The HIV epidemic continues to disproportionately impact marginalized populations, where one in two Black men who have sex with men (BMSM) will be diagnosed with HIV in their lifetime. The lack of research regarding the wellness of Black men who have sex with men living with HIV (BMSM+) inhibits understanding, which could hinder professions missioned with bettering the wellness of BMSM+. Consequently, the purpose of this study was to investigate if resilience and empowerment predict BMSM+'s wellness. However, a lack of internal consistency among the empowerment measurement required the researcher to remove the scale and adjust the scope of the study. A simple linear regression determined that resilience predicted wellness with statistical significance F(1, 247) = 726.012, R2 = .745, p = .000, f2 = 2.92. Descriptive statistics revealed that there were no significant differences in overall wellness when comparing BMSM+ ((N = 249) to norming samples representative of the U.S. population, t(248) = 1.575, p = .12 and African-Americans, t(248) = -1.444, p = .150; though BMSM+ had higher overall wellness when compared to men, t(248) = 9.926, p = .000. Most of the BMSM+ in this study had a resilience score that was somewhat low to very low (M = 123. 39), which was significantly lower than norming samples of the U.S. population, t(248) = -8.345, p = .000 and men, p = .000; males: t(248) = -7.938, p = .000. Additionally, the researcher ran two post hoc analyses that used multi-factor ANOVAs that revealed significant differences in resilience and wellness between groups when examining participants' HIV viral load detectability, CD4 count, mode of HIV contraction, level of religiosity/spirituality, education, and relationship status. Overall, the findings of the current study challenge the assumption that BMSM+ are unwell and has implications for counseling practitioners, counselor educators, researchers, and community-based organizations.

A sound and tested multicultural therapeutic approach is an essential component in providing ethical services to all client populations (e.g., Medley, Lipari, Bose, Cribb, Kroutil, & McHenry, 2015). Therefore, concepts of multiculturalism have been integrated in ethical codes, guidelines on competence, and standards for training in preparation programs within counseling, psychology, and social work fields (e.g., American Counseling Association Code of Ethics, 2014; American Psychological Association Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists, 2002; Council for Accreditation of Counseling and Related Educational Programs Standards, 2016; National Association of Social Workers Standards and Indicators for Cultural Competence in Social Work Practice, 2015). Despite mandates for therapists to utilize a multicultural perspective, multiculturalism has remained a challenging construct to measure. Thus, the goal of this research was to develop and test the psychometrics features of the Multicultural Competency Assessment© (MCA) scores with a national sample of therapists in clinical practice. The MCA and items were constructed employing instrument development best practices (e.g., AERA, APA, & NCME, 2014; DeVellis, 2017; Dimitrov, 2012; Haladyna & Rodriguez, 2013; Lambie, Blount, & Mullen, 2017). The initial 50 item MCA scores were tested with Data1 (N = 407) using exploratory factor analysis (EFA) and parallel analysis (PA), resulting in a 25-item MCA with a four-factor structure that accounted for 64.11% of the total variance. Next, the 25-item MCA scores were tested with Data 2 (N = 233) using confirmatory factor analysis (CFA) and the results supported the four-factor MCA structural model. The four-factor MCA structure represents (a) Knowledge, Skills, and Interventions (21.86% of the variance); (b) Awareness of Self (19.27% of the variance); (c) Awareness of Client Worldview (11.95% of the variance); and (d) System and Institutional Structures (11.03% of the variance). In addition, the MCA scores yielded sound internal consistency reliability (e.g., .953). Evidence of concurrent validity was supported with a positive correlation between MCA and Multicultural Counseling Self-Efficacy Scale -Racial Diversity Form (MCSE-RD) scores (r = .746; p < .001; 55.61% variance explained). Further, a positive correlation was identified between the MCA scores and participants' reported age. The findings from the investigation may be used to: (a) assist researchers in measuring the construct of multicultural competence, (b) aid therapists in evaluating their levels of as multicultural competence, and (c) promote sound curriculum in counselor education programs to promotion trainees' development of multicultural competence. Limitations of the study and areas for future research are presented.

