Recent Research Publications

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Multiracial Shifting Expression and Internalized Racism:

Testing a Minority Stress Mediation Model (2025)

This study explored how racism and discrimination impact the mental health of multiracial adults in the United States. We looked specifically at the emotional toll of two common experiences: changing how one presents their racial identity to fit in with different groups, and internalizing negative racial stereotypes. Our findings show that discrimination leads to psychological distress, in part because it pushes multiracial individuals to constantly adjust their identity and internalize harmful racist beliefs. We conclude by offering guidance for mental health professionals, emphasizing the need to support multiracial clients by challenging society's pressure to fit into single-race boxes.

Reference: Gale, M. M., & Pieterse, A. L. (2025). Multiracial Shifting Expression and Internalized Racism: Testing a Minority Stress Mediation Model. The Counseling Psychologist, 53(3), 360-385.

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THERE ARE NO SIDELINES: A REACTION TO LEGHA’S “GETTING OFF THE RACIST SIDELINES: AN ANTIRACIST APPROACH TO MENTAL HEALTH SUPERVISION AND TRAINING” (2023)

We present a reaction to Legha’s (2023) anti-racist model of clinical supervision. We start by outlining the strengths of Legha’s model, including the need for supervisor self-awareness and the understanding of racism from a historical perspective. We then outline ways in which the model could be enhanced by focusing on epistemic violence, and conclude by discussing potential barriers to clinical and institutional implementation of Legha’s model. We appreciate Legha’s anti-racist model and view it as an important step forward toward the eradication of racism within mental health practice.

Reference: Pieterse, A. L., & Gale, M. M. (2023). There are no sidelines: a reaction to Legha’s “getting off the racist sidelines: An antiracist approach to mental health supervision and training”. The Clinical Supervisor, 42(2), 263-279.

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MULTICULTURAL TRAINING AND EDUCATION QUESTIONNAIRE (2022)

Multicultural training is the process by which mental health professionals learn to work effectively and therapeutically with all clients, including those who are different from them in dimensions such as race, gender, or sexual orientation. Our research team created the Multicultural Training and Education Questionnaire (MTEQ) to measure trainee’s perceptions of multicultural training in professional helping programs (e.g., clinician and counseling psychology). After distributing the questionnaires to doctoral and master’s level trainees, we found evidence that the questionnaire is a valid tool for measuring multicultural training. The questionnaire can be used to assess multicultural training overall, or it can be divided into four separate categories of multicultural training: Importance of Modeling, Clinical Application, Self Exploration/Awareness, and Education and Knowledge. We found that the Modeling and Clinical Applications categories accounted for the most variability in trainee responses, which supports a Multicultural Orientation (MCO) model. The MCO approach includes being open to exploring clients’ cultural experiences (cultural humility), the therapist’s feelings when discussing cultural topics with clients (cultural comfort), and the therapist’s ability to call attention to culturally important information in session (cultural opportunities). Research has shown that parts of the MCO model are related to positive outcomes in therapy, such as stronger alliance between therapist and client. Overall, the MTEQ has the potential to accurately measure areas of multicultural training that can be used to further strengthen graduate training with the goal of preparing future mental health professionals to work effectively with diverse clients.

Reference: Wilcox, M. M., Gale, M. M., McLaughlin, K. L., Squyres, E., Burish, E. C., & Khojasteh, J. (2022). Development and initial validation of the Multicultural Training and Education Questionnaire. Training and Education in Professional Psychology, 16(1), 55.

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INTERNALIZED RACIAL OPPRESSION AND HEALTH-RELATED OUTCOMES: A META-ANALYSIS (2020)

Although racism is often thought of as bias against people in a racial group different from one’s own racial group (e.g., racist attitudes held by White people against Black people), minority group members may also hold biases against their own racial group. Internalized racism can be described as the acceptance of the negative perceptions of a person’s own race (e.g., an Asian person’s attitudes toward Asian people). It is important to note that these attitudes and beliefs stem from systems of racism that benefit majority group members (i.e. Whites) when minority group members internalize racial bias because it makes engagement in racial critique and social justice less likely to occur. Research has shown that internalized racism is related to a range of negative mental health outcomes such as anxiety, depression, and lower self-esteem, as well as to negative physical health outcomes such as hypertension.

Our team explored the relationship between internalized racism and mental and physical health outcomes across 29 research studies. We found that higher levels of internalized racism were related to poor mental health outcomes with a medium strength correlation. Additionally, higher levels of internalized racism were associated with poor physical health outcomes with a small strength correlation. That is, as internalized racism increased, so did negative psychological impacts, as did negative physical health impacts, to a lesser degree. Other findings suggest that certain variables strengthened the relationship between internalized racism and health outcomes. For example, the “racial self-hatred” aspect of internalized racism was more strongly related to poor health outcomes compared to “miseducation” or stereotypes. This suggests that the emotional experience of self-hatred may be more harmful to health compared to misinformed beliefs about race. Additionally, being from the United States was associated with a stronger connection between internalized racism and poor health outcomes. This suggests that the unique history of racism in the United states has especially harmful impacts on health outcomes in People of Color. Finally, we found that gender, setting (i.e. college campus versus medical setting), publication type, and publication year did not strengthen the relationship between internalized racism and health outcomes.

Overall, these findings provide important information for addressing mental and physical health outcomes in People of Color. Mental health professionals may assess Clients of Color for internalized racism, develop interventions focused on positive racial identity development, and push for societal or policy change to address the negative health outcomes associated with the racial climate of the United States.

Reference: Gale, M. M., Pieterse, A. L., Lee, D. L., Huynh, K., Powell, S., & Kirkinis, K. (2020). A meta-analysis of the relationship between internalized racial oppression and health-related outcomes. The Counseling Psychologist, 48(4), 498-525.

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SOCIOCULTURAL FACTORS AND PSYCHOLOGICAL SERVICE REFERRAL OUTCOME (2019)

Mental health treatment needs are becoming more common in college students. When university counseling centers do not have enough resources to offer long-term treatment, they may refer students to services in the community. Research has shown that racial/cultural minority group members may experience disadvantages when seeking mental health treatment. For example, People of Color report more difficulty in finding good quality treatment. Women, sexual minorities (e.g., lesbian and gay individuals), and older individuals are more likely to use mental health treatment compared to men, heterosexual individuals, and younger individuals. Our research team explored how these identities may be related to successful referral from university counseling centers to outside services. A referral was considered successful if a student made contact with mental health services after being referred by the university counseling center care manager. A referral was considered unsuccessful if the student returned to the counseling center for treatment or did not respond to the care manager’s follow up. We found that race, sexual orientation, and gender did not predict how likely a student was to have a successful referral. This may be due to greater diversity or multicultural awareness within the particular university counseling center where the study was conducted. In other words, the staff may have been more aware of the need to support people with these identities in connecting to mental health treatment. Future research should look into the counseling center characteristics that help to make successful referrals for these groups. By contrast, older students were found to be more likely to connect with outside providers compared to younger students. These findings suggest that it is important to provide extra support for younger students (e.g., first-year/freshmen) in need of mental health services. Counseling centers might consider discussing insurance questions, concerns about speaking to providers or family about mental health, and ways to overcome barriers with younger students.

Reference: Gale, M., Franco, M., Reese, E., Hutman, H., & Wang, Y. W. (2020). Sociocultural factors and referral outcome: An exploratory investigation. Journal of College Student Psychotherapy, 34(3), 198-210.

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