Mental healthcare providers increasingly use technology for psychotherapy services. This progress enables professionals to communicate, store information, and rely on digital software and hardware. Emails, text messaging, telepsychology/ telemental health therapy, electronic medical records, cloudbased storage, apps/applications, and assessments are now available within the provision of services. Of those mentioned, some are directly utilized for psychotherapy while others indirectly aid providers. Whereas professionals previously wrote notes locally, technology has empowered providers to work more efficiently with third-party services and solutions. However, the implementation of these advancements in mental healthcare involves consequences to digital privacy and might increase clients' risk of unintended breaches of confidentiality. This manuscript reviews common technologies, considers the vulnerabilities therein, and proposes suggestions to strengthen privacy.

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Purpose: Research has demonstrated associations between discrimination and mental health in lesbian, gay, bisexual, and transgender populations. However, little is known about the influence of geographic location on psychological distress in these populations, particularly among transgender people.Methods: This secondary analysis conducted on a national sample of transgender individuals (N=414) offers a preliminary understanding of the effects of geographic location on psychological distress (i.e., anxiety and depression). A univariate analysis of variance was calculated to determine this relationship.Results: The West South Central division (i.e., Arkansas, Louisiana, Oklahoma, and Texas) revealed highest psychological distress.Conclusion: Results suggest an urgent need for transgender-competent healthcare in this division.

Health service psychology (HSP) graduate programs are shifting from knowledge-to competency-based assessments of trainees' psychotherapy skills. This study used Generalizability Theory to test the dependability of psychotherapy competence assessments based on video observation of trainees. A 10-item rating form was developed from a collection of forms used by graduate programs (n = 102) in counseling and clinical psychology, and a review of the common factors research literature. This form was then used by 11 licensed psychologists to rate eight graduate trainees while viewing 129, approximately 5-min video clips from their psychotherapy sessions with clients (n = 22) at a graduate program's training clinic. Generalizability analyses were used to forecast how the number of raters and clients, and length of observation time impact the dependability of ratings in various rating designs. Raters were the primary source of error variance in ratings, with rater main effects (leniency bias) and dyadic effects (rater-target interactions) contributing 24% and 7% of variance, respectively. Variance due to segments (video clips) was also substantial, suggesting that therapist performance varies within the same counseling session. Generalizability coefficients (G) were highest for crossed rating designs and reached maximum levels (G > .50) after four raters watched each therapist working with three clients and observed 15 min per dyad. These findings suggest that expert raters show consensus in ratings even without rater training and only limited direct observation. Future research should investigate the validity of competence ratings as predictors of outcome. Public Significance StatementRatings of clinical competence are used to determine adequate progress for trainees in HSP and to document competence for accreditation and licensure bodies. This study examined sources of error in these ratings to provide guidance on improving assessment procedures. For competence assessments based on direct observation, we recommend evaluation by multiple raters for each trainee, and observation times of at least 60 min per trainee.

Transgender (trans) individuals and their partners demonstrate significant diversity in terms of sexuality and approaches to romantic relationships. Over 3/4 (77%) of trans individuals identify as sexual minorities, but little is known about how they negotiate sexual and gender identities within a relationship. Additionally, findings have indicated that trans individuals and their partners utilize nonmonogamous relationship structures, but research focused on how these relationships develop and the function of consensual nonmonogamy (CNM) is limited. The goal of this study was to address these gaps through an exploration of CNM in a sample of trans individuals and their partners who participated in a larger study about sex, sexuality, and sexual practice. The subsample consisted of 12 individuals (6 couples) who discussed CNM as part of their broader discussion of relationships and sexual practice. Four individuals (2 couples) were currently engaged in relationships with extradyadic partners. In terms of sexual identity, 67% of participants (n ϭ 8) identified as bisexual-queer-pansexual. A majority of participants identified as transgender (67%; n ϭ 8), and participants' ages ranged from 23 to 39 (M ϭ 30.2, SD ϭ 5.5). Transcripts were analyzed using Charmaz's (2014) approach to grounded theory. Themes identified during analysis highlight factors that facilitate and hinder the development of CNM relationships and individual and relationship factors that impact CNM relationships among trans individuals and their partners. Public Significance StatementThis study advances the idea that consensual nonmonogamy may be an important component of some transgender individuals' and their partners' lives. Results suggest that specific factors related to transgender identity, such as openness to new experiences or adjustment related to defying social norms, may create a unique process that allows for additional possibilities for relationships.

Technologies used for record keeping have rapidly changed over the last 2 decades, with many providers shifting from pen and paper notes to electronic medical records (EMRs) and other cloud-based, digital solutions. This transition to electronic means of client data storage has resulted in greater efficiencies, improved integrated care, and loss prevention. However, moving to digital means of record keeping involves novel legal and ethical consequences, which have been reviewed by various authors (e.g., Devereaux and Gottlieb (2012) and the APA’s, 2007 Record Keeping Guidelines). Importantly, unexamined to date are concerns associated with data after death—specifically, when a mental health provider who uses technology for record keeping unexpectedly departs via incapacitation, death, or other unknown circumstances. These circumstances may prevent continuity of care and access to data among survivors. This article reviews the current use of digital record keeping, federal and state policies, legal and ethical standards, and provides forward-looking recommendations for professionals.

The current study employed qualitative methodology to investigate the experiences of 12 men who came out online, using Facebook. Analysis of coding data yielded several key themes. First, gay men discussed a range of experiences that influenced their online disclosure including homophobia, internalized homophobia, and previous salient sexual identity disclosures. Participants also commonly expressed a variety of goals and concerns about coming out online, including improving relationships and loss of friends. Finally, gay men identified several benefits to coming out on Facebook, including increased efficiency in coming out as compared to face-to-face disclosures, increased authenticity, and decreased ambiguity about their sexuality. Results are discussed within the context of literature on men's coming-out experiences, men and masculinity and online identity management.vi

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