Handbook of Gender and Sexuality in Psychological ...

HANDBOOK OF GENDER AND SEXUALITY IN PSYCHOLOGICAL

ASSESSMENT

Handbook of Gender and Sexuality in Psychological Assessment brings together two interrelated realms: psychological assessment with gender and sexuality. This handbook aids in expanding the psychological assessors’ knowledge and skill when considering how gender and sexuality shape the client’s and the assessor’s experiences. Handbook of Gender and Sexuality in Psychological Assessment is an informative resource for researchers who want to identify important areas of in-vestigation at the intersection of psychological assessment with gender and sex-uality. Throughout the six sections, gender and sexuality are discussed in relation to different psychological methods of assessment; various psychological disor-ders; special considerations for children, adolescents, and older adults; important training and ethical considerations; as well as several in-depth case discussions.

Virginia M. Brabender, PhD, is Professor of Psychology at Widener Uni-versity where she teaches various courses in psychological assessment. Dr. Bra-bender is on the editorial board of the Journal for Personality Assessment and a past president of the Society for Personality Assessment and Section IX (Assessment Psychology) of the Society of Clinical Psychology. She was the co-winner of the 1994 Walter G. Klopfer Award for Outstanding Statistically Based Research Article in Personality Assessment.

Joni L. Mihura, PhD, is Associate Professor of Psychology at the University of Toledo, where she teaches personality assessment, psychodynamic psycho-therapy, and supervises an advanced assessment practicum. She obtained career awards from the Society for Personality Assessment (SPA) and American Psy-choanalytic Association and is an SPA fellow. She is the co-developer of a new Rorschach system—the Rorschach Performance Assessment System (R-PAS), for which she conducts training in the United States and internationally.

“Brabender and Mihura and the esteemed clinician-authors they have assembled have broken crucial new ground in the literature on psychological assessment. This timely volume strikes an optimal blend of scholarly review of research and theory with rich case illustrations to guide assessors in the careful consideration of nuances of gender and sexuality in understanding the people they evaluate. This book epitomizes a model of reflective, empathic, rigorous, ethical, and highly competent assessment for the twenty-first century.”

Anthony D. Bram, PhD, ABAP, Cambridge Health Alliance/Harvard Medical School, Boston Psychoanalytic

Society and Institute, author of Psychological Testing That Matters: Creating a Road Map for Effective Treatment

“Despite psychology being an overwhelmingly female profession, the specialty of psychological assessment is dominated by men. Perhaps as a consequence, too little attention has been paid to the role of gender in the assessment process. This volume, edited by two of the leading psychological assessment researchers and teachers in the world, goes a long way toward redressing that balance. They have assembled an impressive group of senior contributors who thoughtfully address such issues as the role of gender in interpreting various instruments, the intersection of gender and psychopathology, and gender and sexuality in the assessor-client relationship. This is a vitally important book.”

Bruce L. Smith, PhD, ABAP, Associate Clinical Professor of Psychology, University of California, Berkeley

“This impressive handbook is an invaluable resource on the often overlooked yet essential aspects of gender and sexuality in psychological assessment. It serves practitioners extremely well with its wealth of case examples, which include many different types of psychopathology from different areas of assessment practice, such as child/adolescent and forensic. Each chapter ends with a set of practical key points and an annotated bibliography. On a firm empirical ground-ing, this handbook also makes an outstanding scholarly contribution, by provid-ing comprehensive reviews of the current literature and directions for future research endeavors.”

Corine de Ruiter, PhD, Professor of Forensic Psychology, Maastricht University, The Netherlands

PRAISE FOR THIS BOOK

HANDBOOK OF GENDER AND SEXUALITY IN PSYCHOLOGICAL

ASSESSMENT

Edited byVirginia M. Brabender and Joni L. Mihura

First published 2016by Routledge

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and by Routledge2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN

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without intent to infringe.

Library of Congress Cataloging-in-Publication DataNames: Brabender, Virginia, editor. | Mihura, Joni L., editor.

Title: Handbook of gender and sexuality in psychological assessment / edited by Virginia M. Brabender and Joni L. Mihura.

