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Therapy Session

MULTICULTURAL TRAINING AND EDUCATION QUESTIONNAIRE (MTEQ)

In press

Multicultural training is the process by which mental health professionals learn to work effectively and therapeutically with all clients, including those who are different from them in dimensions such as race, gender, or sexual orientation. Our research team created the Multicultural Training and Education Questionnaire (MTEQ) to measure trainee’s perceptions of multicultural training in professional helping  programs (e.g., clinician and counseling psychology). After distributing the questionnaires to doctoral and master’s level trainees, we found evidence that the questionnaire is a valid tool for measuring multicultural training. The questionnaire can be used to assess multicultural training overall, or it can be divided into four separate categories of multicultural training: Importance of Modeling, Clinical Application, Self Exploration/Awareness, and Education and Knowledge. We found that the Modeling and Clinical Applications categories accounted for the most variability in trainee responses, which supports a Multicultural Orientation (MCO) model. The MCO approach includes being open to exploring clients’ cultural experiences (cultural humility), the therapist’s feelings when discussing cultural topics with clients (cultural comfort), and the therapist’s ability to call attention to culturally important information in session (cultural opportunities). Research has shown that parts of the MCO model are related to positive outcomes in therapy, such as stronger alliance between therapist and client. Overall, the MTEQ has the potential to accurately measure areas of multicultural training that can be used to further strengthen graduate training with the goal of preparing future mental health professionals to work effectively with diverse clients.


Reference: Wilcox, M. M., Gale, M. M., McLaughlin, K. L., Squyres, E., Burish, E. C., & Khojasteh, J. (in press). Development and Initial Validation of the Multicultural Training and Education Questionnaire (MTEQ). Training and Education in Professional Psychology.

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Therapy Session

INTERNALIZED RACIAL OPPRESSION AND HEALTH-RELATED OUTCOMES: A META-ANALYSIS

2020

Although racism is often thought of as bias against people in a racial group different from one’s own racial group (e.g., racist attitudes held by White people against Black people), minority group members may also hold biases against their own racial group. Internalized racism can be described as the acceptance of the negative perceptions of a person’s own race (e.g., an Asian person’s attitudes toward Asian people). It is important to note that these attitudes and beliefs stem from systems of racism that benefit majority group members (i.e. Whites) when minority group members internalize racial bias because it makes engagement in racial critique and social justice less likely to occur.  Research has shown that internalized racism is related to a range of negative mental health outcomes such as anxiety, depression, and lower self-esteem, as well as to negative physical health outcomes such as hypertension. 


Our team explored the relationship between internalized racism and mental and physical health outcomes across 29 research studies. We found that higher levels of internalized racism were related to poor mental health outcomes with a medium strength correlation. Additionally, higher levels of internalized racism were associated with poor physical health outcomes with a small strength correlation. That is, as internalized racism increased, so did negative psychological impacts, as did negative physical health impacts, to a lesser degree. Other findings suggest that certain variables strengthened the relationship between internalized racism and health outcomes. For example, the “racial self-hatred” aspect of internalized racism was more strongly related to poor health outcomes compared to “miseducation” or stereotypes. This suggests that the emotional experience of self-hatred may be more harmful to health compared to misinformed beliefs about race. Additionally, being from the United States was associated with a stronger connection between internalized racism and poor health outcomes. This suggests that the unique history of racism in the United states has especially harmful impacts on health outcomes in People of Color. Finally, we found that gender, setting (i.e. college campus versus medical setting), publication type, and publication year did not strengthen the relationship between internalized racism and health outcomes. 

Overall, these findings provide important information for addressing mental and physical health outcomes in People of Color. Mental health professionals may assess Clients of Color for internalized racism, develop interventions focused on positive racial identity development, and push for societal or policy change to address the negative health outcomes associated with the racial climate of the United States. 

Reference: Gale, M., Pieterse, A. L., Lee, D. L., Huynh, K., Powell, S., & Kirkinis, K. (2020). A meta-analysis of the relationship between internalized racial oppression and health-related outcomes. The Counseling Psychologist, 1–28. 

