Diversity within African American, female therapists: Variability in clients' expectations and assumptions about the therapist.

Despite the presence of some literature that has addressed the characteristics of the African American female therapist, most psychotherapy training proceeds with the assumption that therapists are members of dominant groups, and most of the psychological and psychotherapy literature has been written by therapists and psychologists who come from dominant cultural perspectives. Not as much has been written about psychological paradigms or the process of psychotherapy from the perspective of the therapist who is not a dominant group member. This article explores both the common and divergent experiences that we, the authors, share as African American female therapists and the different reactions we frequently elicit in clients. We also explore how individual differences in our physical appearances, personal backgrounds, and different characteristics of our respective practices elicit distinct responses from clients that we believe are based on differences between us, despite the fact that we are both African American women. We believe that many of the stereotypes that affect perceptions of African American female clients also exist for African American female therapists. We will address how the intersection of gender, race, and sexual orientation of the client highlights the complexity of culturally competent practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapists' reactions to treatment of survivors of political torture.

Working with survivors of political torture and war trauma can trigger strong emotional responses in the therapist. As more survivors seek treatment, it is essential to identify and develop robust support systems for therapists who help their clients confront nearly unspeakable experiences. The emotional reactions of 6 psychotherapists who worked with traumatized survivors in a refugee treatment center were explored. The psychotherapists' reactions were compared with those of therapists who worked in different treatment settings with other presenting problems. The results of the study show that the strong level of responsibility therapists feel for their traumatized clients may hide an emotional strain and may lead to burnout. Suggestions are offered for supporting therapists in this difficult but important work. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

African American and European American therapists' experiences of addressing race in cross-racial psychotherapy dyads.

Using Consensual Qualitative Research, 12 licensed psychologists' overall experiences addressing race in psychotherapy were investigated, as were their experiences addressing race in a specific cross-racial therapy dyad. Results indicated that only African American psychologists reported routinely addressing race with clients of color or when race was part of a client's presenting concern. European American psychologists indicated that they would address race if clients raised the topic, and some reported that they did not normally address race with racially different clients. When discussing a specific cross-racial dyad, African American therapists more often than European American therapists addressed race because they perceived client discomfort. Only European American therapists reported feeling uncomfortable addressing race, but therapists of both races perceived that such discussions had positive effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health service utilization among African American and Caucasian mothers and fathers.

Mental health services have been routinely underutilized. This study investigated the influence of parents' gender, race, and psychopathology on perceived barriers and attitudes toward mental health utilization for themselves and for their children. A unique contribution of this study is the examination of father, mother, and child factors influencing service utilization from the parents' perspective. A total of 194 African American and Caucasian parents were recruited from the community to participate. Parents completed measures on barriers and attitudes toward treatment for themselves and for their children, history of mental health service utilization for themselves and for their children, and their own current psychological symptoms. Results indicated that 36.3% and 19.4% of parents and children, respectively, had used mental health services during their lifetime. Parents perceived fewer barriers and had more positive attitudes toward seeking services for their children than for themselves. Race and gender differences were found in parents' perceptions of barriers and attitudes toward treatment. Furthermore, barriers, attitudes, and psychopathology predicted parents' plans for future utilization of mental health services. The clinical implications of this study and directions for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Meta-Analytic Review of Racial-Ethnic Matching for African American and Caucasian American Clients and Clinicians.

A meta-analysis was conducted to evaluate the effectiveness of client-clinician matching on the basis of race-ethnicity on overall functioning, service retention, and total number of sessions attended for African American and Caucasian American adult populations in mental health services. The analysis included 10 published and unpublished studies between 1991 and 2001. A random effects meta-analysis model showed no significant differences between client-clinician dyads matched racially-ethnically and those dyads not matched with respect to overall functioning, service retention, and total number of sessions attended. The finding was consistent for both African American and Caucasian American clients. Further implications of the findings are discussed. The authors also encourage more complete reporting of data suitable for quantitative research synthesis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

African Americans' Perceptions of Psychotherapy and Psychotherapists.

Do you have a multicultural practice? Do you understand the attitudes and expectations African Americans hold about mental health services? The attitudes and beliefs of 201 African Americans regarding psychotherapists, psychotherapy, and barriers to treatment were explored by means of focus groups. Key banners to service utilization included stigma, lack of knowledge, lack of affordability, lack of trust, impersonal service, and lack of cultural understanding. Participants reported that race should not matter in therapy, but they often believed that psychologists were insensitive to the African American experience. The implications of participants' reports for meeting African American mental health and therapy needs are considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Managed mental health care: The client's perspective.

