Competencies have long been central to health service psychology education, with programs required by the Commission on Accreditation to demonstrate how students attain competence across multiple areas (Borden & McIlvried, 2020; Fouad et al., 2009). Competency training includes domains such as professional values, attitudes, behaviors, and communication and interpersonal skills-all of which connect to the broader and foundational competency of building relationships. Cultivating and assessing the relationship competency is essential to the practice, education, and research of health service psychology. Relationship is foundational in the National Council of Schools and Programs of Professional Psychology framework, supporting all other competencies (Mangione & Nadkarni, 2010; Peterson et al., 1997). Rather than existing as a discrete skill, it is the basis upon which other competencies are built. It involves the whole person-cognitively, emotionally, physically, and culturally-and is always contextual and dynamic. We redefine the relationship competency for future generations of health service psychologists and address some reconceptualization of psychology education and training in our approach, as we consider the Health Service Psychology Education Collaborative (2013) and the Task Force on Doctoral Competencies in Health Service Psychology models (Wright, Bergkamp, Grus et al., 2025). Reenvisioning this competency through antioppressive, socially conscious lens is essential. Being in a relationship with others enables psychologists to act as compassionate healers and ethical leaders. Its revitalization must include critical elements such as diversity, justice, decolonization, power, and ethics. How have these shaped relationships in classrooms, clinics, and communities over time?
The professional associations of psychology are calling on the field to address issues of power, privilege, and oppression in our clinical practice (American Psychological Association, n.d.). Similarly, a growing body of literature emphasizes the importance of understanding issues of socially conferred privilege within a historical context, with a specific focus on the legacy of our shared colonial mindset (G. Adams & Salter, 2019). As clinicians, this includes awareness of our social location and the privilege it confers compared to that of our clients (Kabasakalian-McKay & Mark, 2023). Much of the existing literature is theoretical, and the practice guidelines issued by our professional organizations are aspirational rather than mandatory. The need to move from aspiration to practice has yet to be fully articulated in the literature; hence, there is a vital need to begin with a model of case conceptualization. The aggregate model builds from the notion that nothing exists in and of itself but is instead an aggregation of parts that are always changing and recognizes the interwoven aspects of clients' and clinicians' lives (Aron, 1996; Walker, 2019). Offering a pragmatic framework for decolonial clinical case conceptualization, the model demonstrates the interdependent effects of the chronos, social location, and individual strata. This framework is applied to both, and a compare/contrast process produces deeper new insight and a decolonial understanding of the client and the therapeutic relationship. We will provide a theoretical basis for the aggregate model, a case study illustrating its application, and implications for professional practice, education, and training.
Burnout among mental health clinicians increases the likelihood of poor client care, engagement in unethical behaviors, and provider psychological distress. Prior to and during the COVID-19 Alpha variant, women mental health clinicians were more likely to report burnout than their counterparts who identified as men. This cross-sectional study aims to understand the relationship of burnout with workplace factors and experiences of workplace gender-based discrimination among women mental health clinicians. Participants (n = 172) were recruited from accredited programs and training sites over 10 days in June to July 2023. Burnout groups were established using the Copenhagen Burnout Inventory (Kristensen et al., 2005); relationships with the variables of interest were measured using the Decent Work Scale (Duffy et al., 2017) and an adapted single-item gender-based discrimination measure (McKinley et al., 2019). There were significant and practical differences in workplace factors, Lambda = .762, F(5, 166) = 10.365, p< .001, eta(p)& sup2; = .238, and workplace gender-based discrimination, t(160.014) = -3.247, p< .001, g = -.495, by work-related burnout group. These findings are imperative to informing interventions and strategies targeted at reducing women clinicians' burnout in mental health care settings. Public Significance Statement The findings of this study demonstrate the importance of workplace reforms in mitigating gender-based discrimination and poor workplace factors that correlate with burnout among women mental health clinicians. Prioritizing supportive policies, including parental leave policies, can enhance clinician well-being and effectiveness. In the aftermath of the pandemic, institutions must actively implement interventions aimed at reducing burnout. These changes are not only the legal and ethical imperative of workplaces but also necessary to improve client care.
At multiple points in forensic assessments, forensic mental health professionals may find themselves with compelling reasons to decline a referral or to opt out of an existing agreement to undertake or complete an evaluation. Starting with the initial point of contact with the referring party and then proceeding along the timeline of the unfolding assessment, reasons for considering withdrawing, as well as continuing, are identified, along with relevant major professional, ethical, and personal factors. Multiple approaches to decisions about withdrawing are discussed along with barriers to opting out.