Description: New York, NY : Routledge, 2016. | Includes bibliographical references and index.

Identifiers: LCCN 2015029587 | ISBN 9781138782044 (hbk : alk. paper) | ISBN 9781138782051 (pbk : alk. paper) |

ISBN 9781315769387 (ebk)Subjects: LCSH: Psychological tests—Social aspects. | Psychodiagnostics. |

Gender identity. | Sexual orientation. | Sexual minorities— Psychological testing. | Women—Psychological testing.

Classification: LCC BF176 .H356 2016 | DDC 150.28/7—dc23LC record available at http://lccn.loc.gov/2015029587

ISBN: 978-1-138-78204-4 (hbk)ISBN: 978-1-138-78205-1 (pbk)ISBN: 978-1-315-76938-7 (ebk)

Typeset in Bemboby Apex CoVantage, LLC

To Francine Deutsch, my honest and true friend of forty years.— Virginia M. Brabender

To my clients, for trusting me with your emerging selves.— Joni L. Mihura

This page intentionally left blank

CONTENTS

List of Contributors xiPreface xxiAcknowledgments xxvi

PART I

Introductory Chapters 1

1 The Construction of Gender and Sex, and Their Implications for Psychological Assessment 3Virginia M. Brabender and Joni L. Mihura

2 Bringing Multiple Identities Into Focus 44Virginia M. Brabender and Joni L. Mihura

PART II

Assessment Tools 79

3 Hidden in Plain Sight: Gender and Sexuality in the Clinical Assessment Interview 81Matthew L. Whitehead

4 A Framework for Considering Gender in the Cognitive Assessment Process 108Mary T. Rourke and Ellen Bartolini

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5 Gender Considerations in Self-Report Personality Assessment Interpretation 128Radhika Krishnamurthy

6 Sex and Gender Distinctions and the Rorschach Inkblot Method: Conceptual Implications of a Minimum of Difference 149Steven Tuber, Kira Boesch, Gregory Gagnon, and Devon Harrison

7 Human Figure Drawings and Thematic Apperception Test Narratives: Clinical Uses for Understanding Gender Roles and Sexuality 166Marshall L. Silverstein

PART III

Personality, Psychopathology, and Gender-Based Issues 191

8 Assessing and Interpreting Adult Attachment With Gender-Nonconforming Clients 193Hal S. Shorey

9 Beyond Biology: Sex, Gender, and Personality Disorders 211Robert F. Bornstein and Barbara A. McLeod

10 Sex, Gender Identity, and the Assessment of Psychosis 233James H. Kleiger

11 Sex, Gender, and Sexual Orientation in the Assessment of Affective Disorders 256Pavel S. Blagov and Joshua A. Goodman

12 Considering Issues of Gender and Sexuality in the Assessment of Anxiety Disorders 290Julia Hodgson, Rebecca Preiser, and Michael C. Cassano

Contents

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13 Issues of Gender in the Assessment of Feeding and Eating Disorders 316April Fallon and Kari L. Lannon

14 Gender Identity and Sexual Orientation in the Assessment and Management of Suicide 353Alixandra Burks and Robert J. Cramer

PART IV

Case Illustrations of Gender-Based Issues 371

15 Transferential and Countertransferential Aspects of Multicultural Diversity in Psychological Assessment and Psychotherapy: A Case Illustration Highlighting Race and Gender 373Jed Yalof

16 Feeling Gravity’s Pull: Answering Unasked Questions of Gender and Sexuality in Two Collaborative Assessments 396Stacey M. Boyer, Alan L. Schwartz, and David J. York

17 A Case of Gender Bias From Indictment to Disposition 420Ginger Calloway

18 The Intersection of Gender and Immigration in the Personality Assessment of Women 439Giselle A. Hass

19 Psychological Assessment of the Effects of Sexual Harassment 467Nancy Kaser-Boyd

20 Psychological Assessment With Trans People 489Wayne Bullock and Nicholas Wood

21 Using Therapeutic Assessment in Psychological Assessments Required for Sex Reassignment Surgery 511Stephen E. Finn

Contents

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PART V

Gender, Sexual Orientation, and Development Status 535

22 Assessment of Pretend Play: Gender Similarities and Differences 537Sandra W. Russ and Olena Zyga

23 Gender, Sexuality, and Assessment in Adolescence 552A. Jordan Wright and Lynette Nickleberry

24 Who I Was, Who I Am: Gender and Generativity in the Assessment of Older Adults 578Mary Languirand

PART VI

Looking Forward 603

25 Silence Harms: How to Train Professionals in the Clinical Assessment of Sexuality and Gender 605Kile M. Ortigo and Brandon J. Weiss

