The goal of the current study was to experimentally manipulate perceived overqualification (POQ) among a sample of therapists and assess this manipulation’s effect on task meaningfulness, positive affect, and negative affect. To conduct the experiment, we had participants read a clinical case vignette and then randomly assigned them to answer questions using their specialized clinical skills (control group) or using simple recall and transcription (perceived overqualification group). The POQ group reported significantly greater perceived overqualification and significantly less task meaningfulness than the control group. Perceived overqualification also mediated the relation between the experimental condition and task meaningfulness. The groups did not differ on positive or negative affect. Results support previous research and theory suggesting that perceived overqualification can have deleterious effects on job attitudes, which has implications for organizational and individual interventions.

Objective: To explore the relationship between international students' social support at intake and international student distress at end of treatment. Participants: Data was collected from participants (n = 40,085) from 90 United States universities using the Center for Collegiate Mental Health (CCMH) database. Methods: Participants completed measures of psychological distress and perceived social support. Using multilevel modeling, we predicted participants' distress at end of treatment by international student status, social support, race, and length of therapy. Results: We found that international students who reported lower social support at intake ended treatment with higher levels of psychological distress when distress at intake was controlled compared to United States peers. Conclusions: Understanding the significance of social support for international students can help to inform mental healthcare professionals' approach to psychotherapy.

Doctoral students from low-income and economically marginalized (LIEM) backgrounds face unique structural and psychosocial challenges in their programs. Specifically, emerging theories posit that LIEM doctoral students experience interpersonal classism and status uncertainty as they adjust to their new social class contexts (Destin et al., 2017; Garriott, 2020). In turn, these experiences likely affect their sense of belonging and downstream academic outcomes. Therefore, the aim of the present study was to test the relations among interpersonal classism, status-based identity uncertainty (SBIU), belonging, and academic outcomes in a sample of U.S. doctoral students from LIEM backgrounds. While SBIU did not predict the outcomes, interpersonal classism predicted graduate program satisfaction and dropout intentions via belonging. These results suggest the importance of belonging to the academic success of doctoral students from LIEM backgrounds and how experiences of interpersonal classism might erode these students' sense of belonging. Implications for researchers and higher education institutions are discussed.

A common assumption is that upward mobility produces positive psychological outcomes. However, status-based identity framework and social class worldview model propose that perceived social mobility in either direction will lead to increased distress. Based on this claim, we examined relations among subjective social mobility, life satisfaction, and mental health using polynomial regression with response surface mapping. In Study 1, groups that experienced both subjective downward and upward mobility reported more depressive symptomatology than groups that remained in middle or upper social statuses in a sample of 567 adults. We did not find significant relations between subjective social mobility and life satisfaction. In Study 2, both groups that experienced subjective downward and upward mobility reported more depressive and academic distress symptomatology than groups that remained in middle or upper social social statuses in a sample of 7,598 clients from college counseling center data. The results provide insights relevant to multicultural counseling and training.

The working alliance is routinely touted, and empirically supported, as a common factor and robust predictor of decreases in psychological distress. However, advances in more balanced, positively-oriented perspectives in psychotherapy have led to calls to conceptualize therapeutic success as both the decrease of distress and the increase of positive factors. One such positive characteristic that may be enhanced during psychotherapy is positive affect. Engendering positive affect has been considered a common process to psychotherapy but remains underexplored in relation to therapeutic processes common across. If the alliance is a robust predictor of decreases in distress, it may also predict increases in positive affect. To explore this hypothesis, we collected data for this naturalistic psychotherapy study from a doctoral training clinic. Participants (N = 102; 1,118 sessions) completed measures of positive affect, distress, and the alliance at every session. Using multilevel modeling, we disaggregated distress and alliance coefficients into within-participant and between participants effects. Accounting for session number as a linear growth covariate, we found that increases in participants' perceptions of their alliance with their therapists significantly predicted increases in positive affect over the course of treatment. We confirmed the multilevel result using cross-lagged panel modeling via SEM, which indicated that increases in the alliance predict increases in positive affect. The alliance, though a meaningful predictor of distress reduction, is a common factor useful in predicting more than distress reduction alone. Implications for a more balanced conceptualization of outcome and applying positive psychology to psychotherapy are discussed.

We employed a convergent mixed methods design to examine therapist and counseling center effects on international student clients' (ISCs) counseling outcomes. Using the Center for Collegiate Mental Health (CCMH) data set (2015-2017), we conducted a three-level hierarchical linear model with clients (N = 85,110) nested in therapists (N = 1,267), and therapists nested in counseling centers (N = 111), with clients' international status predicting distress (DI) in their last sessions while controlling for initial DI. Compared to domestic students, the average last session DI was significantly higher among ISCs. Random effects were significant, suggesting that some therapists and centers were more effective in their work with ISCs than others. When the proportion of ISCs seen was accounted into the model, we found a cross-level interaction in which the last session DI differences between ISCs and domestic students were significant for centers seeing a small percentage of ISCs but not for centers with large percentages of ISCs in the caseload. Grounded theory analysis of qualitative data from 11 therapists with international backgrounds revealed therapist and center factors that converged with our quantitative findings. Participants reported adhering to general clinical frameworks when working with ISCs given the lack of training on international competence (which may help explain the effectiveness gap), but also noted nuanced culturally-informed components that likely contribute to more effectively working with ISCs. Findings around center effects were complemented by qualitative results emphasizing systemic representation and engagement with diversity, creative outreach efforts, and administrative/leadership support. Implications for practice and research are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

