Determinants of Gay Affirmative Practice Among Mental Health Practitioners

Purpose: The empirical as well as theoretical literature suggests that holding positive attitudes toward lesbian, gay, and bisexual (LGB) individuals is necessary for mental health practitoner engagement in gay affirmative practice (GAP; Crisp, 2006). Participating in training on LGB issues is also essential for exploring practitioner attitudes as well as increasing knowledge and skills in regard to GAP (Lyons, 2010). However, research has not accounted for the potential mechanisms that underlie the relationship between attitudes and training experiences and practitioner engagement in GAP (e.g., counseling self-efficacy and beliefs about GAP). The purpose of this investigation was to test a conceptual model that explains the determinants of GAP among mental health practitioners. The development of our model was based on theorized notions that affirmative attitudes toward LGB individuals and LGB-affirmative training experiences will positively influence beliefs about GAP and LGB-affirmative counseling self-efficacy, which in turn will influence practitioner engagement in GAP. 

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.