26 Sex, Gender, and Psychological Assessment: Integrating Principle and Feminist Ethics 627Patria J. Alvelo, Nancy Maguire, and Linda K. Knauss

Appendix to Chapter 26 649

27 Sex, Gender, and Sexuality in Psychological Assessment: Where Do We Go From Here? 655Joni L. Mihura and Virginia M. Brabender

Appendix to Chapter 27 679

Name Index 683Subject Index 691

CONTRIBUTORS

Patria J. Alvelo, PsyD, MA, has a doctorate in Clinical Psychology from Wid-ener University and a master’s degree in Women’s History from Sarah Lawrence College. Dr. Alvelo completed her post-doctoral residency at Therapy Center of Philadelphia. Dr. Alvelo is currently a staff psychologist at Tuttleman Coun-seling Services at Temple University. She also works part-time as a clinician at Therapy Center of Philadelphia, as a diagnostic supervisor at the Center for Psychotherapy Research at the University of Pennsylvania, and as an adjunct professor at the Philadelphia Center and the Center for Continuing Studies at Widener University.

Ellen Bartolini, MA, received her undergraduate degree in psychology from Wesleyan University and is currently a doctoral candidate at Widener Univer-sity’s Institute for Graduate Clinical Psychology. Her areas of expertise include the treatment of grief and trauma in children, adolescents, and families, and the assessment and treatment of learning disabilities.

Pavel S. Blagov, PhD, received his doctorate in Clinical Psychology from Emory University. He is an Associate Professor of Psychology at Whitman College, teaching such courses as Abnormal Psychology, Personality Theories, and Science of Sexual Orientation. He studies self-defining memories and personality pathology classification. He is a Licensed Psychologist, and his psy-chology private practice in Walla Walla, Washington focuses on psychological assessment.

Kira Boesch, MA, is a doctoral candidate in the Clinical Psychology program at the City College of New York. In 2013, she wrote an article for the Jour-nal of Infant, Child and Adolescent Psychotherapy about her first experiences as a

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therapist. In 2015, it was published as a chapter in the book Early Encounters with Children and Adolescents.

Robert F. Bornstein received his PhD in Clinical Psychology from the State University of New York at Buffalo in 1986 and is Professor of Psychology at Adelphi University. Dr. Bornstein wrote The Dependent Personality and The Dependent Patient: A Practitioner’s Guide, co-authored (with Mary Languirand) When Someone You Love Needs Nursing Home Care, How to Age in Place, and Healthy Dependency, co-edited (with Christopher Hopwood) Multimethod Clinical Assess-ment, and co-edited (with Joseph Masling) seven volumes of the Empirical Studies of Psychoanalytic Theories series, as well as Scoring the Rorschach: Seven Validated Sys-tems. Dr. Bornstein received the Society for Personality Assessment’s 1995, 1999, 2002, 2008, and 2012 awards for Distinguished Contributions to the Personality Assessment Literature, and the Division 12/American Psychological Founda-tion 2005 Theodore Millon Award for Excellence in Personality Research.

Stacey M. Boyer, PsyD, is a Postdoctoral Fellow at The Trauma Disorders Program of Sheppard Pratt Health System, where she provides psychotherapy and assessment services to patients with complex trauma and dissociative disor-ders. She is a graduate of Widener University’s Institute for Graduate Clinical Psychology. Dr. Boyer is a recipient of the Zygmunt Piotrowski Award and is a Scholar of the American Psychological Association’s Division 39 (Psychoanaly-sis). She has presented nationally and locally on the R-PAS, diversity consider-ations in collaborative assessment, and the assessment and treatment of complex trauma and dissociative disorders.