As artificial intelligence (AI) systems continue to support the delivery of many psychological services, health service psychologists must ensure that they are used in an ethical manner. However, our extant literature has yet to fully articulate how psychologists might actually accomplish this goal. The purpose of this article was to offer psychologists an inventory that they might use to focus and put into practice the newly in-revision American Psychological Association [APA] (2024b) Ethical Principles of Psychologists and Code of Conduct with respect to the ethical application of AI. We developed this inventory in consultation with the emerging ethical recommendations regarding the use of AI in mental health, as well as those made within the field of AI science regarding how to ethically apply their technological developments. The first section of this article details each of the relevant codes governing the practice of psychology and what they mean for practitioners potentially employing AI in their practices. The second section of the article introduces the areas covered by the proposed inventory (see also Supplemental Materials). Finally, we discuss the implications that the use of AI has for the field of health service psychology.
This study evaluated the feasibility and acceptability of three brief, guided meditation interventions, distress-based, compassion-based, and self-compassion-based, delivered to psychologists over 3 weeks via audio recordings. Sixty-three psychologists participated, completing pre- and postintervention surveys assessing feasibility and acceptability. All interventions were feasible to implement within professional routines. Preliminary results from a Kruskal-Wallis test showed that the self-compassion-based program achieved a significantly higher score than the other two programs only in the acceptability subdomain of the acceptability measure, H(2) = 9.10, p = .01, indicating higher engagement, continuation likelihood, and satisfaction. Self-compassion may enhance empathic capacity by reducing personal distress and fostering emotional resilience, allowing clinicians to remain open and responsive to others' needs. These preliminary findings support integrating self-compassion practices into clinician well-being programs as brief, scalable tools for emotional support. Future studies should assess long-term outcomes, explore diverse samples, and compare delivery formats to enhance generalizability.
This study aims to analyze clients' sociodemographic characteristics (age and gender) and psychological distress before and during treatment, and to compare clinical outcomes between clients who experienced therapist transfer (transfer group) and those who did not (nontransfer group). This is a quantitative, nonexperimental, longitudinal study, conducting secondary analyses of data coming from a Practice-Oriented Research project in a naturalistic psychotherapy setting. Participants included 33 therapists and 60 clients from a psychotherapy training service; the clients were divided into a transfer (n = 30) and a nontransfer (n = 30) groups. Both groups had the same gender distribution (70% women and 30% men) and the same mean age of 21.23 years (SD = 2.74, range = 18-29). The results of the study showed that the transfer group attended more sessions (M = 19.33) compared to the nontransfer group (M = 10.40). Both groups showed significant reductions in distress scores over time, F(1, 58) = 40.01, p < .001, g = 0.22, with no significant differences between groups. Reliable improvement was identified in 46.7% of participants of both groups; however, only the transfer group showed cases of reliable deterioration (6.7%). The findings show that therapist transfers did not lead to statistically significantly worse psychological distress outcomes in clients from a psychotherapy training service. However, some transfer cases showed deterioration, this highlights the importance of building structured protocols to ensure safe transitions and support the adjustment phase with the incoming therapist.
Sexual and reproductive health is an essential component of wellness that remains understudied and largelyunincorporated in health service psychology training. As such, psychologists and other mental health prac-titioners are typically unprepared to address sexuality issues in their work. Early models provided neededguidance to trainers and practitioners in the pursuit of competence. Although these models incorporated someattention to systems, advocacy, and working across disciplines, they neglected to center the ways structuraloppression contributes directly to experiences of psychological and physical harm. We review four models ofcompetence for their applicability to sexual and reproductive health in health service psychology, particularly inconsideration of their relevance to structural competence. Last, we apply a model that more clearly centersstructural competence by considering the structures that shape clinical work, using more accessible language,translating culture to structure, being attentive to initiating structure interventions, and developing structuralhumility. We present a sexual and reproductive health focused case example with reflective questions to helpreaders consider how individual, deficit-focused perspectives can be improved by employing a structuralapproach to training and practice.
