Sexual minority (SM) individuals live in a heterosexist society that denigrates their sexual orientation identity. The stigma and prejudice they regularly encounter is hypothesized to lead to their significantly increased risk for developing mental health disorders. Because of these factors, therapists should be diligent to create an affirming and supportive therapeutic environment but this is often not the case. SM clients frequently report experiencing sexual orientation microaggressions in therapy, such as heteronormative statements, a disregard for their sexual orientation identity, and an assumption that their presenting issues are rooted in their sexual orientation identity. These microaggressions should be viewed as bias manifested as clinical errors because of how they weaken therapeutic alliance, decrease the effectiveness of treatment, decrease utilization intent, and cultivate feelings of shame, anger, and misunderstanding. This article provides empirically supported findings regarding common SM clinical errors and microaggressions, a clinical example of such biases with corrective examples along with the author's personal reactions, and more general strategies for avoiding microaggressive errors with SM clients. Implications for practice, training, and research are discussed. (PsycINFO Database Record

The overconfidence bias occurs when clinicians overestimate the accuracy of their clinical judgments. This bias is thought to be robust leading to an almost universal recommendation by clinical judgment scholars for clinicians to temper their confidence in clinical decision making. An extension of the Meta-Analysis of Clinical Judgment (Spengler et al., 2009) project, the authors synthesized over 40 years of research from 36 studies, from 1970 to 2011, in which the confidence ratings of 1,485 clinicians were assessed in relation to the accuracy of their judgments about mental health (e.g., diagnostic decision making, violence risk assessment, prediction of treatment failure) or psychological issues (e.g., personality assessment). Using a random effects model a small but statistically significant effect (r = .15; CI = .06, .24) was found showing that confidence is better calibrated with accuracy than previously assumed. Approximately 50% of the total variance between studies was due to heterogeneity and not to chance. Mixed effects and meta-regression moderator analyses revealed that confidence is calibrated with accuracy least when there are repeated judgments, and more when there are higher base rate problems, when decisions are made with written materials, and for earlier published studies. Sensitivity analyses indicate a bias toward publishing smaller sample studies with smaller or negative confidence-accuracy effects. Implications for clinical judgment research and for counseling psychology training and practice are discussed.

In 2016, Tennessee became the first state to allow counselors and therapists in private practice to deny services to any client based on the therapist’s sincerely held principles. The law’s proponents framed mental health care ethics as infringing on counselors’ religious liberties; its critics denounced the bill because it apparently targeted LGBT+ individuals. This exploratory study is the first statewide assessment of LGBT+ Tennesseans’ ( N = 346) perceptions of the law and how it may affect their help-seeking attitudes and behaviors. Evidence suggests widespread awareness of the law among our respondents and deep skepticism toward mental health care. Further, most respondents view the law as cover for discrimination. We stress the need for broader research on conscience clauses and call for advocacy against these laws, which have the potential to engender widespread harm to multiple minority groups.

This study systematically reviewed extant couple therapy outcome studies (k = 111) through December 2018 to evaluate for implicit or explicit, inclusion or exclusion of gender and/or sexual minority individuals and identities. We evaluated sampling, participant demographic reporting, and language used in each manuscript for any reference or consideration given to participants' sexual and/or gender identity. Results indicate that couples have been historically presumed to be heterosexual and cisgender male or female without reported assessment. More recent inclusion and consideration of sexual minority individuals is limited and absent for nonmonosexual and gender minority individuals. These findings are contextualized in supplementary analyses of other sociocultural characteristics (e.g., race, age, length together). Suggestions are provided for affirmative consideration of the plurality of individuals' sexual and gender identities. Implications are discussed for research, training and practice of couple therapy with sexual and/or gender minority couples.

In the current study, the psychological help-seeking attitudes and intentions of 140 lesbian, gay, and bisexual (LGB) individuals were examined in relation to their LGB identity and perceived sexual prejudice of mental health counselors. Relying on the theory of planned behavior (Ajzen, 1991), the looking glass self (Cooley, 1902(Cooley, /1964, and the threat-to-self-esteem model (Nadler & Fisher, 1986), we hypothesized that perceived counselor sexual prejudice mediated the relationship between an individual'sLGB identity and their intentions to seek psychological services using path analysis. Contrary to expectations, perceived counselor sexual prejudice did not mediate the relation between LGB identity and intentions to seek psychological services. Results indicated LGB Identity Affirmation, but not Negative LGB Identity, was related to perceived counselor sexual prejudice such that the more affirming LGB individuals are of their sexual identity the less they perceive counselors to display sexual prejudice. The model illustrated that attitudes toward mental health counseling mediated the relationship between perceived counselor sexual prejudice and intentions to seek psychological services. Furthermore, a negative relationship was found between LGB identity and intentions to seek psychological services, such that the more negative an individual views their LGB identity, the higher their intentions to seek psychological services. Finally, a positive relationship emerged between prior counseling experience and help-seeking attitudes and intentions. Implications of these findings are discussed in terms of training, practice, and research.