Determinants of Gay Affirmative Practice Among Mental Health Practitioners
Method: We recruited a nationwide sample of heterosexual psychologists (n=270), clinical social workers (n=110), and marriage and family therapists (n=63) through the Internet. Participants completed on-line questionnaires examining hours of training, attitudes toward LGB individuals (Worthington, Dillon, & Becker-Schutte); LGB-affirmative counseling self-efficacy (Dillon & Worthington, 2003); and beliefs and engagement in GAP (Crisp, 2006).
Results: We used structural path analysis to examine our proposed model using standard model fit criteria. The cutoff scores used were: chi-square model fit statistic, p > .05 (Ullman, 2001), minimum discrepancy chi-square (CMIN/DF) < 5 (Marsh & Hocevar, 1985), comparative fit index (CFI) > .95 (Hu & Bentler, 1998), and root-mean-square-error of approximation (RMSEA) < .10, with a 90% confidence interval (Kline, 2010). Our proposed path model converged after six iterations. Model fit criteria suggested the model provided a good fit to the data, χ2 (2) = 5.50, p > .05; CMIN/DF = 2.75; CFI = .99, and RMSEA = .06, 90% confidence interval [.00-.13]. The structural model accounted for 45% of the variance in practitioner engagement in GAP. The three hypothesized direct paths were significant: affirmative attitudes were associated with practitioner engagement in GAP and more hours of LGB-related training as well as more positive beliefs about GAP were associated with higher levels of LGB-affirmative counseling self-efficacy. Two mediation paths were significant: beliefs in GAP mediated associations between attitudes and practitioner engagement in GAP (β = -.28, p < .001, 95% CI [-.34- -.21]) and LGB-affirmative counseling self-efficacy mediated associations between attitudes and practitioner engagement in GAP (β = -.02, p< .05, 95% CI [-.04- -.001]). Bootstrap methods supported the magnitude of these indirect effects.
Implications: The significant mediation effects tell us the underlying reasons why practitioners with more affirmative attitudes engage in more GAP: (a) they hold more positive beliefs about GAP and (b) have more self-efficacy about their ability to practice affirmatively. Training interventions should concomitantly target affirmative attitudes and beliefs to increase GAP as well as foster LGB-affirmative counseling self-efficacy to enhance the likelihood that training interventions will be effective in promoting GAP.