2 - (IOP 20) Mind the Gap: The Role of Rater in Measuring Affirmative Practice Within Therapy Dyads

Affirming approaches to care have been positioned widely as best practice, and trainees in behavioral health increasingly endorse meaningful coverage of content related to gender and sexual minority (GSM) communities in their professional programs. Nonetheless, gender and sexual minority (GSM) individuals continue to report barriers to knowledgeable and affirming behavioral health services. The current project seeks to better understand the state of affirming mental healthcare by characterizing the extent and function of affirming practices in treatment as usual through the lens of therapy dyads (i.e., provider and client). Namely, we hypothesized that perspectives on whether therapy is affirming and culturally responsive would vary within therapy dyads, and that the provider’s GSM-related cultural competencies would predict treatment process and outcomes. 73 GSM mental healthcare recipients and 53 of their therapists were recruited to independently evaluate the provider’s GSM-related competencies at two time points. In addition, data on demographics, general satisfaction with treatment, therapeutic process, 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 in their perceptions of provider’s GSM-related competencies, t(53) = -7.093, p < 0.001, r = 0.70. In a series of regression analyses, clients’ perceptions of their providers’ GSM-related cultural competencies were predictive of therapeutic process scores 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 GSM-related cultural competencies were significantly predictive of changes in psychological distress at a three-month follow up. These findings underscore the significance of chosen rater when measuring affirming, culturally responsive approaches to treatment. While results may be limited by ceiling effects in measurement, they suggest that the process of psychotherapy may be improved by attending to GSM and intersecting identities using an individualized, affirming lens.