Culturally responsive training continues garnering attention within the psychological fields. Within the past decade, direct calls have been made to increase cultural competence among psychologists (Benuto et al., 2018; Chu et al., 2022). Nonetheless, culturally responsive training has proven increasingly difficult in health service psychology (HSP), as educators may not know where to look or how to approach the "theoretical versus practical" challenges. Frameworks such as critical consciousness (CC) inherently encapsulate ideologies and strategies in advocating and working against oppressive systems, which employ increased directive toward cultural competency. Focusing on training and development of CC and based within core tenets of liberation psychology and structural competency (J. Brown & Lengyell, 2023; Wilcox et al., 2024), we propose a new framework that guides HSP in fostering CC. System, Environment, Individual, Critical Consciousness (SEICC) is a framework developed to guide the advancement of understanding structural and culturally responsive care in HSP. The SEICC framework has been developed as a tool to assist HSP programs in the teaching and development of CC through providing tangible steps to address larger narratives (e.g., American Psychological Association core competencies), departmental considerations (e.g., hiring of critically conscious faculty), and training. Addressing differing levels of system and individual responsibility, while ensuring the onus does not lie solely among individualized efforts, SEICC seeks to empower autonomy while addressing system and environmental processes needed to foster sustainable growth. Assisting with utilization, we provide descriptive elements (case study) and suggestions (programmatic implementation) within a detailed examination of the individualized and collective elements of the SEICC framework.
This study investigates the complex relationships among assertiveness, trait anxiety, and early maladaptive schemas in a sample of 1,025 Greek adults. Assertiveness, defined as a communication style based on expressing needs and feelings honestly while respecting others, was assessed using the Rathus Assertiveness Schedule. Trait anxiety, characterized by a persistent tendency to experience anxiety in various situations, was measured through the State-Trait Anxiety Inventory. Early maladaptive schemas-deeply rooted cognitive-emotional patterns formed during childhood or adolescence-were evaluated using the Young Schema Questionnaire-Short Form 3. Using structural equation modeling, the hypothesized relationships were confirmed. Results indicated that the entitlement/grandiosity schema positively affected assertiveness, while trait anxiety, emotional inhibition, and subjugation negatively influenced assertiveness. Furthermore, several early maladaptive schemas, including negativity/pessimism and abandonment/instability, were found to positively influence trait anxiety. These findings indicate that targeting core maladaptive schemas may help reduce emotional distress and facilitate self-expression in individuals with low assertiveness and high trait anxiety.
Demand for psychological services in Australia is high, placing psychologists under considerable pressure. Although stress and burnout are common in this group, research has rarely applied theoretical frameworks to examine individual risk and protective factors. This study was therefore guided by the conservation of resources theory and the job demands-resources model. It explored links between perfectionistic concerns, burnout, and mental well-being among registered Australian psychologists, with a focus on the mediating role of self-compassion. Participants were recruited online through professional associations, social media, and direct email to 96 clinics. The final sample comprised 148 psychologists (126 women, 21 men, and one nonbinary; M-age = 42.9, SD = 12.9) who completed an anonymous online survey assessing perfectionism, burnout, mental well-being, and self-compassion. Results showed that 27% of participants met criteria for burnout and 25% reported low mental well-being. Regression analyses indicated that both perfectionistic concerns and self-compassion made significant, independent contributions to burnout. Self-compassion also partially mediated the negative impact of perfectionistic concerns on burnout. These findings suggest that perfectionistic concerns are an important contributor to burnout and that self-compassion may serve as a protective resource, reducing the effects of perfectionistic concerns and promoting well-being in psychologists. Public Significance Statement This study found that many Australian psychologists experience burnout and low mental well-being, particularly those with high levels of self-critical perfectionism. Importantly, psychologists who were more self-compassionate reported lower burnout and better well-being. These findings highlight self-compassion as a practical and accessible way to support psychologists' mental health and sustain the workforce under growing service demands.
