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Fischer, Olivia

University of British Columbia

This dissertation examines the multicultural orientation (MCO) framework within the context of psychotherapy with sexual and gender minority (SGM) clients. To this end, three distinct, but related studies were conducted. In study 1, a systematic review, we aimed to link the MCO framework to existing empirical psychotherapy research with SGM clients and examine how MCO constructs impacted therapeutic processes and outcomes with SGM clients. Results of the review demonstrated how the MCO framework can be used to conceptualize psychotherapy with SGM clients and – using the MCO framework – highlighted potential beneficial and harmful therapist qualities and actions when working with SGM clients. Based on the results of the systematic review, we sampled 483 SGM clients and conducted two additional studies. In study 2, a moderation-based study, we aimed to examine positively and negatively valenced models of the MCO framework. Results indicated that cultural comfort significantly moderated the association between cultural humility and cultural opportunities. Specifically, cultural comfort strengthened the link between cultural humility and cultural opportunities, indicating that therapists’ cultural humility and cultural comfort play important roles in engaging with cultural opportunities. Further, cultural discomfort was found to significantly moderate the association between cultural arrogance and missed cultural opportunities, with the association weakening as cultural discomfort increased. In study 3, a mediation-based study, we aimed to better understand the roles of SGM humility, SGM knowledge, and identity salience in contributing to working alliance and therapy outcomes with SGM clients and investigate the relative contributions of therapist SGM humility and SGM knowledge. Consistent with our hypotheses, SGM humility and SGM knowledge positively predicted therapy outcomes, mediated by the working alliance, and SGM humility had a greater effect on therapy outcomes relative to SGM knowledge. Contrary to our hypotheses, SGM identity salience did not moderate the associations between SGM humility and working alliance or SGM knowledge and working alliance. Combined, these three studies further our understanding of the MCO framework and how it can be applied to improve therapeutic processes and outcomes with SGM clients.

Text

2025-07-04

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/91492

Counselling Psychology

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/