Changes in psychotherapy services have been the focus of controversy between psychologists and the managed-care industry, yet too seldom have client preferences been directly heard in that debate. This study investigated consumer attitudes about the central elements of psychotherapy service delivery by 3 participant groups: self-pay clients, managed-care clients, and adults without therapy experience. Important differences of opinion were found among participant groups, yet results revealed that all 5 elements investigated were considered essential. Autonomy in treatment decision-making was ranked most important, followed by choice of therapist, copayment amount, limits to confidentiality, and ease of access to care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological distress, acculturation, and mental health-seeking attitudes among people of African descent in the United States: A preliminary investigation.

This article investigates the relationship between psychological distress, acculturation, and help-seeking attitudes among people of African descent (N = 130). Psychological distress was measured using the Global Severity Index from the Brief Symptom Inventory (L. R. Derogatis & N. Melisaratos, 1983), acculturation was measured using the Measurement of Acculturation Strategies for People of African Descent (E. M. Obasi, 2005), and help-seeking attitudes were measured using the Attitudes Toward Seeking Professional Psychological Help scale (E. H. Fischer & J. I. Turner, 1970). Overall, as psychological distress increased, attitudes toward seeking professional psychological services became more negative. The negative relationship between psychological distress and confidence in therapist was significantly stronger for participants who expressed a cultural maintenance of traditional beliefs. Future directions for this body of research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Keeping It Real: A Grounded Theory Study of African American Clients Engaging in Counseling at a Community Mental Health Agency.

Few studies have examined African American clients' subjective experiences in counseling from their perspective. This study used a constructivist paradigm, grounded theory methodology, and dimensional analysis to develop a model of clients' subjective experiences in counseling. Derived from clients' perspectives, the model suggests that the African American participants in this study engaged in an ongoing assessing process. Initially, they assessed client-therapist match, which was influenced by 3 factors: salience of Black identity, court involvement, and ideology similarity between client and therapist. These clients then assessed their safety in therapy and their counselor's effectiveness simultaneously. Clients in turn used information obtained from their assessing process to monitor and manage their degree of self-disclosing along a continuum. The model has important implications for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Race differences in psychopathology and disparities in treatment seeking: Community and jail-based treatment-seeking patterns.

Whites in community samples use mental health services at a much higher rate than African Americans (Kessler et al., 2005). Is this also the case among those in jails? In this study of jail inmates (229 African American, 185 White), there were no race differences in the overall need for mental health treatment (63% of participants had significant symptoms on the Personality Assessment Inventory), but race differences in the level and types of symptoms were evident. In addition, although Whites were more likely to report preincarceration treatment, there were no differences in treatment seeking or access to mental health programs while in jail, implying that if barriers to treatment in the community were removed (cost/insurance, location/transportation, time), racial disparities in treatment utilization may be reduced. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The regulation of explicit and implicit race bias: The role of motivations to respond without prejudice.

Three studies examined the moderating role of motivations to respond without prejudice (e.g., internal and external) in expressions of explicit and implicit race bias. In all studies, participants reported their explicit attitudes toward Blacks. Implicit measures consisted of a sequential priming task (Study 1) and the Implicit Association Test (Studies 2 and 3). Study 3 used a cognitive busyness manipulation to preclude effects of controlled processing on implicit responses. In each study, explicit race bias was moderated by internal motivation to respond without prejudice, whereas implicit race bias was moderated by the interaction of internal and external motivation to respond without prejudice. Specifically, high internal, low external participants exhibited lower levels of implicit race bias than did all other participants. Implications for the development of effective self-regulation of race bias are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Guess who's coming to therapy? Getting comfortable with conversations about race and ethnicity in psychotherapy.

Despite the fact that clinical psychology training programs now typically offer course work in multicultural issues, many professional psychologists may continue to feel unsure about how and when to incorporate multicultural awareness into their everyday clinical work. Having open discussions with clients regarding issues of race and ethnicity is one way to actively include a multicultural element into psychotherapy, as well as to strengthen the therapeutic alliance and promote better treatment outcome. The authors make several recommendations designed to provoke thought and stimulate conversation about race and ethnicity in the context of psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of African American and European American adolescents' endorsement of race-conscious social policies.

To examine the predictors of adolescents' evaluations of affirmative action and school desegregation policies, African American and European American students (ns = 94 and 116, respectively; aged 14 to 17 years) attending a racially diverse high school in the Midwestern United States completed measures of (a) implicit racial attitudes, (b) knowledge about historical racism, and (c) perceptions of and attributions for racial disparities. The following day, adolescents learned about either a proposed affirmative action policy (n = 101) or a school desegregation policy (n = 109) and completed measures of their attitudes toward the policy. Results indicated racial differences in policy support and in the factors predicting policy support. Theoretical implications of the findings are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The impact of extratherapeutic encounters: Individual reactions to both hypothetical and actual incidental contact with the therapist.

