Therapists' race and African American clients' reactions to therapy.

This study examines the posttherapy reactions and attitudes of 44 African American clients seen at a university clinic in a midwestern city. Clients were randomly assigned to European American or African American therapists for 10 sessions of interpersonal or problem solving therapy. Therapy attitudes and reactions were assessed through clients' ratings of how well they understood and accepted the goals of therapy, their ability to accept and make use of therapeutic interventions, and perceptions of therapeutic benefit. The impact of European American therapists' efforts to cope with racial differences through therapist-initiated discussion of race in the first session or no therapist-initiated discussion of race were examined. African American clients' ratings of therapy indicated that there was a relationship between therapists' race and the understanding and acceptance of therapeutic interventions and perceived benefit of therapy. Clients rated therapeutic understanding and acceptance higher when assigned to an African American therapist. Therapists' initiation of or noninitiation of discussions of race had no affect on ratings of therapy. The clinical implications of these findings and suggestions for future research are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

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)     

Racial microaggressions against African American clients in cross-racial counseling relationships.

This study examined the relationships among African American clients' perceptions of their White counselors with respect to (a) perceived racial microaggressions in cross-racial counseling relationships, (b) the counseling working alliance, (c) their counselors' general and multicultural counseling competence, and (d) their counseling satisfaction. Findings revealed that greater perceived racial microaggressions by African American clients were predictive of a weaker therapeutic alliance with White therapists, which, in turn, predicted lower ratings of general and multicultural counseling competence. Greater perceived racial microaggressions also were predictive of lower counseling satisfaction ratings. In addition, African American clients' perceptions of racial microaggressions had a significant indirect effect on these clients' ratings of White counselors' general and multicultural counseling competence through the therapeutic working alliance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceptions of European American and African American instructors teaching race-focused courses.

In 2 studies (N = 907), we developed and validated the Perceptions of Diversity Instructors (PDI-32) measure, which assesses college students' ratings of instructors teaching a race-focused diversity course. We also explored how the professor's race/ethnicity, students' attitudes toward similarities and differences, and perceived professor bias influenced students' ratings. Supporting the source effects outlined in the persuasion literature and prior qualitative research, the results indicated that students expect African American instructors to be more biased (subjective/judgmental) but assume European American instructors to have less content expertise (inexpert/unaware). Also, students who are more open to discussing diversity issues rated the instructors more positively. Finally, students' expectation of professor bias mediated the relationship between the professor's race/ethnicity and students' evaluations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

African American client skin tone and clinical judgments of African American and European American psychologists.

After reviewing a photograph and case materials depicting an African American female client, African American and European American psychologists were randomly assigned to one of three skin tone versions of a photograph (light, medium, or dark) and completed a questionnaire. No relationships were found between client skin tone or psychologist sex and either primary diagnosis or treatment recommendation. However, African American psychologists rated the client more physically attractive and likely to benefit from therapy, and they expressed more positive feelings about the client and about working with the client, than did European American psychologists, who more strongly endorsed severe mental disorder diagnoses for the client. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapists' experiences treating Asian American women with eating disorders.

How do psychologists treat eating disorders (EDs) and subclinical issues in Asian American women in a culturally competent manner? Disordered eating and body dissatisfaction are so common in women that most therapists work with the issues to some degree, and it is increasingly likely they will see women of color. Asian American women are at significant risk and yet little treatment literature exists. Twelve therapists with experience in ED treatment were interviewed about their work with Asian American women. Grounded theory and consensual qualitative analysis methods were used to analyze the data, resulting in two central domains of conceptualization within the cultural context and treatment approach. Therapists reported that their clients were mostly first- and second-generation Americans who experienced acculturation stress and cultural conflict, particularly with elders. Other results suggested therapists perceived a strong connection between clients' desires to be thin and successful, and clients' efforts to conform to traditional Asian cultural values and fit in with U.S. mainstream culture. Therapists emphasized the cultural contextualization of family dynamics, developmental processes (e.g., individuation), and intergenerational conflicts. They viewed EDs as providing clients with culturally congruent coping strategies to affectively disconnect and to express distress. Treatment themes centered on psychoeducation and the importance of including parents in the treatment of their adult daughters. Helping clients navigate autonomy within the family and cultural context, and challenging clients and parents on the cultural (both Asian and mainstream U.S.) pressures regarding achievement and beauty were particularly important. Implications for therapy are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Parental attachment, self-esteem, and antisocial behaviors among African American, European American, and Mexican American adolescents.