College Students

UNIVERSITY STUDENT PERCEPTIONS OF A CRITICAL RACE-RELATED INCIDENT

2019

In October 2017, a student at the University of Hartford, Jazzy Rowe, became aware of a social media post in which her former roommate, Brianna Brochu, admitted to contaminating Ms. Rowe’s belongings with bodily fluids to push her into requesting a roommate change. Ms. Brochu, a White student, ended her post by referring to Ms. Rowe, a Black student, as “Jamaican Barbie”. This suggested to many that her actions were motivated by race. The event can be thought of as a critical racial incident, or a racially motivated incident that affects an individual person and impacts the overall racial climate. The incident sparked local and national media attention, a social media hashtag #JusticeforJazzy, and various statements from the president of the university outlining plans to handle discrimination and develop diversity resources on campus. Overall, the event likely impacted the attitudes and perceptions of racial dynamics and justice (racial climate) among students, faculty, and staff of the university. 

Our team explored students’ perceptions of the racial climate, the critical racial incident, and the university’s response through questionnaires and open-ended response questions. We found that perceptions of the racial climate differed significantly between White students and Students of Color with White students perceiving the climate more positively than Students of Color. These perceptions appeared all the more significant as positive perceptions of the racial climate were related to lower levels of psychological distress. Additionally, White students reported feeling that Students of Color were hostile toward them, and reported a decline in social justice attitudes as their perceptions of being discriminated against increased. Students of Color reported that they were negatively impacted by the critical racial incident. They noted a lack of social supports following the incident and were critical of the university’s response. These findings provide suggestions for ways that universities may improve their responses to critical racial incidents. Due to negative perceptions of the racial climate among Students of Color compared to White students, and the psychological distress associated with these perceptions, university administrators might consider increasing resources and supports for Students of Color following critical racial incidents on campus.


Reference: Gale, M., Wimmer, H., Huang, G., & White, M. (2019). An examination of university student perceptions of a critical race-related incident, racial climate on campus, and social justice engagement [Conference presentation]. 36th Annual Winter Roundtable, New York, NY.

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SOCIOCULTURAL FACTORS AND PSYCHOLOGICAL SERVICE REFERRAL OUTCOME

2019

Mental health treatment needs are becoming more common in college students. When university counseling centers do not have enough resources to offer long-term treatment, they may refer students to services in the community. Research has shown that racial/cultural minority group members may experience disadvantages when seeking mental health treatment. For example, People of Color report more difficulty in finding good quality treatment. Women, sexual minorities (e.g., lesbian and gay individuals), and older individuals are more likely to use mental health treatment compared to men, heterosexual individuals, and younger individuals. Our research team explored how these identities may be related to successful referral from university counseling centers to outside services. A referral was considered successful if a student made contact with mental health services after being referred by the university counseling center care manager. A referral was considered unsuccessful if the student returned to the counseling center for treatment or did not respond to the care manager’s follow up. We found that race, sexual orientation, and gender did not predict how likely a student was to have a successful referral. This may be due to greater diversity or multicultural awareness within the particular university counseling center where the study was conducted. In other words, the staff may have been more aware of the need to support people with these identities in connecting to mental health treatment. Future research should look into the counseling center characteristics that help to make successful referrals for these groups. By contrast, older students were found to be more likely to connect with outside providers compared to younger students. These findings suggest that it is important to provide extra support for younger students (e.g., first-year/freshmen) in need of mental health services. Counseling centers might consider discussing insurance questions, concerns about speaking to providers or family about mental health, and ways to overcome barriers with younger students. 

Reference: Gale, M., Franco, M., Reese, E., Hutman, H., & Wang, Y. (2019). Sociocultural factors and referral outcome: An exploratory investigation. Journal of College Student Psychotherapy, 1-13. doi: 10.1080/87568225.2019.1592729