In this mixed methods study, we examined the integration of therapy practice in a predominantly academic career. Licensure records pertaining to 421 faculty members in 66 counseling psychology programs accredited by the American Psychological Association indicated that 65.5% of faculty were licensed, with those in Psy.D. programs and on the tenure-track likelier to be licensed. Data from an online survey of 66 counseling psychology faculty indicated that 76.7% of respondents were licensed, but only 43.8% provided psychotherapy. Open-ended survey responses suggested factors that facilitate (e.g. department support) and hinder (e.g. teaching obligations) engagement in practice for counseling psychology faculty. Phenomenological analysis of the experiences of five academic counseling psychologists who remain engaged in clinical practice elicited 223 meaning units grouped into five themes: (a) a core component of professional identity, (b) remaining in practice makes me a better academic, (c) encouraging therapy practice in academia, (e) forging one's path to therapy practice, and (f) barriers to practicing therapy as an academic. Implications of the finding are discussed in the context of integrating science and practice.

Researchers have demonstrated links between general hope and symptoms of distress. Findings like these are important given the conceptual role of hope in psychotherapy theories like Frank and Frank’s contextual model. Existing literature, however, has involved researchers employing general hope measures despite hope being variable across domains rather than a general trait. The purpose of this study was to explore the relationships between hope for counseling and clients’ outcomes as well as the working alliance. Self-report data were collected from 103 clients in a doctoral training clinic. Evidence (from multilevel modeling) demonstrated that increases in working alliance predict increases in hope for counseling over the course of treatment and that increases in hope for counseling significantly predict decreases in distress over the course of counseling when working alliance and session number are controlled. We discuss implications for clinical practice and positively-oriented work in counseling psychology.

Researchers have suggested that people with refugee status have heightened rates of western-defined psychiatric symptoms. Following this evidence, treatments have been adapted with the intent to foster culturally competent service provision for members of refugee communities. Absent in this research is attention to how clinicians address diverse beliefs about illness constructed within the cultures of refugee individuals. As such, even adapted treatments may not readily integrate beliefs about illness espoused in these communities into counseling. The purpose of this descriptive phenomenological study was to explore the meaning mental health care providers ascribe to integrating refugee individuals' cultural beliefs about illness and treatment into counseling. Interviews (N = 8) were analyzed accordant with descriptive phenomenology. Four themes were identified: (a) Presenting Concerns, Stigma, and Expectations, (b) Centering Diverse Explanations of Distress, (c) Shifting the Work to Connect, and (d) Language as Barrier and Opportunity. The themes represent the meaning that participants ascribed to focusing on what their clients from refugee communities bring to treatment and the value of centering their explanations of distress. Further, they expressed the clinical value of changing how they work and the difficulty as well as benefit of language in treatment. The value of integrating diverse illness beliefs into counseling from a multiculturally oriented perspective is discussed.

Anti-Black racism is often overlooked in predominantly White spaces such as psychotherapy. This pervasive disregard and dehumanization reflects the perpetuation of ongoing racial trauma that can influence the psychological health of Black people seeking psychotherapy. Therapists, therefore, ought to be equipped and comfortable to have conversations about anti-Blackness and anti-Black racism in sessions, though evidence suggests they are often uncomfortable discussing race and racism in practice. To understand therapists’ comfort when clients discuss anti-Black racism, we used a multiple case study approach to interview five practicing clinicians (2 White, 2 Black, 1 biracial Asian and White). Within-case analysis elicited a sense of participants’ personal experiences of being comfortable, and at times less so, when clients discussed having endured anti-Black racism. Cross-case analysis led to the identification of four themes: (a) Beyond Acknowledgement, (b) Drawing Personal Awareness into the Moment, (c) Engaging with One’s Own Emotional Responses, and (d) I Am versus I Should: Proactive and Reactive Comfort. These findings are discussed within the scope of multicultural competence, multicultural orientation, and the value of cultural comfort when clients’ discuss anti-Black racism.

Misunderstandings about qualitative methods, whether phenomenological or otherwise, are prevalent in social science research. Such misunderstandings leave researchers, reviewers, and editors less equipped to conduct or evaluate this method. Evaluation of phenomenology is especially complicated given the different variants that exist and the need for flexibility within these studies. Methodologists have created guides for conducting specific variants of phenomenology; however, these do not provide clear guidance as to what is an adequate sample in phenomenology. The purpose of this systematic review was to help improve implementation of phenomenological methods by exploring sample issues as they relate to study quality. We implemented an explanatory sequential mixed methods design to test relationships between samples and studies’ quality then deepen our understanding of these findings with a focused content analysis. First, we reviewed and coded 200 manuscripts following the PRISMA method. Larger samples were associated with lower quality and studies aligned with a specific phenomenological method tended to be of higher quality. Second, we identified two cases from the studies reviewed and subjected them to deductive qualitative content analysis to identify features that demonstrate quality. Findings are discussed with respect to implications for phenomenological methods in social and health sciences.