This study examined the relation of mother and father attachment to self-esteem and self-reported involvement in antisocial behaviors among African American (n=488), European American (n=661), and Mexican American (n=434) high school students. The attachment dimensions of anxiety and avoidance were examined using self-report scales that were developed and validated with participants in the study. Findings indicated that adolescents from the 3 ethnic/racial groups did not differ greatly in their reported attachment to father and mother. Consistent with theoretical formulations, securely attached adolescents from the 3 ethnic groups had a more positive sense of self-esteem and reported less involvement in antisocial behaviors than their less securely attached peers. (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)     

Coping Strategies of African American Adult Survivors of Childhood Violence.

To enhance recovery, counselors need to recognize the range of coping strategies used by African American clients. A retrospective qualitative study was conducted with 70 African American survivors of childhood violence. The primary goal of this study was to explore the use of coping strategies. Results indicated use of the following strategies: spirituality, community support, activism, creativity, confrontation, introspection, humor, therapy, safety precautions, desensitization, racial reframing/racial attribution, transcendence and temporal framing, and escapism. Clinical implications of these findings are discussed. By attending to these strategies, counselors will be more equipped to address the recovery process of African American survivors of childhood physical and sexual violence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An intersectional approach for understanding perceived discrimination and psychological well-being among African American and Caribbean Black youth.

The present study examined whether combinations of ethnicity, gender, and age moderated the association between perceived discrimination and psychological well-being indicators (depressive symptoms, self-esteem, and life satisfaction) in a nationally representative sample of Black youth. The data were from the National Survey of American Life, which includes 810 African American and 360 Caribbean Black adolescents. The results indicated main effects such that perceived discrimination was linked to increased depressive symptoms and decreased self-esteem and life satisfaction. Additionally, there were significant interactions for ethnicity, gender, and race. Specifically, older Caribbean Black female adolescents exhibited higher depressive symptoms and lower life satisfaction in the context of high levels of perceived discrimination compared with older African American male adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Drinking outcomes following drink refusal skills training: Differential effects for African American and non-Hispanic White clients.

Determining whether a particular treatment works for specific groups of people can help tailor dissemination of evidence-based alcohol treatments. It has been proposed that individuals from different racial groups might have better outcomes in treatments that are sensitive to sociocultural issues that impact alcohol use among these groups. The current study was a secondary analysis of data from the combined behavioral intervention (CBI) condition of the COMBINE study. Those randomly assigned to CBI (n = 776) had the opportunity to receive up to 9 skills training modules, which were chosen by the therapist. The goal of the current study was to determine whether receiving 1 of the CBI modules, drink refusal and social pressure skills training, predicted differential outcomes among African American clients. Results indicated that African American clients who received the drink refusal skills training module (n = 25) had significantly fewer heavy drinking days (d = 0.79) 1 year following treatment than African Americans clients who did not receive the module (n = 35). African American clients who received the module also had significantly fewer heavy drinking days (d = 0.86) than non-Hispanic White clients who received the module (n = 241). Good clinical outcomes at 1 year posttreatment were observed among 80% of African Americans who received the module, compared with 54% of African Americans who did not receive the module and 52% of non-Hispanic White clients who did receive the module. Although small sample size limits interpretation, findings provide preliminary evidence supporting the inclusion of drink refusal skills training as part of alcohol interventions for African American clients. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Beliefs about the prevalence of dissociative identity disorder, sexual abuse, and ritual abuse among religious and nonreligious therapists.

Four hundred ninety-seven Christian therapists and 100 members of the American Psychological Association returned questionnaires indicating the prevalence of dissociative identity disorder (DID), sexual abuse, and ritual abuse in their clinical practices. There was a low rate of diagnosing DID and ritual abuse among all respondents. Christian psychologists were slightly more likely to diagnose ritual abuse than other psychologists, but they were no more likely to diagnose DID or sexual abuse. No differences were observed in diagnosing ritual abuse or DID between Christian psychologists, other licensed Christian therapists, nonlicensed Christian therapists, and lay counselors. Licensed Christian therapists who are not psychologists reported a greater prevalence of sexual abuse among their clients than nonlicensed Christian therapists and lay counselors. Implications for clinical practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting cultural competence: Implications for practice and training.

Training and work experience with clients from diverse groups were examined among 266 recent PhDs in counseling and clinical psychology. Surveys were mailed to 600 participants who completed their graduate work between 1985 and 1987. Analyses examined which training variables predicted self-rated competence in providing services to various cultural groups. Results indicated that most therapists reported competence in working with diverse clients, but there was notable variability among ratings of therapists' self-perceived competence with different client groups. Exposure during training to working with clients from specific cultural groups was important in predicting therapists' current perceived competence. Most respondents reported accessing education and training experiences in providing services to diverse client groups. A small but troubling number of respondents reported seeing clients despite reporting low levels of competence with that client group. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of cross-racial/ethnic friendships in social adjustment.

