Stigma for Seeking Therapy

Owen, Jesse; Thomas, Lauren E.; Rodolfa, Emil

doi:10.1177/0011000012459365

Cited by 21 publications

(12 citation statements)

References 50 publications

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“…Our findings replicate and extend prior research (Deres et al, 2020;Owen et al, 2013;Wade et al, 2011) by demonstrating that the self-stigma associated with seeking psychological help is related to worsened perceptions of the therapist-client working alliance. However, they are inconsistent with those reported by Kendra et al (2014), who found that within-person increases in selfstigma were associated with a stronger working alliance.…”

Section: Discussionsupporting

confidence: 87%

“…First, Wade et al (2011) reported a significantly negative association among 263 college students receiving one session of group counseling when self-stigma was measured after session; presession levels of self-stigma were negatively but not significantly associated with alliance ratings. Second, Owen et al (2013) found that higher self-stigma was associated with lower ratings of the alliance in a sample of 91 college students receiving individual psychotherapy. Most recently, Seidman et al (2022) found a negative but not significant relationship among a sample of 138 college students attending a one-time group therapy session.…”

mentioning

confidence: 95%

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Examining between- and within-person effects of the self-stigma of seeking psychological help on the therapeutic working alliance: The moderating role of psychological distress.

Seidman¹,

Vogel²,

Lannin³

2023

Psychotherapy

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The self-stigma (i.e., shame) associated with psychotherapy is a prominent barrier to seeking psychological help, but less is known about its effects after treatment begins. Evidence suggests that self-stigma may interfere with the formation of the therapeutic alliance, but no studies have examined this throughout the course of psychotherapy. Self-stigma's erosion of the alliance may be most pronounced when clients experience heightened psychological distress, but this also has not been examined. Therefore, the present study addresses these omissions among 37 clients who completed at least three therapy sessions for research credit. Participants completed measures of self-stigma and past-week symptoms of distress before each session and ratings of the working alliance after. Predictor variables were disaggregated into betweenperson (time-invariant or average levels) and within-person (time-variant or session-by-session changes) components to enable investigation of for whom (and under what conditions) self-stigma was associated with the therapeutic alliance. Results indicated that higher levels of self-stigma (between and within persons) predicted a worse alliance. When examined as an interaction effect alongside distress in a multilevel moderation model, higher between-person ratings of self-stigma predicted a weaker therapistclient alliance across levels (M ± 1 SD) of within-person distress. Notably, its effects became more pronounced as symptoms of distress increased, indicating a period in which clients are simultaneously most likely to need help yet least likely to feel allied with their therapist. Findings highlight the importance for therapists to simultaneously monitor and consider both average and session-by-session fluctuations in selfstigma and distress to develop and maintain the working alliance. Clinical Impact StatementQuestion: (a) Does the self-stigma of seeking psychotherapy, when considered at between-(i.e., timeinvariant, or average levels) and within-person levels (i.e., time-variant, or session-by-session fluctuations), interfere with the therapy process by damaging the therapist-client working alliance? (b) Is this relationship moderated by fluctuations in past-week symptoms of psychological distress? Findings: (a) Heightened self-stigma (between and within persons) predicts lower ratings of the alliance. (b) There is a cross-level moderation effect: higher between-person ratings of self-stigma predict a weaker alliance across levels (M ± 1 SD) of within-person distress; its adverse effects are exacerbated as, session-by-session, clients experience heightened symptomatology. Meaning: The effects of self-stigma interfere with the working alliance and do not disappear "at the therapy door." To develop and maintain the alliance, it appears important for therapists to consider self-stigma and distress as both trait-and state-like components. Next Steps: Future research is needed to examine the interactional effects between self-stigma and psychological distress among diverse clinical population...

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Section: Discussionsupporting

confidence: 87%

mentioning

confidence: 95%

Examining between- and within-person effects of the self-stigma of seeking psychological help on the therapeutic working alliance: The moderating role of psychological distress.

Seidman¹,

Vogel²,

Lannin³

2023

Psychotherapy

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“…Identities provide a window into the client’s values, beliefs, and potential consequences of nonconformance. For example, in many communities, therapy is not an ideal way to address problems, and going to therapy is stigmatizing (Owen, Thomas, & Rodolfa, 2013). Collaborating to understand the client’s illness narrative can enhance treatment outcomes with clients from marginalized groups (Benish, Quintana, & Wampold, 2011).…”

Section: Discussionmentioning

confidence: 99%

The multicultural orientation framework: A narrative review.

et al. 2018

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After several decades of slow progress, researchers are beginning to make advances in linking constructs based on the multicultural competencies tradition-especially those focused on qualities of the therapist-to therapy outcomes. The multicultural orientation framework was developed in response to several trends within the multicultural competencies tradition, with a particular emphasis on integrating the multicultural competencies tradition into research on psychotherapy process. We provide a narrative review of studies that include one of the three constructs (i.e., cultural humility, cultural opportunities, and cultural comfort) articulated by the multicultural orientation framework. Results indicate initial evidence linking multicultural orientation constructs to therapy outcomes (e.g., perceived improvement, racial/ethnic disparities in termination, and therapy alliance). Results also supported the social bond and social oil hypotheses from theorizing on humility. Implications for future research and therapy practice are discussed.

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“…Further, this study allows those who have succeeded at long-term, satisfying relationships to pass on their advice and words of wisdom to the rest of the world in terms of what has been important and how difficult times were handled. Stigma around issues within relationships and seeking therapeutic help exists in our world (Owen et al, 2012), and many couples resist exposing marital imperfection, though support is known to provide healing and remediation. Soon, the last of the generations who married "for good," without fear or consideration of an overwhelming divorce rate, will be gone.…”

Section: Purposementioning

confidence: 99%

To Be or Not to Be: Advice From Long-Term Spouses in a Mixed Methods Study

Stahnke

2022

The Family Journal

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Marriage has been a topic of analysis for decades, supported by countless funders such as the government and the Healthy Marriage Initiative. With time, marriage has become less of a societal standard despite overwhelming research supporting its value for adults, children, and society. With the idea that factors that create satisfaction may not be the same ones that result in long-term success, this study uniquely aimed to get the perspectives of those who have been married for 20 or more years. This study's purpose is to record the wisdom on marriage coming from generations of largely successful individuals through anonymous online surveys. Educational level and marital satisfaction are both associated with participants reporting that their marriage is important to their life satisfaction. While infidelity, raising children, health problems, finances, and loss were the struggles most reported, hard work and commitment were reported as the most important needs to come back from difficult times within long-term marriages. Successful, long-term marriages exist as a product of choices of both individuals.

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Stigma for Seeking Therapy

Cited by 21 publications

References 50 publications

Examining between- and within-person effects of the self-stigma of seeking psychological help on the therapeutic working alliance: The moderating role of psychological distress.

Examining between- and within-person effects of the self-stigma of seeking psychological help on the therapeutic working alliance: The moderating role of psychological distress.

The multicultural orientation framework: A narrative review.

To Be or Not to Be: Advice From Long-Term Spouses in a Mixed Methods Study

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