Virginia M. Brabender, PhD, ABPP, is a professor at Widener University, where she teaches courses in psychological assessment, group psychotherapy, and dynamic psychotherapy. She is a past president of the Society for Per-sonality Assessment. She is also a section editor for the Journal of Personality Assessment. In 2001, she served as co-editor of a special issue on ethics and psychological assessment for the Journal of Personality Assessment. She is the 1993 co-winner of the Walter G. Klopfer Award for Outstanding Statistically Based Research Article in Personality Assessment. She can be contacted at: [email protected]

Wayne Bullock, PsyD, MEd, received his Doctor of Psychology and Master of Education degrees from Widener University. Dr. Bullock is currently a psychol-ogy fellow at the William Alanson White Institute and Karen Horney Clinic in New York City, where he provides psychoanalytic psychotherapy.

Alixandra Burks, MA, doctoral candidate, received her master’s degree in Clinical Psychology from Sam Houston State University. She is currently work-ing toward her PhD in Clinical Psychology with Forensic Emphasis at Sam

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Houston State University and works with many diverse justice-involved clients. Her particular research interests include exploring gender and sexual identity fluidity, working with women in prison and LGBT clients, and the impact of victimization experiences on mental health outcomes.

Ginger Calloway, PhD, HSP-P, is a psychologist in private practice in Raleigh, North Carolina, where she conducts forensic evaluations regarding mental sta-tus, child custody, juvenile offender, personal injury including sexual harassment, and Atkins’ evaluations in capital cases. Recently, she was a guest editor for the Journal of Child Custody and provided a double issue on attachment theory and its relevance for child custody matters. Dr. Calloway received her PhD in psychology from North Carolina State University and her BA in psychology from Queens College, in Charlotte, North Carolina. Her pre-doctoral and post- doctoral internships were completed in regional mental health centers in the Appalachian and Piedmont sections of North Carolina.

Michael C. Cassano, PhD, received his doctorate degree in clinical psychol-ogy at the University of Maine. He completed a pre-doctoral internship and post-doctoral fellowship at the Children’s Hospital of Philadelphia. In 2010, he joined the faculty at the Institute for Graduate Clinical Psychology at Widener University, where he co-directs the Widener Child Therapy Clinic and coordi-nates the concentration in child, adolescent, and family therapy.

Robert J. Cramer, PhD, is an Associate Professor in the School of Com-munity and Environmental Health at Old Dominion University in Norfolk, Virginia. He has received past funding from the National Science Foundation and the American Psychological Foundation, among others, to investigate issues of LGBT victimization and health, suicide and violence risk, courtroom sci-ence, and cross-cultural issues in criminal justice. He also currently co-edits the Journal of Aggression, Conflict and Peace Research.

April Fallon, PhD, received her doctorate from the University of Pennsylvania. She is currently on the faculty of Fielding Graduate University as Director of Assessment Training. She is also Clinical Professor at Drexel University College of Medicine in the Department of Psychiatry. She has co-authored five books and numerous other publications on group therapy, eating disorders and body image, and adoption.

Stephen E. Finn, PhD, is a licensed psychologist and founder of the Center for Therapeutic Assessment in Austin, Texas. He is a Clinical Associate Profes-sor at the University of Texas at Austin, Senior Researcher at the European Center for Therapeutic Assessment at Catholic University of Milan, Italy, and Director of Training at the Asian Center for Therapeutic Assessment in Tokyo, Japan. Dr. Finn is the author of many articles and books, including (with Hale

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Martin) Masculinity and Femininity in the MMPI-2 and MMPI-A (University of Minnesota Press, 2010).

Gregory Gagnon, MA, is a doctoral student in the Clinical Psychology Pro-gram at the City College of New York. Greg provides individual and group psychotherapy to children and adults at The Psychological Center, a community clinic in Harlem. He is a Clinical Research Fellow at the CUNY School of Public Health, where he studies ways to improve access to mental health ser-vices for students at urban public universities.

