Little is known about the psychotherapy utilization, presenting concerns, and outcome differences between Black international and African American university students. The aim of this research is to identify potential similarities and differences between the two groups, as well as potential differences between the aforementioned groups and white students. This study examined archival data collected over the course of a 17-year period that focused on experiences of African-American, Black international, and White students at a large university in the Rocky Mountain West, United States. More specifically, archival data were analyzed to identify differences between the aforementioned groups of students in regard to psychotherapy utilization, presenting concerns, distress levels endorsed at intake, and distress levels endorsed at termination. Results indicate significant differences between African-American, Black international, and White student groups in terms of the maximum number of psychotherapy sessions attended and length of treatment in days. We found significant differences between these groups of students on several items assessed in the Presenting Problem Checklist and the Family Concerns Survey. We found no significant difference between African-American, Black international, and White student groups in the severity of presenting distress as measured by the Outcome Questionaire-45. We found a significant difference between groups in treatment improvement as measured by change scores on the Outcome Questionaire-45, with White students experiencing the greatest change, followed by Black international students and African-Americans. Possible explanations and implications for practice will be discussed in the body of the paper.

The current study examined the psychotherapy experiences of Pacific Islander and Asian American students at a large intermountain university on the continental United States. We used archival data collected over a 17-year span to investigate the psychotherapy utilization, presenting concerns, reported distress levels and psychotherapy outcomes of Pacific Islander students compared to Asian American students. In an effort to address the current and problematic practice of combining Asian Americans and Pacific Islanders into a homogeneous category, subgroup outcomes of Pacific Islander students were compared to Asian American students to highlight any significant differences and similarities. Results indicated significant differences between Pacific Islander and Asian American students in terms of amount of psychotherapy sessions attended and length of treatment in days. Asian American students were more likely to remain in therapy during the first 100 days and eight sessions. We found significant differences between both groups on several items assessed in the Presenting Problem Checklist and the Family Concerns Survey. Pacific Islander students reported significantly more traumatic experiences occurring in their family. We also found significant differences in the presenting concerns of both populations. Additionally, on the OQ-45, Pacific Islander students answered questions regarding risk factors significantly different from Asian American students. Clinicians are encouraged to understand the values and nuances of collectivist groups including Pacific Island and Asian cultures. It is recommended that clinicians and counseling centers reach out to Pacific Islander students on their campuses to inform them about mental health services. Counseling centers are encouraged to gather information on the reasons for therapy termination.

Recent research has explored the unique case load of mental health professionals working in university counseling centers (UCCs) and is working to better understand therapist burnout. However, there is a gap in the literature surrounding therapist caseload composition and how this composition can impact the experience of therapists in UCCs. Specifically, more research is needed to understand how therapist caseloads might differ by gender identity of therapist. The current study explored this topic by looking at how therapist caseload varies by gender. Retrospective data gathered at a large western United States UCC from 2014 to 2021 was analyzed using Hierarchical Linear Modeling (HLM). There were 17 client variables (anxiety, social anxiety, academic concerns, eating concerns, hostility, substance use, family concerns, distress, OQ-45 score, distress around confusion about religious beliefs, distress around discrimination, perfectionism, distress around sexual orientation, suicidal intent, suicide attempts, sexual assault, and trauma) that were regressed on therapist gender. The results of the HLM model indicated significant differences between therapist gender and caseload composition. Of the 17 variables, seven estimated significant variances. The model indicated that cisgender female-identifying therapists were estimated to have clients with significantly higher scores on anxiety, eating concerns, distress, perfectionism, sexual assault, and trauma. While cisgender male-identifying therapists were estimated to only have clients with significantly higher scores on distress around sexual orientation. This study showed that differences in caseload composition are a concern that should be addressed in university counseling centers, as they differentially impact male and female therapists. These findings add to the literature surrounding the increased load on university counseling centers and give further insight into the experiences of female clinicians in this setting.

This dissertation presents in the form of two distinct chapters conceptually related in nature. The first chapter integrates literature from various fields such as indigenous, womanist, and feminist lenses to propose nine principles when working with Muslim women. The purpose of the second chapter is to examine Muslim women’s experiences in therapy at university counseling centers. The study explores women’s experiences from a social determinants of health perspective and a narrative inquiry method—namely, how intrapersonal, interpersonal, institutional, community, and policy factors inform women’s experiences. Qualitative analysis from interviews with six women suggests Muslim women navigate multiple systems which inform their beliefs about health and their experiences in therapy.

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