Building on recent theory stressing multicultural orientation, as well as the development of virtues and dispositions associated with multicultural values, we introduce the construct of cultural humility, defined as having an interpersonal stance that is other-oriented rather than self-focused, characterized by respect and lack of superiority toward an individual's cultural background and experience. In 4 studies, we provide evidence for the estimated reliability and construct validity of a client-rated measure of a therapist's cultural humility, and we demonstrate that client perceptions of their therapist's cultural humility are positively associated with developing a strong working alliance. Furthermore, client perceptions of their therapist's cultural humility were positively associated with improvement in therapy, and this relationship was mediated by a strong working alliance. We consider implications for research, practice, and training.

The study of humility has progressed slowly due to measurement problems. We describe a model of relational humility that conceptualizes humility as a personality judgment. In this set of 5 studies, we developed the 16-item Relational Humility Scale (RHS) and offered initial evidence for the theoretical model. In Study 1 (N = 300), we developed the RHS and its subscales--Global Humility, Superiority, and Accurate View of Self. In Study 2, we confirmed the factor structure of the scale in an independent sample (N = 196). In Study 3, we provided initial evidence supporting construct validity using an experimental design (N = 200). In Study 4 (N = 150), we provided additional evidence of construct validity by examining the relationships between humility and empathy, forgiveness, and other virtues. In Study 5 (N = 163), we adduced evidence of discriminant and incremental validity of the RHS compared with the Honesty-Humility subscale of the HEXACO-PI (Lee& Ashton, 2004).

After several decades of slow progress, researchers are beginning to make advances in linking constructs based on the multicultural competencies tradition-especially those focused on qualities of the therapist-to therapy outcomes. The multicultural orientation framework was developed in response to several trends within the multicultural competencies tradition, with a particular emphasis on integrating the multicultural competencies tradition into research on psychotherapy process. We provide a narrative review of studies that include one of the three constructs (i.e., cultural humility, cultural opportunities, and cultural comfort) articulated by the multicultural orientation framework. Results indicate initial evidence linking multicultural orientation constructs to therapy outcomes (e.g., perceived improvement, racial/ethnic disparities in termination, and therapy alliance). Results also supported the social bond and social oil hypotheses from theorizing on humility. Implications for future research and therapy practice are discussed.

In a university counseling center sample of 247 clients who were treated by 50 therapists, we retrospectively examined the association between client ratings of their therapists' cultural humility and the degree to which clients perceived that their therapist missed opportunities to discuss their cultural identity. The results demonstrated that clients who rated their therapist as being more culturally humble also reported better therapy outcomes. Additionally, clients who perceived that their therapist missed cultural opportunities reported worse therapy outcomes. Client ratings of cultural humility moderated the association between cultural opportunities and therapy outcomes. For clients who reported that their therapist was less culturally humble, there was a negative association between missed opportunities and outcomes. However, for clients who reported that their therapist was more culturally humble, the degree to which therapists took advantage of discussing clients' cultural heritage was not associated with outcomes.

A recent qualitative review by Wood, Froh, and Geraghty (2010) cast doubt on the efficacy of gratitude interventions, suggesting the need to carefully attend to the quality of comparison groups. Accordingly, in a series of meta-analyses, we evaluate the efficacy of gratitude interventions (ks = 4-18; Ns = 395-1,755) relative to a measurement-only control or an alternative-activity condition across 3 outcomes (i.e., gratitude, anxiety, psychological well-being). Gratitude interventions outperformed a measurement-only control on measures of psychological well-being (d = .31, 95% confidence interval [CI = .04, .58]; k = 5) but not gratitude (d = .20; 95% CI [-.04, .44]; k = 4). Gratitude interventions outperformed an alternative-activity condition on measures of gratitude (d = .46, 95% CI [.27, .64]; k = 15) and psychological well-being (d = .17, 95% CI [.09, .24]; k = 20) but not anxiety (d = .11, 95% CI [-.08, .31]; k = 5). More-detailed subdivision was possible on studies with outcomes assessing psychological well-being. Among these, gratitude interventions outperformed an activity-matched comparison (d = .14; 95% CI [.01, .27]; k = 18). Gratitude interventions performed as well as, but not better than, a psychologically active comparison (d = -.03, 95% CI [-.13, .07]; k = 9). On the basis of these findings, we summarize the current state of the literature and make suggestions for future applied research on gratitude. (PsycINFO Database Record