Examining therapist effects in relation to clients’ race-ethnicity and gender: An intersectionality approach.

Kivlighan, Dennis M.; Hooley, Isaac W; Bruno, Maria G; Ethington, Lanaya L; Keeton, Paula M; Schreier, Barry A.

doi:10.1037/cou0000316

Cited by 15 publications

(14 citation statements)

References 33 publications

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“…Therefore, therapists may attune to only one salient cultural identity, despite their clients’ holding multiple important cultural identities. This aligns with the results of Kivlighan et al (2019), which suggested that there is significant between-therapist variability in terms of their ability to effectively treat clients based on the interaction of both clients’ racial and gender identities. In the present study, this phenomenon is reflected in the finding that therapists are rated highest in terms of cultural humility when clients rated their first most important identity high in terms of saliency, and their second most important identity low, and vice versa (e.g., a high degree of salience discrepancy).…”

Section: Discussionsupporting

confidence: 84%

Attending to the intersectionality and saliency of clients’ identities: A further investigation of therapists’ multicultural orientation.

Anders¹,

Kivlighan²,

Porter³

et al. 2021

Journal of Counseling Psychology

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Psychotherapy clients often hold multiple and varied cultural identities, and it is important for therapists to attend to the intersectionality of clients' cultural identities, as well as the saliency of these identities. However, to date, few studies have considered the saliency of clients' multiple identities and how this may impact clients' perceptions of cultural processes in therapy. Therefore, this study utilized polynomial regression and response surface analysis to operationalize and examine congruent and discrepant effects between the saliency of clients' multiple identities and their perceptions of their therapists' cultural humility and cultural missed opportunities. Data for this study consisted of 87 clients who received individual counseling services at either a university counseling center or training clinic at two large universities in the United States. As hypothesized, results indicated significant discrepant effects between the saliency of clients' first and second most important cultural identities and perceptions of their therapists' cultural humility and cultural missed opportunities. Specifically, clients' ratings of their therapist's cultural missed opportunities were lowest when they reported either a) high saliency of cultural identity one and low saliency of cultural identity two, or b) low saliency of cultural identity one and high saliency of cultural identity two. Similarly, clients' ratings of their therapist's cultural humility were highest when they reported either a) high saliency of cultural identity one and low saliency of cultural identity two, or b) low saliency of cultural identity one and high saliency of cultural identity two. Public Significance StatementThis study found that when the salience of clients' two most important cultural identities was discrepant (i.e., high-low or low-high), they perceived their therapist to be high in culturally humility and low in cultural missed opportunities. Therapists should acknowledge that clients often hold multiple cultural identities and that the saliency of these identities may differ in meaningful ways. Therapists should attend to this complexity from a multicultural framework to engage in culturally responsive care.

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Section: Discussionsupporting

confidence: 84%

Attending to the intersectionality and saliency of clients’ identities: A further investigation of therapists’ multicultural orientation.

Anders¹,

Kivlighan²,

Porter³

et al. 2021

Journal of Counseling Psychology

Self Cite

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“…This may reflect the methodological challenge of obtaining longitudinal data from sufficient numbers of women and men in diverse ethnoracial groups to permit tests of main effects and interactions. In one study, Kivlighan et al (2019) found no main effects of clients’ ethnoracial status or gender and no significant interaction for predicting changes in distress which decreased significantly across the course of psychotherapy. However, both ethnoracial status and the interaction of gender and ethnoracial status contributed to variability in client outcomes (Kivlighan et al, 2019).…”

Section: Barriers To Accessing Mental Health Carementioning

confidence: 98%

“…In one study, Kivlighan et al (2019) found no main effects of clients’ ethnoracial status or gender and no significant interaction for predicting changes in distress which decreased significantly across the course of psychotherapy. However, both ethnoracial status and the interaction of gender and ethnoracial status contributed to variability in client outcomes (Kivlighan et al, 2019). Crucially, the repeated calls to employ evidence-based treatment for mental health problems are necessarily undermined by the limited literature on how the intersection of ethnoracial identity with other identities (e.g., gender, sexual orientation) may impact needs, access, and efficacy.…”

Section: Barriers To Accessing Mental Health Carementioning

confidence: 98%

Ethnoracial status, intersectionality with gender, and psychotherapy utilization, retention, and outcomes.