SOCIOCULTURAL FACTORS AND PSYCHOLOGICAL SERVICE REFERRAL OUTCOME

2019

Mental health treatment needs are becoming more common in college students. When university counseling centers do not have enough resources to offer long-term treatment, they may refer students to services in the community. Research has shown that racial/cultural minority group members may experience disadvantages when seeking mental health treatment. For example, People of Color report more difficulty in finding good quality treatment. Women, sexual minorities (e.g., lesbian and gay individuals), and older individuals are more likely to use mental health treatment compared to men, heterosexual individuals, and younger individuals. Our research team explored how these identities may be related to successful referral from university counseling centers to outside services. A referral was considered successful if a student made contact with mental health services after being referred by the university counseling center care manager. A referral was considered unsuccessful if the student returned to the counseling center for treatment or did not respond to the care manager’s follow up. We found that race, sexual orientation, and gender did not predict how likely a student was to have a successful referral. This may be due to greater diversity or multicultural awareness within the particular university counseling center where the study was conducted. In other words, the staff may have been more aware of the need to support people with these identities in connecting to mental health treatment. Future research should look into the counseling center characteristics that help to make successful referrals for these groups. By contrast, older students were found to be more likely to connect with outside providers compared to younger students. These findings suggest that it is important to provide extra support for younger students (e.g., first-year/freshmen) in need of mental health services. Counseling centers might consider discussing insurance questions, concerns about speaking to providers or family about mental health, and ways to overcome barriers with younger students. 

Reference: Gale, M., Franco, M., Reese, E., Hutman, H., & Wang, Y. (2019). Sociocultural factors and referral outcome: An exploratory investigation. Journal of College Student Psychotherapy, 1-13. doi: 10.1080/87568225.2019.1592729

Open Book

PUBLICATIONS

Fence Shadow

THERE ARE NO SIDELINES: A REACTION TO LEGHA’S “GETTING OFF THE RACIST SIDELINES: AN ANTIRACIST APPROACH TO MENTAL HEALTH SUPERVISION AND TRAINING”

2023

We present a reaction to Legha’s (2023) anti-racist model of clinical supervision. We start by outlining the strengths of Legha’s model, including the need for supervisor self-awareness and the understanding of racism from a historical perspective. We then outline ways in which the model could be enhanced by focusing on epistemic violence, and conclude by discussing potential barriers to clinical and institutional implementation of Legha’s model. We appreciate Legha’s anti-racist model and view it as an important step forward toward the eradication of racism within mental health practice.

Reference: Alex L. Pieterse & Michael M. Gale (2023) There are no sidelines: a reaction to Legha’s “getting off the racist sidelines: an antiracist approach to mental health supervision and training”, The Clinical Supervisor, DOI: 10.1080/07325223.2023.2251971

Many Books

MULTICULTURAL TRAINING AND EDUCATION QUESTIONNAIRE (MTEQ)

2021

Multicultural training is the process by which mental health professionals learn to work effectively and therapeutically with all clients, including those who are different from them in dimensions such as race, gender, or sexual orientation. Our research team created the Multicultural Training and Education Questionnaire (MTEQ) to measure trainee’s perceptions of multicultural training in professional helping  programs (e.g., clinician and counseling psychology). After distributing the questionnaires to doctoral and master’s level trainees, we found evidence that the questionnaire is a valid tool for measuring multicultural training. The questionnaire can be used to assess multicultural training overall, or it can be divided into four separate categories of multicultural training: Importance of Modeling, Clinical Application, Self Exploration/Awareness, and Education and Knowledge. We found that the Modeling and Clinical Applications categories accounted for the most variability in trainee responses, which supports a Multicultural Orientation (MCO) model. The MCO approach includes being open to exploring clients’ cultural experiences (cultural humility), the therapist’s feelings when discussing cultural topics with clients (cultural comfort), and the therapist’s ability to call attention to culturally important information in session (cultural opportunities). Research has shown that parts of the MCO model are related to positive outcomes in therapy, such as stronger alliance between therapist and client. Overall, the MTEQ has the potential to accurately measure areas of multicultural training that can be used to further strengthen graduate training with the goal of preparing future mental health professionals to work effectively with diverse clients.

 

Reference: Wilcox, M. M., Gale, M. M., McLaughlin, K. L., Squyres, E., Burish, E. C., & Khojasteh, J. (2022). Development and Initial Validation of the Multicultural Training and Education Questionnaire (MTEQ). Training and Education in Professional Psychology.