Joshua A. Goodman, MA, is a doctoral student in the Department of Coun-seling, Clinical, and School Psychology at the University of California, Santa Barbara. His research focuses on mental health in LGBTQ populations, with particular emphasis on internalized stigma and the development of interven-tions to support LGBTQ mental health. As a practicum student, Joshua has provided clinical services in a university counseling center, alcohol and drug intervention program, and community mental health clinic.

Devon Harrison, MA, is a doctoral candidate in the Clinical Psychology Pro-gram at the City College of New York. She earned her master’s degree in Child and Human Development from Tufts University and has a background working with grieving children and families. She currently teaches Adolescent Devel-opment at City College of New York and serves as a group therapist at The Addiction Institute of New York.

Giselle A. Hass, PsyD, earned a Doctorate in Clinical Psychology from Nova Southeastern University in 1992. For the past 22 years, she has worked as a forensic expert in family and immigration law for local and national attorneys, nonprofits, and government agencies. She is co-author with James Butcher, Roger Greene, and Linda Nelson of the book Using the MMPI-2 in Forensic Assessments (American Psychological Association, 2015).

Julia Hodgson, MA, is a doctoral candidate in Clinical Psychology at Widener University and is also working on her MEd in Human Sexuality. She was one of the developers of the Safe Space program at Widener University, providing training for faculty and students to be allies to LGBT individuals. She is cur-rently working in an integrative medicine practice to provide comprehensive care for patients dealing with addiction, mental health, and chronic illness.

Nancy Kaser-Boyd, PhD, ABAP, is Associate Clinical Professor of Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine at the University of California, Los Angeles and in private practice in Forensic Psy-chology in Los Angeles. She received post-doctoral training at the University of Southern California Institute of Psychiatry and Law. She is a consultant to

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the USC Gould School of Law Post-Conviction Justice Project. She serves as a member of the Los Angeles County Superior Court Psychiatric Panels, con-ducting forensic evaluations on a variety of subjects. She is the co-author of Forensic Psychological Assessment in Practice (Routledge, 2015), as well as chapters and journal articles on victimization and its effects.

James H. Kleiger, PsyD, ABPP, ABAP, is a Diplomate in Clinical and Assess-ment Psychology and Fellow in the Society for Personality Assessment. Dr. Kleiger is a practicing psychoanalyst in Bethesda, Maryland. He is past president of the Baltimore Washington Society for Psychoanalysis and was pre-viously the Director of the Postdoctoral Psychology Training Program at the Menninger Clinic in Topeka, Kansas. Dr. Kleiger is the author of Disordered Thinking and the Rorschach (The Analytic Press, 1999) and senior author of Assessing Psychosis: A Clinician’s Guide (Routledge, 2015), along with numerous papers and presentations on psychotherapy and psychoanalytic perspectives of psychological assessment.

Linda K. Knauss, PhD, ABPP, is a professor at Widener University’s Institute for Graduate Clinical Psychology. She has authored several book chapters and journal articles on ethics and has taught many continuing education workshops on a variety of ethical issues. Dr. Knauss has served on local, state, and national ethics committees and is the recipient of the 2002 Ethics Educators Award presented by the Pennsylvania Psychological Association’s Ethics Committee. In addition to her work at Widener University, Dr. Knauss maintains a private clinical practice, where she sees children, adolescents, adults, and families. She can be contacted at: [email protected]

Radhika Krishnamurthy, PsyD, ABAP, is a Professor of Clinical Psychology at Florida Institute of Technology and a licensed psychologist in Florida. She is a former (2011–2013) president of the Society for Personality Assessment and former (2008) president of Section IX, Assessment Psychology, of the Ameri-can Psychological Association’s Division 12. She is a diplomate of the Ameri-can Board of Assessment Psychology and fellow of the Society for Personality Assessment and the American Psychological Association. She serves on the editorial boards of the journals Assessment, Journal of Personality Assessment, and Psychological Assessment, and has co-authored several books, book chapters, and journal articles on psychological assessment.