The extent to which therapists are comfortable discussing clients' cultural identities in psychotherapy has been considered a valuable component of how therapists integrate clients' cultures into treatment. Cultural comfort specifically reflects a therapist's way of being at ease, relaxed, and open when discussing clients' cultural identities in treatment. Some initial research has demonstrated the relationships between cultural comfort and clinical outcomes, yet this work has relied largely on cross-sectional designs. The purpose of this preliminary study was to use longitudinal psychotherapy data to explore the relationships between clients' perceptions of their therapists' cultural comfort and clients' distress over the course of psychotherapy. Data were collected from 48 clients who attended 476 sessions in a doctoral training clinic. Multilevel modeling was used to account for the nested nature of the data. Results showed that, when session number was held constant, within-client increases in their perceptions of their therapists' cultural comfort were predictive of decreases in psychological distress. We discuss these findings in light of the multicultural orientation literature and with respect to the implications for therapists striving to be comfortable with culture in sessions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Evidence-based practice necessitates the inclusion of client identity and contextual information when conceptualizing diagnosis. OBJECTIVE To examine how therapists' perceptions of Generalized Anxiety Disorder is influenced by client environmental contextual and identity factors, like class and race. METHOD Therapists (n = 138; 76% women; Mage  = 38.3) were randomly assigned three of six client vignettes and asked to provide diagnostic recommendations, confidence in diagnosis, and perception of client's concerns. Vignettes differed in their description of client class, race, and contextual factors. A linear mixed-model was used to test confidence in diagnosis and generalized linear mixed-models were conducted to predict diagnosis and client concerns. RESULTS Therapists altered diagnosis, confidence, and client concerns based on client contextual factors-but not identity factors. CONCLUSIONS Therapists consider contextual factors in making clinical decisions, with overall tendency towards diagnosis regardless of if symptoms met the diagnostic criteria of being "excessive" given the environmental context.

Understanding the clinical utility of positive client characteristics like resilience can help bring a balanced perspective to psychotherapy in which clinicians work to alleviate distress and foster positive traits. Existing literature documents the value of resilience as a resource to navigate stressful life experiences. However, minimal research has explored the utility of resilience within psychotherapy. The purpose of this meta-analysis was to understand the relationships between clients' resilience and distress as well as the influence of psychotherapy on resilience. PRISMA procedures led to the identification of ten studies meeting inclusion criteria. We conducted two random-effects model meta-analyses to understand the relationship between clients' resilience and distress (n = 5) and understand how psychotherapy treatment influences changes in resilience (n = 6). For both analyses, we found moderate effect sizes demonstrating that (a) there appears to be an inverse relationship between resilience and psychological distress and (b) resilience appears to increase during psychotherapeutic intervention. Findings are discussed in light of the role resilience may play in psychotherapy. The disperse operationalization of resilience is also discussed.

This article seeks to demonstrate the effectiveness of an age-specific, manualized self-regulation treatment approach, Self-Regulation Training System (SRTS). SRTS interventions were implemented through waitlist control design over a span of two months to students in fourth grade classes from eight different elementary schools in the Midwestern United States (N = 373). The sample comprised of 52% boys, with an average age of 9.25 (SD = 0.45). A significant increase in average teacher-reported self-regulation scores was observed in both waitlist and experimental groups after the intervention was administered. In addition, students' problem behaviors increased in the waitlist group when students had not received the intervention and remained stable once students experienced the intervention in both the experimental and waitlist conditions. Overall, the results provide initial evidence that the classroom wide interventions like the SRTS may be helpful in promoting self-regulation skills in children. Interventions such as the SRTS provide a feasible way for schools to promote self-regulation skills and influence problem behaviors in the classroom.

Hope is a critical component of therapeutic change. However, hope does not singularly emanate from clients. Therapists’ hope for their clients represents a specific therapeutic factor that may impact clinical outcomes. Currently no measure exists to assess the uniqueness of therapist’s hope in therapy with specific clients. Our purpose in this study was to develop and initially validate the Therapist Hope for Clients Scale (THCS). Participants ( N = 380) completed the THCS, plus four additional measures to assess therapists’ use of clients’ strengths, self-efficacy in helping skills, working alliance with individual clients, and a general measure of hope. We subjected the THCS to parallel analysis, factor analyses, reliability testing, and validity testing. These steps led to the development of a 10-item measure. THCS scores were positively related to therapists’ use of clients’ strengths, helping skills, self-efficacy, and working alliance. Implications of the THCS are discussed.