Mental health is a critical and pervasive issue for children and adolescents in the United States, with one in five youth living with a diagnosable mental health condition (Center for Disease Control and Prevention, 2017). Despite the increasing rates of mental health disorders, barriers to treatment are abundant and most young people do not receive appropriate treatment (Merikangas, 2009). Mental health literacy is the knowledge and beliefs surrounding mental health that guide recognition, management, and prevention (Jorm, 1997, p. 143). Mental health literacy is a particularly important framework for youth from economically disadvantaged backgrounds as they face increased vulnerabilities to mental health distress and barriers to treatment (World Health Organization, 2017). The aim of the present study was to investigate if an after school mental health literacy intervention changed adolescents' self-reported measures of mental health knowledge, mental health stigma, help-seeking, and hope across three waves of data collection: wave one (immediately before the intervention), wave two (immediately after the intervention), and wave three (one month post-intervention) as measured by: (a) Mental Health Knowledge and Attitude Survey [MHKAS] (Kutcher, McLuckie, & Weaver, 2014), (b) General Help Seeking Questionnaire [GHSQ] (Wilson, Deane, Ciarrochi, & Rickwood, 2005) 2005), (c) Children's Hope Scale [CHS] (Snyder et al., 1997).; and Self-Stigma of Mental Illness-Short Form [SSMIS-SF] (Corrigan et al., 2012). Main findings of the investigation included a significant difference for multivariate analysis between wave one and wave two (Pillai's Trace = .546, F(4, 56) = 16.816, p < .001, partial ƞ2 = .546). There was a statistically significant positive change in mental health knowledge (p < .001; d = 1.992) and help-seeking attitudes (p = .025; d = .934) and a significant negative change in personal mental health stigma (p < .001; d =.582) across wave one and wave two. There was no statistically significant change in hope (p = .904; d = .000) across wave one and wave two. Moreover, there was a statistically significant change from wave one to wave three for multivariate within subjects analysis (Pillai's Trace = .604, F(4, 27) = 10.297, p < .001, partial ƞ2 = .604), indicating changes were maintained at one-month follow-up. Specifically, there was a statistically significant positive change in mental health knowledge (p < .001, d = 1.960) and help-seeking attitudes (p = .007; d = 1.210) and a significant decrease in mental health stigma (p = .002; d = 1.210). There was no significant change in measures of hope from wave one to wave three (p = .467; d = .271). Results of the study are reviewed and compared to similar studies. The researcher discusses implications of findings for counseling, counselor education, and public policy.

The significance of multicultural counseling competence (MCC) has been increasingly recognized in the literature on mental health. Cultural diversification in the United States has prompted greater research in specialized mental health needs among diverse populations. However, despite the specialized mental health needs, diverse cultural groups have faced challenges in finding multiculturally competent mental health services. Accordingly, mental health professions have placed a greater emphasis on the development of therapists' MCC through the training and education, but also made ongoing efforts to integrate MCC into evidenced-based treatment. However, the mental health professions have faced difficulty in exploring evidence for the validity of MCC in therapy, due to a measurement concern regarding MCC. Specifically, such measurement concern in the MCC literature is involved with the fact that there has not existed a client-rated instrument designed to measure therapists' actual MCC performance (i.e., multicultural competent behaviors) in therapeutic process. Therefore, the present study aimed to develop the Client Assessment of Multicultural Competent Behavior (CAMCB) and examine its psychometric properties with a sample of clients. With a correlational research design, the present study involved two phases (Phase I and II) with a sample of diverse clients to inform the development and validation investigation of the CAMCB. Exploratory factor analysis (EFA; n = 280) with the initial pool of 30 items resulted in a three-factor, 23-item CAMCB model. Subsequently, confirmatory factor analysis (CFA; n = 282) was performed to cross-verify the three-factor, 23-item structure of the CAMCB (as identified from EFA) and accumulate evidence of its psychometric properties. CFA resulted in a final three-factor, 19-item CAMCB model with an acceptable model fit. The final CAMCB was found to have good internal consistency reliability and initial evidence for convergent validity with the current data. Lastly, results from a multivariate analysis of variance (MANOVA) and one-way analysis of variance (ANOVA) indicated small but significant difference in the CAMCB total or subscale scores by some subgroups (e.g., race, gender, religion). Discussion of results, limitations of the present study, recommendations for future research, and implications for mental health professionals, researchers, and educators are provided.

