Religious and Sexual Identities: An Intersectional,Longitudinal Examination of Change in Therapy

Abstract

The current study employs an intersectional framework to understand how well counselors are meeting the needs of lesbian, gay, bisexual, queer, questioning (LGBQQ) and religious clients by examining clients’ initial anxiety and depression levels and changes in these symptoms through psychotherapy. Data from 12,825 participants from the Center for Collegiate Mental Health 2012–2014 data set were analyzed. Results from hierarchical linear modeling indicate lower baseline anxiety and depression among religious clients and faster rates of change of anxiety symptoms among nonreligious clients. LGBQQ clients presented with higher initial anxiety and depression, but there were no differences in rates of change of anxiety and depression between heterosexual and LGBQQ clients. Significant but minimal interaction effects between religious and sexual identities were found, indicating a need for further research. Counselors are encouraged to be mindful of these disparities in therapy.

Keywords

intersectionality LGBQQ religion/spirituality anxiety depression

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References

American Psychological Association (2010). Ethical principles of psychologists and code of conduct. Retrieved from http://www.apa.org/ethics/code/

American Psychological Association, Task Force on Appropriate Therapeutic Responses to Sexual Orientation (2009). Report of the American Psychological Association Task Force on Appropriate Therapeutic Responses to Sexual Orientation. Retrieved from https://www.apa.org/pi/lgbt/resources/therapeutic-response.pdf

Anhalt

Morris

T. L.

Scotti

J. R.

Cohen

S. H.

(2003). Student perspective on training in gay, lesbian, and bisexual issues: A survey of behavioral clinical psychology programs. Cognitive and Behavioral Practice, 10, 255–263. doi:10.1016/S1077-7229(03)80038-X

Astin

A. W.

Astin

H. S.

Lindholm

J. A.

Bryant

A. N.

Calderone

Szelényi

(2003). The spiritual life of college students: A national study of college students’ search for meaning and purpose. Los Angeles, CA: Higher Education Research Institute, UCLA.

Barnes

D. M.

Meyer

I. H.

(2012). Religious affiliation, internalized homophobia, and mental health in lesbians, gay men, and bisexuals. American Journal of Orthopsychiatry, 82, 505–515. doi:10.1111/j.1939-0025.2012.01185.x

Bilgrave

D. P.

Deluty

R. H.

(2002). Religious beliefs and political ideologies as predictors of psychotherapeutic orientations of clinical and counseling psychologists. Psychotherapy: Theory, Research, Practice, Training, 39, 245–260. doi:10.1037/0033-3204.39.3.245

Bolker

B. M.

Brooks

M. E.

Clark

C. J.

Geange

S. W.

Poulsen

J. R.

Stevens

M. H. H.

White

J. S. S.

(2009). Generalized linear mixed models: a practical guide for ecology and evolution. Trends in Ecology & Evolution, 24, 127–135. doi:10.1016/j.tree.2008.10.008

Bonelli

R. M.

Koenig

H. G.

(2013). Mental disorders, religion and spirituality 1990 to 2010: A systematic evidence-based review. Journal of Religion and Health, 52, 657–673. doi:10.1007/s10943-013-9691-4

Bowman

N. A.

Small

J. L.

(2012). Exploring a hidden form of minority status: College students’ religious affiliation and well-being. Journal of College Student Development, 53, 491–509. doi:10.1353/csd.2012.0050

10.

Cochran

S. D.

Sullivan

J. G.

Mays

V. M.

(2003). Prevalence of mental disorders, psychological distress, and mental health services use among lesbian, gay, and bisexual adults in the United States. Journal of Consulting and Clinical Psychology, 71, 53–61. doi:10.1037/0022-006X.71.1.53

11.

Cole

E. R.

(2009). Intersectionality and research in psychology. American Psychologist, 64, 170–180. doi:10.1037/a0014564

12.

Crenshaw

(1989). Demarginalizing the intersection of race and sex: A Black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. University of Chicago Legal Forum, 1989, 139–167.

13.

