This study suggests that individuals who identify outside the gender binary (e.g., genderqueer, gender nonconforming) experience more discrimination, victimization, poor mental health outcomes, and suicidality or self-harm than do both trans-and cisgender men and women. It highlights sociocultural factors such as lack of knowledge about genderqueer experiences and pronouns, poor access to legal and medical resources, and systemic discrimination that may be responsible for these trends. 396A Caballo Regalao no se le Mira el Colmillo: Colonial Mentality and Puerto Rican Depression

The current state of college student mental health is frequently labeled a "crisis," as the demand for services and severity of symptomatology have appeared to increase in recent decades. Nationally representative findings are presented from the Center for Collegiate Mental Health, a practice research network based in the United States, composed of more than 340 university and college counseling centers, in an effort to illuminate trends in symptom severity and patterns in treatment utilization for the campus treatment seeking population. Clinical data collected over 5 academic years (2010-2015) showed small but significantly increasing trends for self-reported distress in generalized anxiety, depression, social anxiety, family distress, and academic distress, with the largest effect sizes observed for generalized anxiety, depression, and social anxiety. On the other hand, a significantly decreasing trend was observed for substance use. No significant changes were observed for eating concerns and hostility. Utilization data over 6 years indicated a gradual yet steady increase in the number of students seeking services (beyond the rate expected with increasing institutional enrollment), as well as increases in the number of appointments scheduled and attended, with great variation between centers. Within the context of changing national trends, we conclude that it is advisable to consider the specific needs of local centers to best accommodate distinct student bodies. (PsycINFO Database Record

There are mixed findings regarding the differential efficacy of the group and individual format. One explanation of these mixed findings is that nearly all-recent meta-analyses use between-study effect sizes to test format equivalence introducing uncontrolled differences in patients, treatments, and outcome measures. Only 3 meta-analyses were located from the past 20 years that directly tested format differences in the same study using within-study effect sizes; mixed findings were reported with a primary limitation being the small number of studies. However, we located 67 studies that compared both formats in the same study. Format equivalence (g = -0.01) with low effect size heterogeneity (variability) was found in 46 studies that compared identical treatments, patients, and doses on primary outcome measures. Format equivalence (g = -0.06) with moderate effect size heterogeneity was found for 21 studies that compared nonidentical treatments; however, allegiance to a specific format moderated differences in effect sizes. There were no differences between formats for rates of treatment acceptance, dropout, remission, and improvement. Additionally, there were no differences in outcome between formats by patient diagnosis; however, differences in pre-to-post improvement were explained by diagnosis with depression, anxiety, and substance disorder posting the highest outcomes and medical and childhood disorders the lowest. Findings are discussed with reference to the practical challenges of implementing groups in clinical practice from an agency, clinician, and reimbursement perspective. (PsycINFO Database Record

No abstract

This study is a longitudinal examination of the impact of therapist stage of training on client outcomes in psychotherapy. The study included 22 PhD-level psychologists who work in a university counseling center (8 female, 14 male) who had completed at least 2 training periods in the center where data were gathered. Therapists worked with 4,047 clients, and 40,271 sessions were included in our analyses. Clients were given the Outcome Questionnaire-45 (OQ-45) on a session-by-session basis, tracking treatment response. The effect of stage of training on both the magnitude and speed of OQ-45 change was examined through hierarchical linear modeling. Therapists were found to achieve the same amount of change or less change on average in their later stages of training. Therapists were also found, on average, to achieve the same rate of change or a slower rate of change in later stages of training. Findings suggest that as therapists progress through formal stages of training, they do not improve in their ability to effect change in their clients. Given these findings, a better understanding of expertise in psychotherapy practice and how to develop it may be an important area for future theory development, research, and training program development. We call for further work examining if and how an individual therapist can become more effective with time. (PsycINFO Database Record

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

The goal of this article is to present information about a standardized multidimensional measure of psychological symptoms, the Counseling Center Assessment of Psychological Symptoms (CCAPS; Locke et al., 2011; Locke, McAleavey, et al., 2012; McAleavey, Nordberg, Hayes, et al., 2012), developed to assess difficulties specific to college students' mental health. We provide (a) a brief review and summary of the psychometric and research support for the CCAPS; (b) examples of the use of the CCAPS for various purposes, including clinical, training, policy, and counseling center advocacy; and (c) implications of the integration of routine outcome monitoring and feedback for the future of training, research, and clinical practice. In particular, the article emphasizes how the assimilation of and symbiotic relationship between research and practice can address the scientist-practitioner gap.

Data from psychotherapy groups are nested by nature. Ignoring this nesting when performing statistical tests can result in inflated Type I error rates and spurious significant results. This presents a serious problem for interpreting research that does not account for members nested within a specific group. Factor analytic methods are not immune to the negative effects of nesting, and when it is ignored, a poorly fitting factor structure can be hidden if one does not examine model fit at both the between or within-group level. Multilevel confirmatory factor analysis allows the researcher to account for nesting by separately examining both the between-and within-group structures of measures used in group research. This article presents an overview of methods for evaluating the level of group dependency using the intraclass correlation coefficient (ICC) and a comparison of 2 methods for calculating ICCs. It then provides an overview and an example of multilevel factor analysis as a method for testing the model fit at the between and within levels separately by using partially saturated models. The authors end by reviewing common problems and offering guidelines for interpreting differences in within-and between-level fit in group research.