Original Article by SIG Members
Mitigation of Minority Stress in the Context of Training for Clinical Psychologists
Colin A. Tidwell, B.A., The University of Arizona
Natalie Holt, Ph.D., VA Quality Scholars
September 1, 2022
Mitigation of Minority Stress in the Context of Training for Clinical Psychologists
Colin A. Tidwell, B.A., The University of Arizona
Natalie Holt, Ph.D., VA Quality Scholars
September 1, 2022
In this article we explore the unique needs of sexual and gender minority (SGM) trainee clinical psychologists through the lens of minority stress theory. We discuss actions clinical training programs could implement to foster the success of their SGM trainees and present several options trainees themselves can use to create change within their programs.
Minority Stress in the Context of Clinical Training
Clinical psychology trainees come from a myriad of backgrounds and their experiences of psychological science varies distinctly by individual. A critical developmental milestone and often challenging process for trainees is acculturation into a new program, the process through which trainees assimilate into the culture of clinical science and academia.¹ For SGM trainees, this acculturation occurs alongside the unique stressors this group already faces because of their SGM identities — a phenomenon often called minority stress. Originated by Dr. Virginia Brooks² and defined by Dr. Ilan Meyer, minority stress is the combination of prejudice, perceived and actual rejection, concealment, and a variety of other stress processes unique to SGM populations.³ For SGM trainees, the process of acculturation is complicated by the need to simultaneously navigate clinical training while developing their own buffers to minority stress in a new role.
Minority stress specific to trainees can include experiences of identity-based prejudice and ignorance from peers and supervisors, perceived need for concealment during clinical work,⁴ lack of training in how to handle potential self-disclosure, and other forms of systemic oppression. In addition to adding to SGM individuals’ stress, this cumulative burden has been shown to impact academic productivity, with nondisclosure and concealment of SGM identity correlated with extern burnout and reduced publication rates.⁵ At the heart of what trainees need to help reduce these added stressors is equitable treatment from their training programs. This treatment can come in the form of structural changes toward creating training environments where students can be authentic,⁶ increased funding opportunities, curricula changes, and active steps taken to affirm SGM identities throughout training.
Programmatic Steps Toward Progress
Structural Efforts
Clinical training programs are uniquely poised to, and as described in section⁷ (Education and Training) of the American Psychological Association’s ethics code, have an obligation to ensure that their training is equitable and inclusive for trainees of all identities. Positive steps already being taken by some clinical training programs include the commitment to providing equitable access to restroom facilities (such as by constructing all-gender restrooms), creating department sponsored SGM affinity groups, and including pronouns on department websites, clinic, and event name badges. Other programs search for and disseminate SGM-specific funding opportunities available to clinical trainees.
Curricula Changes
These structural efforts are necessary in conjunction with consideration of SGM trainee needs in coursework, supervision, and externship placement. Some programs structure course materials and discussions in such a way as to create dialogue critical of the role clinical science has had in furthering minority stress. Clinical training can include discussing disclosure practices and micro or macroaggressions trainees may experience in clinical work. Intentionally creating space to explore these considerations offers an excellent chance to help buffer minority stress experienced by trainees. To reduce issues of burnout, programs can work to ensure that SGM trainees have access to identity-affirming externship sites and, upon placement, continue to foster equitable trainee treatment at the site.
Programmatic Climate
Further ways for programs to ameliorate the experience of minority stress for their trainees is elucidated by Palitsky et al. in a new paper about the experience of health service psychology trainees.⁷ The authors suggest programs should work to center the voices of trainees experiencing minority stress, train faculty and supervisors to reduce “privilege-related defensiveness” when working with marginalized trainees, and implement evidenced-based change in all programmatic aspects. One way to center SGM voices in the improvement of department climate surrounding marginalized identities can be accomplished via program administration eliciting input from SGM trainees and community resources. Programs can also provide transparency in how their departments handle diversity related issues and support trainee-led initiatives.
Trainee-Led Change
Collective Action through Willful Opacity
Trainees themselves have the power to advocate for the changes explored above. One powerful method trainees have to create these changes is described as “willful opacity,” the process wherein a group leverages institutional rhetoric to create change while functioning within institutional norms.⁸ An example of this kind of willful opacity is seen in the creation of initiatives such as wellbeing/health committees and SGM affinity groups. In clinical programs, wellbeing groups can also collect data on student adjustment and use it to advocate in areas of concern. In doing so, these groups provide a space wherein trainees can meet amongst themselves and create a sense of autonomy.