Mary Languirand, PhD, earned her doctorate in clinical psychology at the State University of New York at Buffalo and interned at the R. H. Hutchings Psychiatric Center in Syracuse, New York. She has since practiced in Mary-land, Pennsylvania, and New York in a variety of settings, and she is currently in private practice in Garden City, New York. She co-authored a number of books with Robert Bornstein on caregiving (When Someone You Love Needs

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Nursing Home, Assisted Living, or In-Home Care, winner of the Caregiver Friendly award from the National Association of Caregivers), aging in place/retirement planning (How to Age in Place: Planning for a Happy, Independent, and Financially Secure Retirement, cited by Library Journal as one of the best self-help books of 2013), and interpersonal dependency (Healthy Dependency). She also co-founded a cognitive rehabilitation program (described in The Thinking Skills Workbook: A Cognitive Remediation Manual for Adults).

Kari L. Lannon, PhD, is a licensed clinical psychologist who received her doctoral degree from Fielding Graduate University. Currently, she works as an adjunct faculty for Fielding, is continuing research on social and emotional learn-ing in urban environments and the relationship between sexual abuse and eating problems, and conducting psychological assessments, therapy, and supervision at Liberating Lives Christian Counseling and Psychological Services in Norfolk, Virginia. Kari has experience working with a wide variety of clients, including trauma survivors, families, and children, as well as collaborating with commu-nity organizations such as schools and churches to increase awareness of and access to mental health services. She has presented at several conferences and was co-author of a chapter titled “Spirituality: Neuroscience Studies Overview” in the book Critical Neurophilosophy and Indigenous Wisdom (Sense Publishers, 2010).

Nancy Maguire, PsyD, is a psychologist in private practice. She specializes in treating trauma and in providing group psychotherapy, supervision, and assess-ment. She has developed several treatment programs for traumatized girls and was the director of the Women’s Therapy Center. Currently, she is creating the Feminist Therapy Collective, a collaborative community of feminist therapists.

Barbara A. McLeod, MA, Capt. USAF, is a PhD candidate at the Derner Institute of Advanced Psychological Studies, at Adelphi University. She was a recipient of the Armed Forces Health Professions Scholarship Program for the United States Air Force. She is currently completing her clinical psychology internship at Wilford Hall Ambulatory Surgical Center. Her research interests include sex, gender, and interpersonal dependency.

Joni L. Mihura, PhD, is an associate professor of psychology at the University of Toledo, where she teaches personality assessment, an advanced assessment practicum, and psychodynamic/integrative therapy. She obtained early career awards from her two areas of expertise—the American Psychoanalytic Associa-tion Fellowship and the Society for Personality Assessment’s (SPA) Samuel J. & Anne G. Beck Award for Outstanding Early Research. She was a co-winner of SPA’s Walter G. Klopfer Award for Outstanding Statistically Based Research Article in Personality Assessment. Dr. Mihura has published many articles on personality assessment, has served on SPA’s Board of Trustees and is an SPA Fellow, and is on the editorial board for the Journal of Personality Assessment

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and Rorschachiana. She is one of the developers of a new Rorschach system—the Rorschach Performance Assessment System—on which she is editing a case book to be published by Guilford Press in 2017, entitled Applications of the Ror-schach Performance Assessment System (R-PAS).

Lynette Nickleberry, PhD, received her doctoral degree from the University of Missouri in Human Development and Family Studies. As a scholar in the interdisciplinary fields of family studies, gender studies, student development, and African American studies, her research primarily adheres to an intersec-tionality approach, centralizing race, class, sexuality, and other identities in the construction and production of family issues, academic self-concepts, and bod-ily, racial, and gender ideologies. Dr. Nickleberry is currently embarking on the exciting challenge of college administration and program development as the Director of Advising and Transfer Development at her undergraduate alma mater, Stephens College.

Kile M. Ortigo, PhD, is a clinical psychologist and PTSD Resource Specialist at Palo Alto Veterans Institute for Research (PAVIR) and the National Center for PTSD—Dissemination and Training Division of the Veterans Administration (VA) Palo Alto Health Care System in California. Dr. Ortigo received his PhD from Emory University, and after his internship at VA Palo Alto, he completed fellowship training in PTSD and Substance Use as well as an inaugural fel-lowship in Interprofessional LGBT Health Care at San Francisco VA Medical Center. He holds a part-time private practice to continue to deepen his clinical skills while maintaining an active research career.