Advocacy, a vital tool for cultivating individual and systems-level change, aligns with the ethical, professional, and social responsibilities of health service psychologists. It is imperative that psychologists engage in evidence-informed advocacy to promote human rights, advance mental health equity, disrupt systemic injustices, and encourage laws and policies that facilitate socially just communities. Despite its importance, advocacy participation remains low among health service psychology trainees and professionals due to a lack of instructional methods, limited knowledge about opportunities, competing time demands, and the field's uneven commitment to advocacy as a fundamental competency. To advance health service psychologists' capacity to embrace their professional identity as advocates and advocate effectively, this article proposes a capability-informed competency blueprint for integrating advocacy throughout health service psychology education, training, practice, research, and lifelong learning. Grounded in a scientist/scholar-practitioner-advocate model, this framework emphasizes that advocacy must be scientifically grounded, values driven, and ethical. Eight core subcompetencies are identified: developing an advocate identity, prioritizing self-reflection, empowering others, analyzing data and assessing needs, communicating effectively, collaborating with advocacy partners, engaging in systems-level change, and participating in policy development. Actionable strategies (didactic and experiential) are provided for implementing this framework across the professional lifecycle. We recommend a lifelong learning approach that prepares health service psychologists to apply their knowledge, skills, and attitudes flexibly to advance social change in partnership with others. Empirical study is needed to assess the effectiveness and outcomes of such advocacy efforts. Public Significance Statement Psychologists are uniquely positioned to create fairer, healthier communities, but many received little training in how to advocate for change. This article offers a practical roadmap that prepares psychologists to stand with individuals and communities, amplify marginalized voices, and influence policies that improve people's daily lives. Empowering psychologists to become effective advocates ultimately strengthens our collective ability to build more just and compassionate communities.
The repeated exposure to traumatic events that firefighters experience as a product of their work, results in an elevated risk to develop a trauma disorder. Despite this elevated risk, most firefighters do not develop clinically significant posttraumatic stress disorder. Still, it is postulated that most firefighters experience posttraumatic stress symptoms (PTSS). These PTSS, while not at the severity of warranting a posttraumatic stress disorder diagnosis, still manifest distress. Focusing on the factors that protect against all levels of PTSS may be more relevant as a means to decrease firefighter distress across the spectrum of experience. Yet, the protective factors that guard against negative trauma outcomes for firefighters are often ambiguous. To explore these potential protective factors, data were collected from 171 career and volunteer firefighters at both the district and state level. To explore the association with PTSS, the following variables were investigated: emotion regulation strategies (cognitive reappraisal and emotional suppression), social support, resilience, and years of experience. Using Pearson correlations and hierarchical linear regression analyses, emotion regulation strategies were found to weakly predict PTSS, while resilience and social support were the strongest negative predictors of PTSS. Years of firefighting experience did not have a statistically significant association with PTSS. These findings indicate that the construct of resilience and social support systems may buffer the negative effects of firefighter trauma exposure. Focusing on practical ways to strengthen the implementation of these constructs could prepare firefighters for the traumatic events they encounter on the job and potentially decrease the severity of PTSS. Public Significance Statement This study discusses the factors most likely to protect against negative posttraumatic stress for firefighters following exposure to occupational trauma. By identifying the best predictors of traumatic stress, there is a possibility to enhance the pragmatic implementation of preventative interventions in firefighter training and inform clinical practice.
The presence of faculty-trainee multiple relationships is inherent in the supervision and mentoring process that psychology trainees experience during professional training in the United States and Canada. Despite the pervasiveness of multiple relationships during training activities, limited attention has been given to this issue in recent research and ethics practice articles. The current article provides a detailed examination of the strengths and weaknesses of the American Psychological Association (2017) and Canadian Psychological Association (2017a) ethics codes on the issue of faculty-trainee multiple relationships. Attention is given to informed consent, confidentiality, and the clear use of decision-making models for the diverse range of complex multiple relationships that occur. As trainees hold less power in the faculty-trainee relationship, we call for greater attention to proactively considering and prioritizing trainee needs in situations where these may conflict with faculty or departmental interests. Faculty and departmental programs have a responsibility to prepare trainees for professional practice and ensure no harm occurs. This requires objectivity, fairness, and transparency by both departments and faculty, together with a strong focus on departmental culture, policies, and practices. We provide recommendations on how to manage such relationships from the unique perspectives of institutions, department training programs, faculty, and trainees.
Therapists frequently encounter clients seeking individual therapy for relationship difficulties while wishing to maintain their partnerships, yet significant gaps exist in clinical training to screen, assess, and intervene when intimate partner violence is present. This article examines the dangerous intersection of client and therapist biases that can compromise treatment effectiveness and safety. Individual therapy for couple problems occurs frequently but lacks empirical validation and may produce iatrogenic effects when therapists inadvertently validate biased client narratives without systemic understanding. Research demonstrates that relationship perceptions are systematically distorted by protective psychological processes, with biases becoming particularly pronounced in violent relationships. We propose a comprehensive clinical framework encompassing information gathering, bias recognition, case conceptualization, and intervention planning. Practice, training, policy, and research implications are discussed along with ethical considerations.
