of doctoral training in counseling and clinical psychology may enhance trainees' empathy, attitudes toward older adults, and interest in work with older adults.

Tailored Psychoeducational Home Interventions for Children with a Chronic Illness: Families' Experiences

The quality of life for a child with a chronic illness depends on various factors, including the illness's severity, medical treatments, psychosocial and educational support, resource availability, and community involvement. These biopsychosocial factors become significant when the child receives care at home. This article presents and evaluates a highly personalized support project offered to 40 Sicilian families, consisting of educational, social, and psychological services delivered at the families homes and in their communities. Guided by the Psychosocial Assessment Tool (PAT) and the Functional Psychology framework, the project employed a family-focused approach to healthcare and was based on a continuous dialogue between all stakeholders. The project was evaluated through a qualitative interview with eight families in the Palermo area, which was analyzed using consensual qualitative research. Results revealed families' appreciation of the project and the importance of a professional who listened to their needs, provided a connection with the medical team, and tailored activities inside and outside the home. The ability of professionals to listen and adapt activities to different contexts and needs was crucial for the project's success. We conclude that creating tailored family-level interventions with an educator acting as a liaison with the medical team is a widely acceptable strategy that should be further developed and investigated.

A Content Analysis of the Counseling Psychology Literature on Religiousness and Spirituality

This study reviewed the literature on religiousness and spirituality (RS) published in three major journals in counseling psychology. We aimed to evaluate (a) the content and methods of RS research and (b) operational definitions of RS constructs and suggestions for research and practice. At Level 1, we reviewed 901 articles that included an RS related word(s) anywhere in the article. At Level 2, we further analyzed 108 empirical studies and 31 conceptual articles that included RS as a study variable or a primary topic. Both quantitative and qualitative (i.e., thematic analysis) methods were used for data analysis. To summarize the key findings, major topics related to RS included mental health, wellbeing, LGBTQ experiences, help-seeking, counseling process, eudaimonic wellbeing, identity, discrimination, and minority stress. Religiousness and spirituality tended to be defined in a dichotomous way. We suggest future directions for research, practice, advocacy, education, and training, building on the holistic, multicultural, and positive premises of counseling psychology.

Future Directions in Mental Health Treatment with Stigmatized Youth

Stigma refers to societally-deemed inferiority associated with a circumstance, behavior, status, or identity. It manifests internally, interpersonally, and structurally. Decades of research indicate that all forms of stigma are associated with heightened risk for mental health problems (e.g., depression, PTSD, suicidality) in stigmatized youth (i.e., children, adolescents, and young adults with one or more stigmatized identities, such as youth of Color and transgender youth). Notably, studies find that stigmatized youth living in places with high structural stigma - defined as laws/policies and norms/attitudes that hurt stigmatized people - have a harder time accessing mental health treatment and are less able to benefit from it. In order to reduce youth mental health inequities, it is imperative for our field to better understand, and ultimately address, stigma at each of these levels. To facilitate this endeavor, we briefly review research on stigma and youth mental health treatment, with an emphasis on structural stigma, and present three future directions for research in this area: (1) directly addressing stigma in treatment, (2) training therapists in culturally responsive care, and (3) structural interventions. We conclude with recommendations for best practices in broader mental health treatment research.

Standing Up for Culturally Competent Care in Portugal: The Experience of a “Health in Equality” Online Training Program on Individual and Cultural Diversity

Health professionals play an essential role in the protection and promotion of health rights without distinction of sex, sexual orientation, gender identity and expression, ethnicity/race, nationality and migration status, age, functional diversity, or any other individual and/or cultural positions. With the growing diversity of patient populations, health professionals must be able to identify and be responsive to individual and cultural diversity, ensuring equity in access to high-quality individually-centered care. For this, it is fundamental to promote training in cultural competence, understood as responsivity and the ability to work the valorization of multiple and intersectional identities throughout life. The paper aims to describe the experience of the implementation of the program “Health in Equality”, aimed at training the primary healthcare workforce in Portugal, which was based on Sue and Sue’s (2008) three-dimensional model of multicultural skills, which champions cultural best practices in an intersectional perspective. Based on the trainees’ and trainers’ evaluation of four completed editions developed online between March and July 2021, this study discusses ways to improve the impact of the training program and amplify the number of leaders and role models for other health care providers towards culturally competent healthcare systems and organizations.