Children who endure complex trauma and multiple adverse childhood experiences (ACEs) suffer with various physical, social, and mental health-related consequences, such as increased rates of depression, posttraumatic stress disorder (PTSD), attention deficit/hyperactivity disorder (ADHD), cardiometabolic disorders, substance abuse disorders, ischemic heart disease, and suicidality. Child-Centered Play Therapy (CCPT) is a promising evidence-based child mental health intervention, and researchers have demonstrated the efficacy of CCPT for improving empathy, social competence, behavior problems, and self-regulation among children with multiple ACE exposures. In the current study, the researcher examined the co-regulatory process and relational mechanisms of CCPT with children with histories of complex trauma and early adversities, using child-counselor physiological synchrony values within and across play therapy sessions. Participants were children (N = 4; boys, n = 2; girls, n = 2) ages 5-8 who endured four or more ACEs. The researcher utilized a time series design to examine change processes in CCPT, using intensive longitudinal data (e.g., thousands of physiological data points per session). Children received between 10-14 twice weekly 30-minute CCPT sessions in the school setting. The child participants and counselor wore Empatica© E4 wristbands during play therapy sessions to continuously measure heart rate, as well as sympathetic and parasympathetic heart rate variability (HRV) biomarkers. The researcher computed Surrogate Synchrony (SUSY) analyses and found consistent, large child-counselor heart rate synchrony levels across play therapy sessions. The researcher presents the implications of this research for mental health counselors, play therapists, and counselor educators working with children impacted by complex trauma.

This investigation examined the relationship between multiple losses and mental health in refugees. More specifically, the researcher examined the hypothesized directional relationship between adult refugees' loss distress and their identity distress, trauma symptoms, and family functioning. The investigation was cross-sectional, and the researcher used questionnaires for data collection. The researcher conducted descriptive analyses and used Partial Least Squares (PLS-SEM) to assess the investigation's hypotheses. The final sample size for this investigation was 330 participants (men, n = 189; women, n = 136; other genders, n = 4). Participants' ages ranged from 19 to 72 years old (M = 34.3, SD = 8.3). The study findings supported the hypotheses and indicated that higher loss distress was associated with increased trauma symptoms (f2 = 0.925), identity distress (f2 = 0.682), and family dysfunction (f2 = 0.036). The researcher emphasized the critical need to develop tailored counseling interventions that specifically target loss as a significant factor in predicting mental health issues within the refugee population. Furthermore, the researcher underscored the importance of conducting further research studies to explore the profound effects of multiple losses experienced by refugees on their mental health.

The focus of current research is to elucidate the relationship between collectivism/individualism (as measured by the Horizontal and Vertical Individualism and Collectivism Scale [HVIC; Triandis & Gelfand, 1998]), working alliance (as measured by the Working Alliance Inventory-Therapist [WAI-T; Horvath, 1981]), self-differentiation (as measured by the Differentiation of Self Inventory-Revised [DSI-R; Skowron & Schmitt, 2003]), and countertransference management (as measured by the Countertransference Factors Inventory-Revised [CFI-R; Hayes et al. , 1997]). The study attempts to address the proposed research hypotheses using structural equation modeling (SEM). The research underscores the complex interplay of variables and highlights the central role of cultural orientation in the working alliance. The primary analysis shows that self-differentiation serves as a significant mediator between horizontal individualism, vertical individualism, horizontal collectivism, and the effectiveness of countertransference management. In addition, the current analysis confirms that self-differentiation also functions as a mediator between horizontal individualism, vertical individualism, horizontal collectivism, and working alliance. The findings underscore the role that self-differentiation plays in different cultural contexts, underscoring its critical importance within the therapeutic relationship. However, contrary to initial expectations, countertransference management did not show a significant mediating effect between individualism/collectivism orientations and working alliance. This suggests that countertransference management may not directly influence working alliance within the proposed cultural contexts. Finally, the study substantiates the serial mediation of self-differentiation and countertransference management between individualism/collectivism orientations and working alliance. Specifically, horizontal individualism positively influences working alliance through the sequence of self-differentiation followed by countertransference management, whereas vertical individualism and horizontal collectivism negatively influence working alliance through the same serial mediation. However, vertical collectivism does not show a meaningful mediating effect within this sequence, suggesting the potential presence of other yet unidentified factors.

