Year of Award


Document Type


Degree Type

Doctor of Philosophy (PhD)

Degree Name

Clinical Psychology

Department or School/College

Department of Psychology

Committee Chair

Bryan Cochran

Commitee Members

Duncan Campbell, Anisa Goforth, Kirsten Murray, Jennifer Waltz


affirmative therapy, gender minority, LGBT, mental health, multicultural competence, sexual minority


University of Montana


Although there have been targeted efforts to improve mental health care provision to SGM individuals in the last several decades, SGM mental health consumers report ongoing barriers to therapy, including providers' poor SGM-specific multicultural competencies. The current project examines (1) differences in perceptions of SGM-specific multicultural competence between providers and their clients, and (2) how perceptions of SGM multicultural competence are predictive of variation in treatment outcomes. To this end, 73 SGM mental health consumers and 53 of their therapists were recruited to independently evaluate the mental health provider's SGM-specific multicultural competence at two time points, with respective retention rates of 93.2% and 94.3%. In addition, data on demographics, general satisfaction with treatment, therapeutic process outcomes, and mental health outcomes were collected. In the current sample, therapy clients (M = 5.60, SD = 0.53) and their providers (M = 6.19, SD = 0.29) varied significantly on their perceptions of provider's SGM-specific multicultural competence, t(53) = -7.093, p < 0.001, r = 0.70. In a series of regression analyses, therapy clients' perceptions of SGM multicultural competence were predictive of 5.9% of the variation in the therapeutic process outcomes above and beyond general satisfaction with care, F(3,49) = 11.92, p = 0.03.; therapists' perceptions were not significantly predictive. Neither clients' nor providers' perceptions of SGM multicultural competence were significantly predictive of changes in the client's psychological distress at the three-month follow up. These results suggest that disparate perceptions of multicultural competence could have important considerations for the therapeutic process. Implications for research and practice are discussed.



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