Rebecca Preiser, PsyD, received her doctorate degree in Clinical Psychology at Widener University. She specializes in working with children and families to provide support with behavioral issues, developmental transitions, and parent-ing concerns. She is also a certified school psychologist, and her current work involves psychoeducational testing, school collaboration, as well as individual and family psychotherapy in the Philadelphia area.

Mary T. Rourke, PhD, is a licensed psychologist and certified school psycholo-gist in Pennsylvania. She is on the faculty of the Institute for Graduate Clinical Psychology at Widener University, where she directs the School Psychology program and teaches child/adolescent and school psychology classes. She co-di-rects a community-based clinic as well as a private practice, both of which provide therapy and assessment services to children, adolescents, and families.

Sandra W. Russ, PhD, a clinical child psychologist, is a Distinguished Univer-sity Professor of Psychology at Case Western Reserve University and holds the Louis D. Beaumont University Professor chair. She has served as president of the Society for Personality Assessment, of the Clinical Child Section of Division 12

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in APA, and of the Division of Aesthetics, Creativity and the Arts (Division 10) in APA. Her research program has focused on relationships among pretend play, creativity, and adaptive functioning in children. She developed the Affect in Play Scale, which assesses pretend play in children. Her most recent book is Pretend Play in Childhood: Foundation of Adult Creativity (APA Books, 2014).

Alan L. Schwartz, PsyD, is the Director of Behavioral Health Services for Christiana Care, a nonprofit health system in Northern Delaware. In addition to specializing in psychodiagnostic assessment and psychotherapy, Schwartz leads Christiana Care’s team of behavioral health experts embedded in integrated roles for primary and specialty care. Schwartz received his doctoral degree from the Institute for Graduate Clinical Psychology at Widener University, is on fac-ulty and teaches at the Philadelphia College of Osteopathic Medicine in Phila-delphia, and is a Fellow of the Society for Personality Assessment.

Hal S. Shorey earned his PhD in Clinical Psychology from the University of Kansas. He has a private psychotherapy practice and is an Associate Profes-sor at Widener University’s Institute for Graduate Clinical Psychology, where he directs the Psychology and Business (PsyD/MBA) Joint Degree Program. He conducts research and publishes on the application of personality develop-ment, positive psychology, and attachment theory to psychotherapy and lead-ership development, and he is an Associate Editor for the Journal of Personality Assessment.

Marshall L. Silverstein, PhD, is Professor in the clinical psychology program at Long Island University (Brockville, New York). He was previously Senior Psychologist at Michael Reese Medical Center and Director of Training in Psy-chology at the Illinois State Psychiatric Institute. A diplomate of the American Board of Professional Psychology in clinical psychology, Dr. Silverstein also was on the faculty of the Department of Psychiatry, University of Chicago Pritzker School of Medicine and the School of Education, Northwestern University. His research interests include longitudinal course and outcome in psychiatric dis-orders, neuropsychological dysfunction in psychiatric disorders, and psychoana-lytic self psychology. Dr. Silverstein is the author of Self Psychology and Diagnostic Assessment, Disorders of the Self, and Personality Assessment in Depth: A Casebook.

Steven Tuber, PhD, ABPP, is Professor of Psychology and Director of Clinical Training in the Clinical Psychology Program at the City College of New York. He is the author of four books on the intertwining nature of assessment and treatment in children, adolescents, and adults, and he has taught courses in psy-chological testing and child psychotherapy for more than 30 years.

Brandon J. Weiss, PhD, is a Postdoctoral Fellow at The National Center for PTSD Dissemination and Training Division, Palo Alto VA Health Care System,

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and Stanford University School of Medicine. He completed his PhD in clinical psychology at the University of Nebraska–Lincoln and his clinical predoc-toral internship at the Boston VA. His primary research and clinical interests include assessment and treatment of PTSD and related disorders (particularly among underserved groups such as LGBT individuals) and applying technology to evidence-based mental health care in order to improve access to care and increase the effectiveness of interventions.

