How Psychotherapists Address Hypothetical Multiple Relationships Dilemmas with Asian American Clients: A National Survey

This study examined how psychotherapists address hypothetical nonsexual multiple relationships dilemmas with Asian American clients and identified predictors of conservative decisions and the use of culture-based rationales. This survey of 787 Asian American and non-Asian American psychotherapists revealed that clinicians rely on mostly their personal policies and seldom focus on the clients' cultural backgrounds. Psychotherapists who consider their clients' Asian culture have more cultural knowledge and awareness, have been mental health providers longer, and are Asian American and female. Clinicians who avoid multiple relationships tend to cite formal policies as justification and are less likely to consider clients' cultural worldviews, the therapeutic relationship, or their own values. The results are discussed in terms of specific revisions needed in the American Psychological Association Ethics Code, the benefits of more frequent consultation with colleagues and supervisors about ethical dilemmas, and recommendations for psychotherapists.     

Toward a Bahá'í Concept of Mental Health: Implications for Clinical Practice

The author highlights the emerging interest in understanding religious beliefs as a resource for more fully conceptualizing clients' psychological functioning. Although various authors have explored religious theories of mental health in an effort to increase understanding of clients' problems, there is a dearth of information on the Bahá'í client and how this particular religion conceives of mental health. The purpose of this article is to create an initial formulation for a Bahá'í concept of mental health and to discuss its clinical implications to aid in counseling Bahá'í clients.     

Using Case Documentation to Strengthen Counselor Trainees' Case Conceptualization Skills

A format for organizing case notes is presented that could increase counselor trainees' case conceptualization skills. The STIPS format of case note writing consists of 5 major sections, including documenting clients' current Signs and symptoms, Topics discussed in counseling, counseling Interventions used, clients' Progress and counselors' continuing plan for treatment, and finally, any Special issues of importance regarding clients (e.g., suicidality). The structure and design of this STIPS format is intended to enhance trainees' ability to acquire relevant facts about clients, better understand clients' presenting problems, better monitor counseling processes, and better evaluate and adjust treatment interventions.     

Predicting Expectations About Counseling: Psychological Factors and Gender Implications

The authors replicated and extended prior research regarding the relations among stages of change and expectations about counseling for actual clients. They added testing the predictive effects of personal growth orientation and gender for clients' expectations about counseling. Results indicated that personal growth orientation and gender contribute to understanding clients' expectations about counseling and that these effects may interact. Prior counseling experience was not an important predictor of these expectations for men or women.     

The perceived helpfulness of rendering emotional first aid via email

The present research examined the perceived helpfulness of an increasingly widespread mode of psychological assistance, namely, emotional first aid via email. The sample comprised 62 naturally occurring email interactions between distressful clients and trained volunteers operating within the framework of the Israeli Association for Emotional First Aid. Data were gathered by means of a structured questionnaire and open-ended questions so as to examine the clients' motivation to seek help via email and evaluate their satisfaction with the responses obtained. The results revealed a preference for written communication and the accessibility of assistance to be the most frequent reasons for clients to choose the medium of email. Most clients found the responses to be helpful in providing emotional support, enhancing cognitive change and suggesting practical ways of coping. Women perceived the assistance to be more helpful than men did. The results are discussed in terms of the unique value of email as an agent of mental health assistance.     

End‐of‐Life Care: An Overview for Professional Counselors

Although “End‐of‐Life Care for Terminally Ill Clients” is a section of the ACA Code of Ethics (American Counseling Association, 2005), neither the Code nor the counseling literature provides much direction for counselors who work with clients who are dying and with the clients' loved ones. The authors provide counselors with an overview of the issues that may be relevant when working with such clients.     

Attorney- client decision- making in criminal cases: Client competence and participation as perceived by their attorneys

The authors employed a structured interview to ascertain public defenders' perceptions of their clients' competence and the degree of their participation in the defense. In a sample of 122 randomly selected, non-dismissed felony cases, attorneys had doubts about the competence of 14.8% (n = 18) of their clients. Attorneys reported that clients whose competence was doubted were less involved in decision-making and, overall, were passive participants in their cases. Nearly one-half of these clients were not referred for assessment by a mental health professional. The authors compare the practices of attorneys faced with clients of suspected competence with those of mental health clinicians treating patients with impairments in decision-making capacity.     

Performance of Mental Health Counselors in Integrated Primary and Behavioral Health Care

Integrated primary and behavioral health care (IPBH) is becoming a preferred mode of service delivery in the United States. Integrated care includes the participation of medical and mental health professionals, such as mental health counselors. The clinical outcomes of these professionals need to be studied to determine their effectiveness in such settings. We examined the performance of 10 mental health counselors on the clinical outcome of 1,747 clients treated in an IPBH center. Analyses using growth curve modeling and pre‐post test design revealed that mental health counselors were effective overall, but they differed in client dropout rates and efficiency in reducing clients' initial symptoms. We used the analyses to rank order counselors based on their effectiveness. Counselors who were the most effective varied in their efficiency but demonstrated the lowest client dropout rates. Implications for future research and counseling practice were discussed.     

