The development and initial validation of a client-rated measure of therapist cultural comfort (the Therapist Cultural Comfort Scale [TCCS]) is reported. The first phase of the study involved content validation of the initial pool of items via consultation with (a) focus groups of doctoral student therapists and (b) experts in the field of multicultural counseling and psychotherapy. A 56-item pool generated during this phase, together with instruments used to gauge convergent and incremental validity, were administered to a community adult sample of current psychotherapy clients (N ϭ 889). Exploratory factor analysis suggested 2 subscales representing negative and positive indicators of therapist cultural comfort. Item response theory principles guided final selection of subscale items. Analyses suggested good factor stability and reliability of the 13-item TCCS as well as strong measurement invariance across racial/ ethnic minority status and gender. Total and subscale scores related as expected with other measures of multicultural constructs (cultural humility, missed cultural opportunities, and multicultural competencies). Generally, TCCS total and subscale scores also predicted working alliance and treatment progress above and beyond the effects of therapist general comfort. There were few differences in clients' perceptions of therapist cultural comfort based on client demographic characteristics. Implications for research and practice are discussed. Public Significance StatementThis study reports the development of the Therapist Cultural Comfort Scale, a new scale designed to measure clients' perceptions of their therapist's cultural comfort during session. Additionally, this study highlights the role of cultural comfort in effective psychotherapy.

Frank and Frank suggested that the primary goal of contextually oriented therapy is remoralization through the promotion of hope. According to Snyder's hope theory, hope is a psychological characteristic consisting of pathways thinking, agency, and goals. Although these concepts are relevant to understanding how hope develops through therapy, no instrument exists to measure hope within counseling. The present research was undertaken to develop and validate the Hope for Change Through Counseling Scale (HCCS). Study 1 (N = 191) was an analogue study to pilot the scale and identify its factor structure. Study 2 (N = 306) consisted of a confirmatory factor analysis to further refine the HCCS. Study 3 utilized the HCCS with clients (N = 50), providing evidence of construct validity and incremental validity for the scale. Implications of the HCCS as an assessment tool to facilitate focus on client hopefulness within counseling are discussed. Keywordshope for change through counseling, hope theory, domain-specific hope, positive psychological assessment, client factors

Hope is often identified as a central process in psychotherapy, with researchers supporting links between clients' hope, symptom distress, and process variables. However, this body of literature is yet to specifically ask what it means for psychotherapists to have hope for their clients. Our purpose, with this descriptive phenomenological study, was to understand the meaning of therapists' hope for their clients. This information has the potential to better inform how therapists think about their own hope for clients and the ways in which this is transmitted to clients who may enter therapy in a state of hopelessness. To accomplish this, we interviewed psychologists (N ϭ 8) using a semistructured interview protocol. Interviews were transcribed then analyzed in accordance with descriptive phenomenology guidelines. Four themes were identified: (a) a sense of holding and possibility; (b) fundamental, dynamic, and reflective practice; (c) client influence (positive and negative) on hope; and (d) connection through hope. The findings are discussed in light of therapist effects in psychotherapy, the internal world of therapists, and training implications. Public Significance StatementTherapists' hope for their clients has been understudied despite being a valuable concept that could influence how therapists work during treatment. Our results provide an understanding of the phenomenology of therapists' hope not documented elsewhere in literature. Thus, psychologists can draw from the meanings offered by these participants to foster their own reflections on their hope for clients, where this hope originates from, and how fluctuations in their hope may influence the course of care for clients.

This methodological review was undertaken to explore how researchers use mixed methods in culture-specific psychological research. Mixed methods represents a budding approach with the potential to explore the nexus of context and psychology, capturing the uniqueness of psychological phenomena within cultures. Twelve empirical studies that used mixed methods in culturally specific psychology were examined to determine designs commonly used as well as patterns of mixed methods use in culturally driven psychological research. In line with the study by Creswell and Plano Clark (2007) , concurrent, sequential, and embedded designs were identified with some variation. Analyses indicate that mixed methods is an integral means to ask complex psychological questions without imposing Western norms and ignoring contextual factors. Culturally specific psychological research is discussed as an overarching discipline in which culture is at the forefront of psychological discovery and analysis. Mixed methods is situated within this broad discipline as a method that provides distinct contributions to studying the intersections of cultures and psychology.