Participants (N = 763) responded to a hypothetical scenario in which they imagined encountering their therapist outside of the therapy setting. The intimacy of the setting (i.e., anonymous vs. intimate encounter) and the perceived success of the therapy (i.e., helpful vs. unhelpful) were manipulated between subjects. Based on a principal components analysis of participant reactions to these hypothetical scenarios, 4 subscales were derived: “Acknowledgement,” “Violation of Expectations,” “Awkwardness and Discomfort,” and “Professional Responsibility.” Results indicate that reactions to the hypothetical encounter on these subscales were related to both the setting and the success of therapy. In general, participants indicated that they preferred acknowledgment from their therapists, especially in less intimate settings. However, Asian Americans, in contrast to European Americans, indicated less desire for acknowledgment and greater perceived expectation violations. Implications for psychotherapy process and training of clinicians are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relation of pain and depression with various health-promoting behaviors in African American elders.

Purpose/Objective: In this study, the authors investigated how presence of pain interferes with various health behaviors in a sample of urban African American elders, examining depression as a potential mediator. Research Method/Design: 74 African Americans over the age of 60 years and residing in Detroit participated in both self-report questionnaires and physical performance measures. Regression analyses were used to determine the effect of pain interference on health behaviors, and partial correlations were used to determine whether depression mediated the relations. Results: The authors found that pain interference was significantly related to physical functioning and frequency of aerobic exercise. The latter relation (pain interference and frequency of exercise) was partially mediated by depression. Conclusions/Implications: Given these findings, the effect of pain interference on health behaviors is neither simple nor direct, and depression may be a key variable. Identification and treatment of pain and depression in older persons may reduce physical impairment and health care costs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of full-day and half-day workshops for health care providers in techniques for increasing resistant clients' motivation.

Are psychotherapy training workshops worth the time and money? The current study examined the effectiveness of 3-hr and 6-hr versions of a workshop for health care providers in techniques for increasing motivation in resistant clients. Role plays were used to examine pretraining and posttraining behavior of graduate student and clinician participants from various health care fields. Both workshops were associated with higher levels of workshop-consistent behavior and lower levels of workshop-inconsistent behavior. Degree status (student or clinician) and openness to the material were not related to these changes. Results suggest potential guidelines for clinicians to determine whether a training opportunity would be useful. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gay and bisexual male clients' perceptions of counseling: The role of perceived sexual orientation similarity and counselor universal-diverse orientation.

A recurring question in multicultural counseling is whether client–counselor similarity on sociodemographic characteristics benefits counseling. A related issue is how counselor orientation to diversity relates to counseling process and outcome, both as a main effect and in interaction with counselor–client sociodemographic match. This cross-sectional study investigated these questions in relation to gay and bisexual male clients' counseling experiences by examining clients' perceived similarity to their counselor in sexual orientation, as well as counselors' self-reported orientation to diversity (assessed in terms of level of universal-diverse orientation [UDO]). Data were from 83 male–male client–counselor dyads recruited from lesbian/gay/bisexual-affirming counseling practices, where clients identified as gay or bisexual and counselors identified as gay, bisexual, or heterosexual. Counselor UDO was positively and uniquely associated with client ratings of the working alliance, session depth, and session smoothness. Perceived sexual orientation similarity was not directly related to any of the counseling-related criterion variables. Moreover, when counselors reported low levels of UDO, perceived similarity was negatively associated with the client-rated alliance and perceived improvement. Client religious commitment—a control variable in all analyses—was uniquely and negatively associated with client ratings of perceived improvement in counseling. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Using culturally sensitive theories and research to meet the academic needs of low-income African American children.

The economic and social barriers to the academic and social success of many African American children remain in place as the new millennium begins. These realities provide impetus for developing community-based partnership education programs designed to self-empower African American children for academic and social success under any socioeconomic conditions that exist in their lives. Progress toward effective program development, however, has been hindered by a dearth of culturally sensitive theories and research. The Research-Based Model Partnership Education Program (Model Program) is an effective, community-based, university-school-community partnership education program for self-empowering African American children for success. The formative and summative research of the Model Program is described in hopes of advancing theory and research for meeting the academic and social needs of low-income African American children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The professional preparation of African American graduate students: A student perspective.

Even though growth relationships include traditional aspects of academic mentoring, without emphasizing personal development, professional growth is incomplete. Most African American faculty are overloaded with teaching, research, and advising responsibilities and, therefore, are unable to adequately mentor African American graduate students without jeopardizing their careers. Non-African Americans can provide adequate mentoring to African American students; however, because of the lack of a common cultural context, obstacles exist in cross-cultural mentoring relationships. By portraying the growth relationships established between an elder and 2 young professionals, this study illustrates how the involvement of non-academic affiliated African American professionals with African American graduate students is beneficial and indeed essential in the students' academic and personal development. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Autonomic responses and their relationship to race attitudes.

Slides showing Negroes elicited greater GSR in Ss having scale-measured prejudice. But the sex of the S also was a factor. "Autonomic activity may be considered as another dimension of attitudinal behavior to be considered along with the verbal and overt action dimension." (PsycINFO Database Record (c) 2010 APA, all rights reserved)