Dehlin

J. P.

Galliher

R. V.

Bradshaw

W. S.

Hyde

D. C.

Crowell

K. A.

(2015). Sexual orientation change efforts among current or former LDS church members. Journal of Counseling Psychology, 62, 95–105. doi:10.1037/cou0000011

14.

Dessel

Bolen

(2014). Conservative Christian beliefs and sexual orientation in social work: Privilege, oppression, and the pursuit of human rights. Alexandria, VA: CSWE Press.

15.

Else-Quest

N. M.

Hyde

J. S.

(2016). Intersectionality in quantitative psychological research: I. Theoretical and epistemological issues. Psychology of Women Quarterly, 40, 155–170. doi:10.1177/0361684316629797

16.

Eubanks-Carter

Burckell

L. A.

Goldfried

M. R.

(2005). Enhancing therapeutic effectiveness with lesbian, gay, and bisexual clients. Clinical Psychology: Science and Practice, 12, 1–18. doi:10.1093/clipsy/bpi001

17.

Finch

A. E.

Lambert

M. J.

Schaalje

B. G.

(2001). Psychotherapy quality control: The statistical generation of expected recovery curves for integration into an early warning system. Clinical Psychology and Psychotherapy, 242, 231–242. doi:10.1002/cpp.286

18.

Howard

K. I.

Kopta

S. M.

Krause

M. S.

Orlinsky

D. E.

(1986). The dose-effect relationship in psychotherapy. The American Psychologist, 41, 159–164. doi:10.1037/0003-066X.41.2.159

19.

Judd

C. M.

McClelland

G. H.

Ryan

C. S.

(2011). Data analysis: A model comparison approach. New York, NY: Routledge.

20.

Juster

Smith

N. G.

Ouellet

É.

Sindi

Lupien

S. J.

(2013). Sexual orientation and disclosure in relation to psychiatric symptoms, diurnal cortisol, and allostatic load. Psychosomatic Medicine, 75, 103–116. doi:10.1097/PSY.0b013e3182826881

21.

Keating

A. M.

Fretz

B. R.

(1990). Christians’ anticipations about counselors in response to counselor descriptions. Journal of Counseling Psychology, 37, 293–296. doi:10.1037/0022-0167.37.3.293

22.

Kelley

F. A.

(2015). The therapy relationship with lesbian and gay clients. Psychotherapy, 52, 113–118. doi:10.1037/a0037958

23.

Larson

D. B.

(1996). Have faith: Religion can heal mental illness. In Slife

(Ed.), Taking Sides: Clashing views on controversial psychological issues (pp. 388–392). Guilford, CT: Dushkin.

24.

Lefevor

G. T.

Park

Pederson

(2016, August). The impact of sexuality, religion, and their intersection on mental health. Poster presented at the Annual Convention of the American Psychological Association, Denver, CO.

25.

Locke

B. D.

McAleavey

A. A.

Zhao

Lei

P.-W. P.-W.

Hayes

J. A.

Castonguay

L. G.

… Lin

Y.-C.

(2012). Development and initial validation of the Counseling Center Assessment of Psychological Symptoms-34. Measurement and Evaluation in Counseling and Development, 45, 151–169. doi:10.1177/0748175611432642

26.

Lutz

Leon

S. C.

Martinovich

Lyons

J. S.

Stiles

W. B.

(2007). Therapist effects in outpatient psychotherapy: A three-level growth curve approach. Journal of Counseling Psychology, 54, 32–39. doi:10.1037/0022-0167.54.1.32

27.

Mayers

Leavey

Vallianatou

Barker

(2007). How clients with religious or spiritual beliefs experience psychological help-seeking and therapy: A qualitative study. Clinical Psychology & Psychotherapy, 14, 317–327. doi:10.1002/cpp.542

28.

McAleavey

A. A.

Castonguay

L. G.

Locke

B. D.

(2011). Sexual orientation minorities in college counseling: Prevalence, distress, and symptom profiles. Journal of College Counseling, 14, 127–142. doi:10.1002/j.2161-1882.2011.tb00268.x

29.