Therapy Session

INTERNALIZED RACIAL OPPRESSION AND HEALTH-RELATED OUTCOMES: A META-ANALYSIS

2020

Although racism is often thought of as bias against people in a racial group different from one’s own racial group (e.g., racist attitudes held by White people against Black people), minority group members may also hold biases against their own racial group. Internalized racism can be described as the acceptance of the negative perceptions of a person’s own race (e.g., an Asian person’s attitudes toward Asian people). It is important to note that these attitudes and beliefs stem from systems of racism that benefit majority group members (i.e. Whites) when minority group members internalize racial bias because it makes engagement in racial critique and social justice less likely to occur.  Research has shown that internalized racism is related to a range of negative mental health outcomes such as anxiety, depression, and lower self-esteem, as well as to negative physical health outcomes such as hypertension. 


Our team explored the relationship between internalized racism and mental and physical health outcomes across 29 research studies. We found that higher levels of internalized racism were related to poor mental health outcomes with a medium strength correlation. Additionally, higher levels of internalized racism were associated with poor physical health outcomes with a small strength correlation. That is, as internalized racism increased, so did negative psychological impacts, as did negative physical health impacts, to a lesser degree. Other findings suggest that certain variables strengthened the relationship between internalized racism and health outcomes. For example, the “racial self-hatred” aspect of internalized racism was more strongly related to poor health outcomes compared to “miseducation” or stereotypes. This suggests that the emotional experience of self-hatred may be more harmful to health compared to misinformed beliefs about race. Additionally, being from the United States was associated with a stronger connection between internalized racism and poor health outcomes. This suggests that the unique history of racism in the United states has especially harmful impacts on health outcomes in People of Color. Finally, we found that gender, setting (i.e. college campus versus medical setting), publication type, and publication year did not strengthen the relationship between internalized racism and health outcomes. 

Overall, these findings provide important information for addressing mental and physical health outcomes in People of Color. Mental health professionals may assess Clients of Color for internalized racism, develop interventions focused on positive racial identity development, and push for societal or policy change to address the negative health outcomes associated with the racial climate of the United States. 

Reference: Gale, M., Pieterse, A. L., Lee, D. L., Huynh, K., Powell, S., & Kirkinis, K. (2020). A meta-analysis of the relationship between internalized racial oppression and health-related outcomes. The Counseling Psychologist, 1–28. 

College Students

UNIVERSITY STUDENT PERCEPTIONS OF A CRITICAL RACE-RELATED INCIDENT

2019

In October 2017, a student at the University of Hartford, Jazzy Rowe, became aware of a social media post in which her former roommate, Brianna Brochu, admitted to contaminating Ms. Rowe’s belongings with bodily fluids to push her into requesting a roommate change. Ms. Brochu, a White student, ended her post by referring to Ms. Rowe, a Black student, as “Jamaican Barbie”. This suggested to many that her actions were motivated by race. The event can be thought of as a critical racial incident, or a racially motivated incident that affects an individual person and impacts the overall racial climate. The incident sparked local and national media attention, a social media hashtag #JusticeforJazzy, and various statements from the president of the university outlining plans to handle discrimination and develop diversity resources on campus. Overall, the event likely impacted the attitudes and perceptions of racial dynamics and justice (racial climate) among students, faculty, and staff of the university. 

Our team explored students’ perceptions of the racial climate, the critical racial incident, and the university’s response through questionnaires and open-ended response questions. We found that perceptions of the racial climate differed significantly between White students and Students of Color with White students perceiving the climate more positively than Students of Color. These perceptions appeared all the more significant as positive perceptions of the racial climate were related to lower levels of psychological distress. Additionally, White students reported feeling that Students of Color were hostile toward them, and reported a decline in social justice attitudes as their perceptions of being discriminated against increased. Students of Color reported that they were negatively impacted by the critical racial incident. They noted a lack of social supports following the incident and were critical of the university’s response. These findings provide suggestions for ways that universities may improve their responses to critical racial incidents. Due to negative perceptions of the racial climate among Students of Color compared to White students, and the psychological distress associated with these perceptions, university administrators might consider increasing resources and supports for Students of Color following critical racial incidents on campus.


Reference: Gale, M., Wimmer, H., Huang, G., & White, M. (2019). An examination of university student perceptions of a critical race-related incident, racial climate on campus, and social justice engagement [Conference presentation]. 36th Annual Winter Roundtable, New York, NY.

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