Joiner¹,

Robison²,

Robertson³

et al. 2022

Journal of Consulting and Clinical Psychology

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Objective: Psychotherapy access, utilization, retention, and effectiveness require continued improvement, especially for groups for whom availability and outcomes may be currently suboptimal, including ethnoracial minorities. Further, ethnoracial status’ intersectionality with other identity variables (e.g., gender) may relate to structural barriers to care and effectiveness of care, an area in need of further research. Method: The Florida State University Psychology Clinic, a low-cost population-facing treatment center, has routinely collected clinically relevant information on all consenting clients, including severity of clinical presentation at intake and over time, number of therapy sessions attended and of no-shows, premature termination, demographics, etc. A large sample of clients (N = 2,076; 57% women; 67.9% non-Hispanic White) on whom we collected and entered at least some data, though missing data were common, has accrued. We conducted chi-square tests to examine treatment utilization gaps, analysis of variance to measure differences in intake severity, and analysis of covariance to measure differences in treatment effectiveness. Results: Based on the percentages of ethnoracial minority groups with mental disorders in the broader local community, we are falling short in outreach to Black clients, and when we do engage them, we retain them suboptimally. Once well engaged, however, results across groups suggest few differences in outcomes by ethnoracial status, gender, or their intersection. Ethnoracial match was associated with more sessions attended in Black people. Conclusions: Psychotherapy effectiveness has the potential to be optimized for everyone, and a promising direction in this regard is the case conceptualization of a cultural formulation interview and cultural humility mindset.

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“…As such, graduates from current clinical programs will and are increasingly serving more and more diverse clients, perhaps most significant of which may include immigrant populations (Iwamasa et al, 2002;Lim & Nakamoto, 2008;Lopez & Bursztyn, 2013; The APA Presidential Task Force on Immigration, 2013;Yznaga, 2008). Further, trainees and clinicians, including supervisors and academic instructors, must examine intersectional diversity in their work (Anders et al, 2021;Kivlighan et al, 2019;Lee & Kealy, 2018).…”

mentioning

confidence: 99%

The Worldview Genogram: A process model for enhancing diversity responsiveness and competence in education, training, and clinical supervision.

Chege¹,

Fu²,

Bustrum³

et al. 2023

Psychological Services

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Diversity responsiveness and competence is an imperative in current graduate psychology training and few, if any, will debate this. However, what has been and still remains frustrating to most practicum and internship clinical supervisors and graduate school instructors is a dearth of safe and practical tools to enhance this process, particularly in terms of the awareness domain. The authors of this article present a process model, the Worldview Genogram (WVG), that has been developed and implemented in clinical field placements and classroom settings over the last 22 years with significant success. The WVG, anchored by a three-generational family-of-origin genogram, is a depiction of individual and cultural diversity constructs that impact a person’s identity formation. A rationale for the model and specific, practical steps in implementing it in academic and clinical settings are described. The model’s uniqueness lies in the fact that it is nonpathologizing, strengths-based, trainee driven, and predicated on instructor or supervisor modeling.

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Examining therapist effects in relation to clients’ race-ethnicity and gender: An intersectionality approach.

Cited by 15 publications

References 33 publications

Attending to the intersectionality and saliency of clients’ identities: A further investigation of therapists’ multicultural orientation.

Attending to the intersectionality and saliency of clients’ identities: A further investigation of therapists’ multicultural orientation.

Ethnoracial status, intersectionality with gender, and psychotherapy utilization, retention, and outcomes.

The Worldview Genogram: A process model for enhancing diversity responsiveness and competence in education, training, and clinical supervision.

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