McCoach

D. B.

Black

A. C.

(2008). Evaluation of model fit and adequacy. In O’Connell

A. A.

McCoach

D. B.

(Eds.), Multilevel modeling of educational data (pp. 245– 272). Charlotte, NC: Information Age.

30.

Meyer

I. H.

(2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674– 697. doi:10.1037/0033-2909.129.5.674

31.

Norcross

J. C.

Lambert

M. J.

(2011). Evidence-based therapy relationships. In Norcross

J. C.

(Ed.), Psychotherapy relationships that work: Evidence-based responsiveness (2^nd ed.) (pp. 3–21). New York, NY: Oxford University Press. doi:10.1093/acprof:oso/9780199737208.003.0001

32.

Pate

R. H.

Jr. Bondi

A. M.

(1992). Religious beliefs and practice: An integral aspect of multicultural awareness. Counselor Education and Supervision, 32, 108–115. doi:10.1002/j.1556-6978.1992.tb00180.x

33.

Perez

R. M.

DeBord

K. A.

Bieschke

K. J.

(2000). Handbook of counseling and psychotherapy with lesbian, gay, and bisexual clients. Washington, DC: American Psychological Association. doi:10.1037/10339-000

34.

Pew Research Center. (2015, May). American’s changing religious landscape. Retrieved from: http://www.pewforum.org/2015/05/12/americas-changing-religious-landscape/

35.

Phillips

J. C.

Fischer

A. R.

(1998). Graduate students’ training experiences with lesbian, gay, and bisexual issues. The Counseling Psychologist, 26, 712–734. doi:10.1177/0011000098265002

36.

Phillips

J. C.

Fitts

B. R.

(in press). Beyond competencies and guidelines: Training considerations regarding sexual minority and transgender and gender nonconforming people. In DeBord

Fischer

Bieschke

Perez

(Eds.), The Handbook of Sexual Orientation and Gender Diversity in Counseling and Psychotherapy (3rd ed.). Washington, DC: American Psychological Association.

37.

Pinheiro

Bates

DebRoy

Sarkar

, & R Development Core Team (2013). nlme: Linear and Nonlinear Mixed Effects Models [Computer software manual]. Retrieved from https://CRAN.R-project.org/package=nlme

38.

R Development Core Team. (2014). R: A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing. Retrieved from http://www.R-project.org/

39.

Rasic

D. T.

Belik

Elias

Katz

L. Y.

Enns

Sareen

(2009). Spirituality, religion and suicidal behavior in a nationally representative sample. Journal of Affective Disorders, 114, 32–40. doi:10.1016/j.jad.2008.08.007

40.

Raudenbush

S. W.

Bryk

A. S.

(2002). Hierarchical linear models: Applications and data analysis methods (Vol. 1). Thousand Oaks, CA: Sage.

41.

Rosmarin

D. H.

Pargament

K. I.

Pirutinsky

Mahoney

(2010). A randomized controlled evaluation of a spiritually integrated treatment for subclinical anxiety in the Jewish community, delivered via the Internet. Journal of Anxiety Disorders, 24, 799–808. doi:10.1016/j.janxdis.2010.05.014

42.

Savin-Williams

R. C.

(2006). Who’s gay? Does it matter? Current Directions in Psychological Science, 15, 40–44. doi:10.1111/j.0963-7214.2006.00403.x

43.

Smith

D. P.

Orlinsky

D. E.

(2004). Religious and spiritual experience among psychotherapists. Psychotherapy: Theory, Research, Practice, Training, 41, 144–151. doi:10.1037/0033-3204.41.2.144

44.

Wang

P. S.

Berglund

P. A.

Olfson

Kessler

R. C.

(2004). Delays in initial treatment contact after first onset of a mental disorder. Health Services Research, 39, 393–415. doi:10.1111/j.1475-6773.2004.00234.x

45.

Yarhouse

M. A.

Johnson

(2013). Value and ethical issues: The interface between psychology and religion. In Pargament

K. I.

Mahoney

Sharanske

E. P.

(Eds.), APA handbook of psychology, religion, and spirituality (Vol 2): An applied psychology of religion and spirituality (pp. 43–70). Washington, DC: American Psychological Association. doi:10.1037/14046-003