Creating Change
This autonomy is key in that it allows trainees to 1) identify the power structures of their program, 2) gain credibility in voicing their concerns on issues related to diversity, equity, and inclusion, 3) create community with other marginalized students and trainees, and 4) share the burden of working toward systemic change. At one institution, for example, trainees recognized the need for dialogue between department administration and SGM trainees regarding equity and inclusion. They were able to use their trainee wellbeing group’s data on SGM trainees to advocate for a listening session with their department head that can now be revisited as a means of accountability.
Continuing Momentum
Ultimately, a component of acculturation specific to SGM trainee clinical psychologists involves the concurrent experience of minority stress. Unique training and support needs arise in the face of this experience that programs can work to address through structural efforts, curricula changes, and adjusting programmatic climate. When programs fail to do this, or attempt to make changes without centering trainee voices, trainees can use collective action to work toward these changes themselves.
Additional Resources for Advocacy:
References
Minority Stress in the Context of Clinical Training
Clinical psychology trainees come from a myriad of backgrounds and their experiences of psychological science varies distinctly by individual. A critical developmental milestone and often challenging process for trainees is acculturation into a new program, the process through which trainees assimilate into the culture of clinical science and academia.¹ For SGM trainees, this acculturation occurs alongside the unique stressors this group already faces because of their SGM identities — a phenomenon often called minority stress. Originated by Dr. Virginia Brooks² and defined by Dr. Ilan Meyer, minority stress is the combination of prejudice, perceived and actual rejection, concealment, and a variety of other stress processes unique to SGM populations.³ For SGM trainees, the process of acculturation is complicated by the need to simultaneously navigate clinical training while developing their own buffers to minority stress in a new role.
Minority stress specific to trainees can include experiences of identity-based prejudice and ignorance from peers and supervisors, perceived need for concealment during clinical work,⁴ lack of training in how to handle potential self-disclosure, and other forms of systemic oppression. In addition to adding to SGM individuals’ stress, this cumulative burden has been shown to impact academic productivity, with nondisclosure and concealment of SGM identity correlated with extern burnout and reduced publication rates.⁵ At the heart of what trainees need to help reduce these added stressors is equitable treatment from their training programs. This treatment can come in the form of structural changes toward creating training environments where students can be authentic,⁶ increased funding opportunities, curricula changes, and active steps taken to affirm SGM identities throughout training.
Programmatic Steps Toward Progress
Structural Efforts
Clinical training programs are uniquely poised to, and as described in section⁷ (Education and Training) of the American Psychological Association’s ethics code, have an obligation to ensure that their training is equitable and inclusive for trainees of all identities. Positive steps already being taken by some clinical training programs include the commitment to providing equitable access to restroom facilities (such as by constructing all-gender restrooms), creating department sponsored SGM affinity groups, and including pronouns on department websites, clinic, and event name badges. Other programs search for and disseminate SGM-specific funding opportunities available to clinical trainees.
Curricula Changes
These structural efforts are necessary in conjunction with consideration of SGM trainee needs in coursework, supervision, and externship placement. Some programs structure course materials and discussions in such a way as to create dialogue critical of the role clinical science has had in furthering minority stress. Clinical training can include discussing disclosure practices and micro or macroaggressions trainees may experience in clinical work. Intentionally creating space to explore these considerations offers an excellent chance to help buffer minority stress experienced by trainees. To reduce issues of burnout, programs can work to ensure that SGM trainees have access to identity-affirming externship sites and, upon placement, continue to foster equitable trainee treatment at the site.
Programmatic Climate
Further ways for programs to ameliorate the experience of minority stress for their trainees is elucidated by Palitsky et al. in a new paper about the experience of health service psychology trainees.⁷ The authors suggest programs should work to center the voices of trainees experiencing minority stress, train faculty and supervisors to reduce “privilege-related defensiveness” when working with marginalized trainees, and implement evidenced-based change in all programmatic aspects. One way to center SGM voices in the improvement of department climate surrounding marginalized identities can be accomplished via program administration eliciting input from SGM trainees and community resources. Programs can also provide transparency in how their departments handle diversity related issues and support trainee-led initiatives.