Despite growing evidence that a greater number of students are seeking counseling in college and university counseling centers throughout the United States, there is a dearth of empirical information about (a) the presenting concerns for which students seek treatment and (b) how these concerns differ according to client demographic factors. The purpose of this descriptive and exploratory study was to explore how counseling center clinicians categorize client presenting concerns, and how these concerns vary according to client demographics. Given the importance of client suicide within the field of college counseling, the frequency of suicidality as an identified presenting concern was also explored. A sample of 1,308 clinicians from 84 counseling centers rated the presenting concerns of 53,194 clients using the Clinician Index of Client Concerns (CLICC) after an initial consultation. Results of descriptive and nonparametric analyses indicated that the most prevalent concerns were anxiety, depression, stress, family, and academic performance, and that clients who belong to different demographic groups frequently present to counseling with broadly similar types of concerns. Furthermore, suicidality represented an area of concern for 8.4% of all clients, and it ranked 20 of 44 as a clinician-rated concern. Comparable rates emerged across the range of client demographic groups examined, although rates were notably higher for a handful of groups. The findings offer one of the largest and most generalizable descriptions of why college students seek counseling services, as determined by clinicians' evaluations of presenting concerns. Implications for research and clinical applications of the findings are discussed. (PsycINFO Database Record

Misunderstandings about qualitative methods, whether phenomenological or otherwise, are prevalent in social science research. Such misunderstandings leave researchers, reviewers, and editors less equipped to conduct or evaluate this method. Evaluation of phenomenology is especially complicated given the different variants that exist and the need for flexibility within these studies. Methodologists have created guides for conducting specific variants of phenomenology; however, these do not provide clear guidance as to what is an adequate sample in phenomenology. The purpose of this systematic review was to help improve implementation of phenomenological methods by exploring sample issues as they relate to study quality. We implemented an explanatory sequential mixed methods design to test relationships between samples and studies’ quality then deepen our understanding of these findings with a focused content analysis. First, we reviewed and coded 200 manuscripts following the PRISMA method. Larger samples were associated with lower quality and studies aligned with a specific phenomenological method tended to be of higher quality. Second, we identified two cases from the studies reviewed and subjected them to deductive qualitative content analysis to identify features that demonstrate quality. Findings are discussed with respect to implications for phenomenological methods in social and health sciences.

We employed a convergent mixed methods design to examine therapist and counseling center effects on international student clients' (ISCs) counseling outcomes. Using the Center for Collegiate Mental Health (CCMH) data set (2015-2017), we conducted a three-level hierarchical linear model with clients (N = 85,110) nested in therapists (N = 1,267), and therapists nested in counseling centers (N = 111), with clients' international status predicting distress (DI) in their last sessions while controlling for initial DI. Compared to domestic students, the average last session DI was significantly higher among ISCs. Random effects were significant, suggesting that some therapists and centers were more effective in their work with ISCs than others. When the proportion of ISCs seen was accounted into the model, we found a cross-level interaction in which the last session DI differences between ISCs and domestic students were significant for centers seeing a small percentage of ISCs but not for centers with large percentages of ISCs in the caseload. Grounded theory analysis of qualitative data from 11 therapists with international backgrounds revealed therapist and center factors that converged with our quantitative findings. Participants reported adhering to general clinical frameworks when working with ISCs given the lack of training on international competence (which may help explain the effectiveness gap), but also noted nuanced culturally-informed components that likely contribute to more effectively working with ISCs. Findings around center effects were complemented by qualitative results emphasizing systemic representation and engagement with diversity, creative outreach efforts, and administrative/leadership support. Implications for practice and research are discussed. Public Significance StatementInternational student clients reported worse distress outcomes at the end of therapy than domestic students at college counseling centers. This difference varied across therapists and counseling centers and was significant for centers that saw a small percentage of international students but not for centers with a large percentage of international students in the caseload. We identified both challenges and culturally-informed approaches among therapists and centers that contribute to differential counseling outcomes among international students.

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