Contributing Factors to Early Premature Termination at a College Counseling Center

The authors investigated the relationships between clients' early premature termination of counseling and ratings of their counselors' expertness, trustworthiness, and attractiveness and the extent to which clients believed that they were understood by their counselors. A follow-up survey was conducted to assess the clients' reasons for terminating prematurely. Participants were 148 students who sought individual counseling at a university counseling center. The two groups did not differ on the variables investigated. Most of the participants who terminated prematurely reported that they did so because they did not have time for further sessions, did not need further sessions, or forgot their appointments.     

the résumé's secret identity: a tool for narrative exploration in multicultural career counseling

The résumé can be a window into the life story of a client and help address barriers to work and life success. Using the résumé as a narrative tool, career counselors can address these barriers and increase clients' employment potential. The strength of this approach is its cultural relevance to clients who may not otherwise seek counseling and as a talking tool within counseling. This article explores the potential for the résumé development and refinement process to enhance the counseling process akin to narrative career counseling. A model and case example are provided to illustrate the application of this approach.     

The Impact of Racial Microaggressions on Mental Health: Counseling Implications for Clients of Color

This study examined the relationship between racial microaggressions (subtle and unintentional forms of racial discrimination) and mental health. Results from a large sample (N = 506) indicated that higher frequencies of racial microaggressions negatively predicted participants' mental health and that racial microaggressions were significantly correlated with depressive symptoms and negative affect. Differences in the types of microaggressions experienced by various racial groups (Asian, Latina/o, Black, White, and multiracial) and counseling implications are discussed.     

Trust as an Underlying Dynamic in the Counseling Process: How Clients Test Trust

Trust is a basic issue for clients entering into the counseling process. Counselors need to recognize and respond to clients' ways of testing trust.     

'No-show': therapist racial/ethnic disparities in client unilateral termination

In the present study, the authors examined the source of racial/ethnic minority (REM) disparities in unilateral termination (i.e., the client ending therapy without informing the therapist)--a form of dropout that is associated with poor alliance and outcome. First, the authors tested whether some therapists were more likely to have clients who reported unilaterally terminating as compared with other therapists. Next, the authors examined 2 competing hypotheses regarding the therapists role in termination disparities: (a) that racial/ethnic disparities in unilateral termination are similar across therapists and thus due to other components of the treatment process or (b) that racial/ethnic disparities in unilateral termination are specific to therapists, where some therapists are more likely, on average, to have higher rates of unilateral termination with REM clients as compared with White clients. The sample included 155 REM clients and 177 White clients who were treated by 44 therapists at a university counseling center. The results showed that therapists accounted for a significant proportion of the variation in clients' unilateral termination, and REM clients were more likely to report they unilaterally terminated from therapy as compared with White clients. Furthermore, racial/ethnic disparities in clients' report of unilateral termination varied across therapists' caseloads. These results suggest that therapists have a central role in their clients' unilateral termination and have implications for understanding racial/ethnic mental health disparities.     

Critical Race Theory as a Decisional Framework for the Ethical Counseling of African American Clients

The authors introduce critical race theory as a decisional framework for ethical counseling, with a focus on racial disparities when working particularly with African American clients. The authors provide a fictional case example that explains how this framework can be implemented when conducting cross‐cultural counseling with African American clients. Implications for counselors are provided.     

Understanding the psychological processes of the racial match effect in Asian Americans

Some studies on mental health outcomes research have found that when clients and therapists are ethnically or racially matched, this tends to be related to greater satisfaction and better outcomes. However, the precise underlying mechanism for the match effect has not been extensively examined. In this experimental study, we tested the effect of racial match on critical counseling processes (i.e., therapist credibility and the working alliance) using a sample of 171 Asian American respondents. We also examined Asian ethnic identification as a potential moderator of the racial match effect. Structural equation modeling analyses indicated that racially matched individuals perceived greater experiential similarity with the therapist than nonmatched individuals, and experiential similarity was positively associated with therapist credibility. Although racial match did not predict attitudinal similarity, attitudinal similarity was strongly related to the working alliance and therapist credibility. Counseling implications are discussed.     

Worldviews of Women: Comparisons Between White American Clients,White American Counselors,and Chinese International Students

Worldviews of White American women clients, White American women counselors, and Chinese international women students were surveyed. Multivariate planned comparisons showed significant differences between (a) White American clients and White American counselors and (b) Chinese international students and White American counselors. Income was a significant predictor of worldviews for White American clients. Age and marital status contributed strongly to the worldviews of White American counselors. Among the Chinese students, the Taiwanese and the Mainland Chinese held significantly different worldviews. Worldviews of women are discussed from feminist as well as cross-cultural perspectives. Future directions for practice, research. and theory are suggested regarding the multicultural counseling process with clients of different worldview orientations.     

Understanding Clients' Perceptions of Stress

The association of individual behavioral and personality characteristics with the stress response provides a natural role for stress management and the development of coping responses within the counseling process. The incorporation of stress management within the counseling process requires a theoretical framework for examining clients' perceptions of their coping capabilities as they experience difficulty with stressful life events. In this article the author presents a framework based on learned helplessness, called systematic rationalization. Empirical support and applications of the framework for working with clients experiencing difficulties coping with stressful life events are discussed.     

Crying for a Vision: The Native American Sweat Lodge Ceremony as Therapeutic Intervention

The Native American sweat lodge ceremony or sweat therapy is being used increasingly in various medical, mental health, correctional, and substance abuse treatment centers serving both Native and non‐Native clients. This article explores the sweat lodge ceremony's background, elements of Native American spirituality, origin story, cultural symbolism, prayer, and contemporary use. Current evidence of effectiveness and therapeutic benefits is presented, then implications for integrating the sweat lodge ceremony as a complementary counseling approach are discussed.