Trainee-Led Change
Collective Action through Willful Opacity
Trainees themselves have the power to advocate for the changes explored above. One powerful method trainees have to create these changes is described as “willful opacity,” the process wherein a group leverages institutional rhetoric to create change while functioning within institutional norms.⁸ An example of this kind of willful opacity is seen in the creation of initiatives such as wellbeing/health committees and SGM affinity groups. In clinical programs, wellbeing groups can also collect data on student adjustment and use it to advocate in areas of concern. In doing so, these groups provide a space wherein trainees can meet amongst themselves and create a sense of autonomy.
Creating Change
This autonomy is key in that it allows trainees to 1) identify the power structures of their program, 2) gain credibility in voicing their concerns on issues related to diversity, equity, and inclusion, 3) create community with other marginalized students and trainees, and 4) share the burden of working toward systemic change. At one institution, for example, trainees recognized the need for dialogue between department administration and SGM trainees regarding equity and inclusion. They were able to use their trainee wellbeing group’s data on SGM trainees to advocate for a listening session with their department head that can now be revisited as a means of accountability.
Continuing Momentum
Ultimately, a component of acculturation specific to SGM trainee clinical psychologists involves the concurrent experience of minority stress. Unique training and support needs arise in the face of this experience that programs can work to address through structural efforts, curricula changes, and adjusting programmatic climate. When programs fail to do this, or attempt to make changes without centering trainee voices, trainees can use collective action to work toward these changes themselves.
Additional Resources for Advocacy:
- American Psychological Association of Graduate Students Committee on Sexual Orientation and Gender Diversity. (2015). Proud and prepared: A guide for LGBT Students Navigating Graduate Training. American Psychological Association. https://www.apa.org/apags/resources/lgbt-guide.pdf
- Ralston, A. L., Caze, T. J., Sawyer, B., & Hayes-Skelton, S. A. (2021, November). Toward an inclusive clinical science: How to fight for systemic changes to increase the impact of behavioral and cognitive therapies. Panel discussion conducted at the 55th Annual Meeting of the Association for Behavioral and Cognitive Therapies, New Orleans, Louisiana (virtual conference due to COVID-19). Recording available at https://www.eventscribe.net/2021/ABCT/index.asp?presTarget=1713226
References
- Handelsman MM, Gottlieb MC, Knapp S. Training ethical psychologists: an acculturation model. Prof Psychol Res Pr. 2005 Feb;36(1):59-65. doi: 10.1037/0735-7028.36.1.59. PMID: 17066556.
- Brooks, V. R. (1981). Minority stress and lesbian women. Free Press.
- Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychological bulletin, 129(5), 674–697. https://doi.org/10.1037/0033-2909.129.5.674
- Shepherd, B.F., Brochu, P.M. (2021). Identity concealment as a risk factor for burnout among sexual and gender minoritized psychology trainees. Poster presented at the 55th Annual Meeting of the Association for Behavioral and Cognitive Therapies, New Orleans, Louisiana (virtual conference due to COVID-19).
- Nelson J, Mattheis A, Yoder JB (2022). Nondisclosure of queer identities is associated with reduced scholarly publication rates. PLOS ONE 17(3): e0263728. https://doi.org/10.1371/journal.pone.0263728
- Hsueh, L., Werntz, A., Hobaica, S., Owens, S. A., Lumley, M. A., & Washburn, J. J. (2020). Clinical psychology PhD students’ admission experiences: Implications for recruiting racial/ethnic minority and LGBTQ students. In Journal of Clinical Psychology (Vol. 77, Issue 1, pp. 105–120). Wiley. https://doi.org/10.1002/jclp.23074
- Palitsky, R., Kaplan, D. M., Brodt, M. A., Anderson, M. R., Athey, A., Coffino, J. A., Stevenson, B. (2022, January 31). Systemic challenges in health service psychology internship training: A call to action from trainee stakeholders. Retrieved from psyarxiv.com/5y6eb
- Mayo, C., & Blackburn, M.V. (Eds.). (2019). Queer, Trans, and Intersectional Theory in Educational Practice: Student, Teacher, and Community Experiences (1st ed.). Routledge. https://doi.org/10.4324/9780367816469