The Use of Social Justice Concepts in Rehabilitation Counselor Education: Results of an Exploratory Study

Divisive social rhetoric and prevalent racism make the need for infusing social justice throughout counselor education even more urgent than the decades—long calls for it. There is a dearth of empirical inquiry into the ways social justice concepts are enacted across rehabilitation counseling curricula. The current study used an exploratory survey to collect information about the techniques used by rehabilitation counselor educators ( n = 71) to infuse social justice across all of their courses, including their pedagogical choices, rates of frequency for updating coursework, and professional development choices. Findings reveal that educators have favorable attitudes about social justice, are more likely to use academic journals and related disciplines in course development, and to use self-reflection and intuition-based opportunities for social justice professional development. Implications of the findings also include relevancy for supervisors and practitioners, who have the responsibility to and lead social justice education once trainees have entered the field as professionals.

Multicultural ethics in rehabilitation services

BACKGROUND: Rehabilitation professionals are required to be competent in serving multiculturally diverse individuals in a manner that promotes empowerment and full engagement. Multicultural competency is critical for accurate clinical assessment and diagnosis and for effectively serving a diverse population of clients. OBJECTIVE: The major objective of this paper is to promote multicultural competency and sensitivity by increasing knowledge and awareness of ethical considerations for multicultural populations in rehabilitation settings. CONCLUSION: Diagnostic tools and ethical decision-making models that integrate multicultural considerations are discussed, and recommendations for building multicultural competency are provided.

Counselors’ Role in Decreasing Suicide in Mental Health Professional Shortage Areas in the United States

A mental health professional shortage area (MHPSA) is an area lacking psychiatrists as designated by the Health Resources and Services Administration. Prior research found the lack of psychiatrists can be directly related to adverse health outcomes. The current investigation focused on the United States by state level and the relationship between MHPSAs, suicide rates, and access to professional counselors. Results from a cross-sectional analysis found MHPSAs were highly correlated with suicide deaths. There was a significant inverse relationship between number of professional counselors in an area and suicide deaths, and being uninsured was highly related to MHPSA and suicide. The results support the need for access to professional counselors. Policies incentivizing professional counselors to work in MHPSAs are needed because of their potential role in minimizing suicide deaths.

Effects of Sexual Orientation, Disability, and Gender Identity on Others’ Prosocial Behavior

The theory of intersectionality posits that people possess multiple identities varying in the level of privilege and oppression. The current study assesses participants’ prosocial behavior toward a target possessing sexual, disability, and gender minority identities. Prosociality was measured using the validated and reliable dictator game. The authors predicted that targets with increased minority identities would receive less prosocial behavior from their partner than targets with fewer intersecting identities. Contrary to our hypothesis, it was found that participants were significantly more prosocial toward targets with a disability, than toward targets without. Consistent with our hypothesis, these researchers found that participants were significantly less likely to be prosocial toward targets who were gay than straight. These results have implications for rehabilitation counselors working with clients with intersecting marginalized identities. To the authors’ knowledge, this is the first study to experimentally explore observed prosocial behavior toward individuals with intersecting gender, disability, and sexual minority identities.

Counseling Psychology and the Amelioration of Oppression: Translating Our Knowledge Into Action

In the new millennium, counseling psychologists have answered the call to address oppression related to intersectional identities. We have played a major role in the development of practice guidelines and policies, as well as in the application of ethical principles in cultural contexts. The Counseling Psychologist has served to disseminate information addressing needs and interventions for diverse communities. In this article, we review the history and impact of our efforts to ameliorate oppression. The pressing challenges of economic and educational disparities are highlighted along with how counseling psychologists are uniquely situated to meet the needs of the underserved. Our research, training, and practice are anchored in methodological pluralism, global helping paradigms, participatory engagement, and the promotion of liberation and radical healing. We offer recommendations to deconstruct current models and reconstruct a decolonized approach, embrace interdisciplinary collaboration to fight cultural encapsulation, strengthen prevention and advocacy, train a culturally diverse workforce, and prioritize intersectional research.

White Supremacy and Counseling Psychology: A Critical–Conceptual Framework

The mainstreaming of White nationalism in the United States and worldwide suggests an urgent need for counseling psychologists to take stock of what tools they have (and do not have) to combat White supremacy. We review the rise of social justice issues in the field of counseling psychology and allied helping professions and point to the limits of existing paradigms to address the challenge of White supremacy. We introduce transnationalism as an important theoretical perspective with which to conceptualize global racisms, and identify White racial affect, intersectionality, and allyship as three key domains of antiracist action research. Finally, we suggest three steps for sharpening counseling psychologists’ approaches to social justice: rejecting racial progress narratives, engaging in social justice-oriented practice with White clients, and centering White supremacy as a key problem for the field of counseling psychology and allied helping professions.

Challenges in Promoting Race Dialogues in Psychology Training: Race and Gender Perspectives

Given today’s racial diversity and the ongoing racial tensions in our communities as a result of police shootings of unarmed Black men, terrorist acts in the United States and globally, and expressions of racism and xenophobia in the political arena, it is essential for psychologists to be culturally competent. Four diverse faculty members engaged in a self-study of their multicultural teaching practices to explore the challenges inherent in participating in authentic race dialogues. In this article, we discuss the findings from our independent and collective analysis of faculty narratives and provide recommendations for facilitating honest and courageous race dialogues in graduate psychology training.