The purpose of this study was to examine the frequency and correlates of cross-racial/ethnic friendships. The sample consisted of 509 (188 African American, 135 European American, 106 Asian American, and 80 Latino) children in 4th grade from 39 classrooms in several public elementary schools. The authors hypothesized that (a) the frequency of cross-racial/ethnic friendships would be different across races/ethnicities and (b) these friendships would be uniquely associated with social adjustment (relational inclusion, leadership). Results showed that European American children displayed a higher frequency of cross-racial/ethnic friendships than African American children. Compared with the sample average, Latino children exhibited a lower frequency of these friendships. Further, findings revealed that children who formed cross-racial/ethnic friendships were more likely to be viewed as relationally inclusive and possessing leadership skills by teachers. Overall, the results showed that cross-racial/ethnic friendships were associated with positive developmental outcomes and that future studies that examine how these friendships are formed and maintained, and how these pathways are related to social adjustment, are warranted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cultural themes in the psychotic symptoms of African American psychiatric patients.

Professional psychologists need to recognize ethnic/racial differences between African Americans and European Americans in psychotic symptom expression to treat individuals with severe mental illness from various cultural backgrounds. Specifically, they need to understand confluent paranoia or the interaction between culture and pathology in psychotic symptom expression. To assist mental health professionals, the present study identified cultural themes in the delusions and hallucinations of a sample of 156 African American psychiatric patients via content analysis. Race-related themes and religious themes were observed in the psychotic symptoms of these patients assessed with the Structured Clinical Interview for DSM IV. Race-related and religious content were manifested in different types of delusions. Race-related themes were more common in persecutory delusions, whereas religious themes occurred more often in other delusions. Race-related themes were associated more with delusions, while religious themes correlated with both delusions and hallucinations. Implications for the treatment of confluent paranoia in African Americans are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Applicability of cognitive-behavior therapy with American Indian individuals.

There is little empirical evidence to support the claim that cognitive- behavior therapy (CBT) is an especially suitable treatment for culturally diverse clients. The purpose of this study was to compare the applicability of CBT in a community sample of European American and American Indian individuals. Participants completed the Cognitive Behavior Therapy Applicability Scale (CBT-AS), in which they rated their preference for characteristics consistent with three tenets of CBT. European Americans rated a stronger preference for CBT's focused in-session behavior and structured therapeutic relationship than did American Indians. Both groups rated the active stance domain of CBT as mutually acceptable. On the basis of the findings, several modifications to CBT for therapists working with American Indian clients are proposed for future investigation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of racial perspectives and contextual variables on marital trust and adjustment for African American couples.

This study examined the associations of racial perspectives that represent pro-African American, anti-African American, or a mixture of these beliefs with marital trust and adjustment for African American couples (N=93). Religious well-being and socioeconomic status (SES) were examined as contextual moderators. For husbands only, the anti-African American perspective was inversely associated with couple functioning, the mixed perspective was inversely associated with marital trust, and the pro-African American perspective predicted marital trust only for husbands having relatively low religious well-being and relatively high SES. The limited effects of pro-African American attitudes suggest the need to evaluate a wider range of these attitudes in future research. Also, findings corroborate suggestions for therapists to routinely assess and address both cultural pride and shame issues relevant to African American couple relationships. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lay theory of race affects and moderates Asian Americans' responses toward American culture.

People may hold different understandings of race that might affect how they respond to the culture of groups deemed to be racially distinct. The present research tests how this process is moderated by the minority individual's lay theory of race. An essentialist lay theory of race (i.e., that race reflects deep-seated, inalterable essence and is indicative of traits and ability) would orient racial minorities to rigidly adhere to their ethnic culture, whereas a social constructionist lay theory of race (i.e., that race is socially constructed, malleable, and arbitrary) would orient racial minorities to identify and cognitively assimilate toward the majority culture. To test these predictions, the authors conducted 4 studies with Asian American participants. The first 2 studies examine the effect of one's lay theory of race on perceived racial differences and identification with American culture. The last 2 studies tested the moderating effect of lay theory of race on identification and assimilation toward the majority American culture after this culture had been primed. The results generally supported the prediction that the social constructionist theory was associated with more perceived similarity between Asians and Americans and more consistent identification and assimilation toward American culture, compared with the essentialist theory. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Race and the workforce: Occupational status, aspirations, and stereotyping among African American children.

This study examined whether African American children's perceptions of occupational status and their own vocational interests are affected by racial segregation of the workforce. Children (N = 92) rated familiar occupations with respect to status, desirability, and stereotyping. Children also rated novel jobs that had been depicted with African Americans, European Americans, or both African and European Americans. As predicted, for familiar jobs, children's judgments were linked to their knowledge of racial segregation of these jobs. In addition, novel occupations that had been depicted with African Americans were judged as lower in status than the identical occupations that had been depicted with European Americans, demonstrating a causal influence of workers' race on children's judgments. Children's age and socioeconomic background moderated their occupational judgments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)