The purpose of this study was to investigate the directional relationship between student-athletes' degree of mental health stigma, help-seeking attitudes, depression, anxiety, and life stress scores. This investigation tested the theoretical model that student-athletes' (N = 621) degree of mental health stigma (as measured by the Perceived Devaluation-Discrimination Scale – Adapted [PDD-A; Eisenberg et al., 2009]) contributed to their attitudes towards help-seeking (as measured by the Attitudes Toward Seeking Professional Psychological Help – Short Form [ATSPPH-SF; Fisher & Farina, 1995]) and levels of depression (as measured by the Patient Health Questionnaire – 9 [PHQ-9; Kroenke et al., 2001]), anxiety (as measured by the Generalized Anxiety Disorder - 7 [GAD-7; Spitzer et al., 2006]), and life stress (as measured by the College Student-Athlete Life Stress Scale [CSALSS; Lu et al., 2012]). Specifically, the researcher tested the hypothesized directional relationship that student-athletes with a greater amount of mental health stigma would have (a) decreased positive help-seeking attitudes and (b) increased levels of depression, anxiety, and life stress. The results of the structural equation model (SEM) analyses identified that student-athletes' amount of mental health stigma contributed to help-seeking attitudes (25.6% of the variance), but not levels of depression (.16% of the variance), anxiety (.09% of the variance), or life stress (.81% of the variance). Specifically, student-athletes' degree of mental health stigma shared a strong negative relationship (-.506) with attitudes towards seeking professional psychological help. Further, the results identified that personal stigma mediates the relationship between public stigma and help-seeking attitudes. Implications of the findings include (a) greater knowledge of the importance student-athletes' mental health stigma and attitudes toward receiving help; (b) increased understanding for counselors of student-athletes mental health needs; and (c) insight into practices for institutions of higher education as they implement mental health initiatives within intercollegiate athletics.

Thesis (Ph.D.)--Kent State University, 2009. / Title from PDF t.p. (viewed Feb. 17, 2010). Advisor: Martin Jencius. Keywords: graduate counseling student ratings of teachers; generational; Q methodology; student preferences. Includes bibliographical references (p. 218-232).

The Council for Accreditation of Counseling and Related Educational Programs (CACREP, 2009) defines a counseling student’s internship as the “capstone” experience in his or her training (p. 60), and the importance and value of the counseling internship experience has been established in the literature (Bernard & Goodyear, 2004; Gibson et al., 2010; Gnilka et al., 2012). However, despite all of its benefits, the masters-level internship process itself can pose several stressful challenges for the counseling intern, specifically “peripheral stressors”. Peripheral stressors refer to those stressful challenges or issues that counseling students face outside of counseling sessions and beyond client work. The purpose of this study was to assess counseling interns’ perceived peripheral stressors when completing their masters-level internship. Research questions included: What are the student-perceived peripheral stressors when completing a masters-level counseling internship? How stressful are these challenges to counseling interns, if at all? Do students in CACREP recommended internship structures experience various stressors differently than students in longer internship structures? Is there a difference in the effect of stressors among demographic groups? A survey was developed and distributed in Qualtrics survey software. The survey was used to identify counseling interns’ perceived peripheral stressors as they relate to the counseling internship, and determine how stressful these challenges are to interns, if at all. The results indicated that some peripheral stressors experienced by interns could be considered “a concern” or “problematic.” Further, an exploratory factor analysis was conducted, resulting in the peripheral stressors being appropriately grouped into six common or underlying dimensions: Deficient Training Experience at Internship Site, Struggles with University Supervisor, Internship Site Selection Process, Personal Wellness and Financial Strain, Meeting CACREP Requirements, and Issues with Internship Site Personnel. The factor scores were then used to compare peripheral stressors in internship across internship structures and other demographic groups through analysis of variance and t-tests. Certain groups of students, including but not limited those employed outside of their counseling internship and those that must find and secure their own internship site, perceived more stress in some of the peripheral stressor factors than other counseling interns.