Breaking Institutional Habits: A Critical Paradigm for Social Change Agents in Psychology

There is a growing concern in counseling psychology that the field is not matching its commitment to social justice with adequate preparation of social change agents. Compiling and building off of a uniquely interdisciplinary framework, this article offers an alternative way forward for psychologists and trainees. Recommendations include a reorientation to institutions in which psychologists are immediately embedded and a legitimization of direct-action methods.

Implementing Social Change: A Qualitative Analysis of Counseling Psychologists’ Engagement in Advocacy

In recent years, many counseling psychology training programs in the United States have adopted social justice principles into training. Although previous studies have provided thought-provoking discussions on social justice advocacy, they mostly reflected the voices of psychologists in academia; therefore, the advocacy work of practitioners has been neglected. In order to explore the advocacy experiences of counseling psychologists in practice, we utilized qualitative content analysis to analyze semistructured interviews with 11 practitioners who were trained in social justice-oriented counseling psychology doctoral programs. The findings were clustered under three domains: (a) participants’ development of a social justice orientation, (b) different ways of implementing advocacy in practice, and (c) positioning advocacy in psychology. The interviews depicted resources and challenges with regard to integrating advocacy into practice indicating that counseling psychologists continue to struggle with systemic barriers that limit their advocacy actions. We discuss implications for research, practice, and training in counseling psychology.

Confronting White Hegemony: A Moral Imperative for the Helping Professions

In this article, we respond to observations offered by Sue, Cross and Reinhardt, and Helms regarding the Major Contribution on White racial justice allyship. We focus on three interrelated themes that emerged across the reactants’ comments: (a) the field has made some progress since the early 1990s, but much more is needed, (b) White allies are few and far between, and (c) there is a moral imperative for the field to disrupt current training models that reinforce color-blind racial ideology. We conclude with some preliminary ideas on possible ways forward.

Make It Personal: A Qualitative Investigation of White Counselors’ Multicultural Awareness Development

In this qualitative research study, we explored the multicultural awareness development of 12 multiculturally adept non-Latino White counselors. Using a grounded theory approach, we found that early personal experience with diversity was the most important contributing factor in developing understanding and empathy for oppression among White counselors. This factor appeared to lay the foundation for an ongoing personal initiative to develop multicultural awareness. Subsequently, counselors tried to maximize what they could learn from their culturally diverse clients, work environments, coursework, supervision, and mentoring opportunities. Their personal initiative also inspired them to persevere despite the difficult emotions and conflict inherent in this developmental process. Results suggest the need to incorporate personally transformative experiences in counselor training and to prepare counselors for the emotional challenges of multicultural awareness development.

White Professors Teaching About Racism: Challenges and Rewards

One of the complexities of multicultural teaching is that course content inevitably relates to personal experiences of privilege and oppression among both students and professors. Even when professors have benefitted from their own multicultural training, teaching about race and racism presents particular challenges to different professors based upon their own social locations. In this article, we answer the following question: What personal and professional challenges can White professors expect when they work as social justice educators? The authors present relevant considerations and illustrate them with examples from their own teaching experiences.

Multicultural Counseling Meets Potentially Harmful Therapy

This reaction includes an appraisal of contributions, limitations, and questions raised in Wendt, Gone, & Nagata’s major contribution regarding potentially harmful therapy (PHT) and multicultural counseling. The authors are commended for initiating a convergent dialogue between the PHT and multicultural counseling literatures, creating a strong argument for their integration, and contextualizing the prior division. Commentary is provided in response to the narrow emphasis on an ethnoracial domain of culture, and suggestions for broadening the PHT/multicultural counseling dialogue through inclusion of multiple identities and intersectionality are provided. Greater integration of specific ethics codes and guidelines is also encouraged. Finally, future directions for consideration and study are posited, including the practicalities of researching harm within an integrated PHT/multicultural counseling framework, the necessity of working toward a refined definition of harm, and the manner through which the multicultural counseling perspective on addressing culturally based injury could augment existing PHT efforts to mitigate harm.

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.

Non-Traditional Teaching Methods That Promote Social Justice

This brief article serves as an introduction to the special issue of The Counseling Psychologist devoted to non-traditional teaching methods that promote social justice. We introduce the historical importance of social justice in the field of counseling psychology and discuss current events that maintain the need for further work in this area. We introduce the need for a focus on pedagogy that promotes social justice. We briefly summarize the manuscripts in the two special issue volumes and discuss the broad categories into which they fall. Finally, we call for further scholarship and action related to innovative teaching that promotes social justice.