Matthew L. Whitehead, PsyD, completed his doctoral work at the Institute for Graduate Clinical Psychology of Widener University, where he now serves as an adjunct instructor of courses in psychological assessment and psycho-analytic psychotherapy. Currently, he is completing psychoanalytic training at the Institute for Relational Psychoanalysis of Philadelphia. He maintains a pri-vate practice in Philadelphia, where he practices psychoanalysis, psychoanalytic supervision, psychoanalytic psychotherapy, and psychological assessment, and he has an interest in working with LGBTQ clients and their families.

Nicholas Wood, PsyD, is a Psychologist and Assistant Professor at Chestnut Hill College in Philadelphia, where he coordinates field placements and teaches courses in trauma, group work, and LGBT concerns. He has spent many years working in medical settings with a focus on HIV, chronic illness, and substance abuse. He currently supervises the psychology training program at Kensington Hospital in Philadelphia.

A. Jordan Wright, PhD, ABAP, received a master’s degree in psychology in education from Teachers College, Columbia University and a PhD in clinical psychology from Columbia University. He specializes primarily in psychological testing and assessment, is board certified by the American Board of Assessment Psychology, and is the author of Conducting Psychological Assessment: A Guide for Practitioners (Wiley, 2010). He works clinically with children, adolescents, and adults, and he has published on LGBTQ minority stress and homonegative microaggressions, having authored the Homonegative Microaggression Scale.

Jed Yalof, PsyD, ABPP, ABSNP, is Professor and Chair of the Department of Graduate Psychology at Immaculata University and has published in the areas of psychoanalytic interviewing, teaching, training, and assessment. He is on the faculty of the Psychoanalytic Center in Philadelphia and is in private practice in Haverford, Pennsylvania.

David J. York, PhD, earned his doctorate in clinical psychology from the University of Florida in 1993 and completed a post-doctoral internship at the Institute of the Pennsylvania Hospital in Philadelphia in 1994. He has worked at Christiana Care Health System in Delaware since 1997, where he has co- supervised a psychological assessment practicum for doctoral psychology

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students. Since April 2015, Dr. York has been working as an embedded, inte-grated behavioral health consultant in the hospital’s largest primary care medical practice while continuing to provide psychological assessment services for the hospital’s medical group.

Olena Zyga, BA, received her bachelor’s degree in psychology at Case Western Reserve University and is currently enrolled in the clinical psychology doctoral program there. Her current research focuses on better understanding the neural mechanisms of cognitive processes associated with pretend play and imagination and how these areas relate to social and emotional development in typically developing children and those with various disabilities or disorders.

PREFACE

In his 2015 State of the Union address, President Obama used a word that made headline news: transgender. This event captured the attention of the press because never before had a president in a spotlight moment recognized gender identity as worthy of respectful attention. History will show whether this moment was a watershed for the full integration into society of individuals with gender- variant identities, who are able to enjoy the rights and privileges of the cisgendered population—that is, those whose gender identity matches the identity assigned to them at birth. Given society’s reluctance to embrace individuals on the full spectrum of gender identities and sexual orientations, it is not surprising that the field of psychological assessment has paid such little attention to sexual and gen-der identity statuses that depart from what is seen as normative. More perplexing, perhaps, is that gender has not received the thorough exploration that might ben-efit psychological assessors. Through the chapters in this handbook, we will see that various issues concerning gender and psychological assessment are far from resolved, issues such as the desirability of gender-based norms or mixed norms. In the past 10–15 years, individual facets of identity such as gender identity and sexual orientation have been explored in the psychological literature. Yet, the intersection of these identities with each other, and with other important identity facets such as race, ethnicity, religion, and spirituality, has received far less atten-tion. This handbook aims (a) to spark the assessment community’s interest in the topic of gender, sex, and psychological assessment; (b) to identify central issues in need of theoretical and empirical attention; and (c) to identify what, in the views of experts in the different areas of this text, constitutes competent, respectful prac-tice in assessing individuals across different gender and sexual identities. However, we recognize that this handbook is only the beginning of the discussion.

This handbook is divided into six sections. Section I provides the framework for ensuing chapters. Chapter 1 defines basic terminology related to gender

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and sexuality identities and discusses how these identities are pertinent to every stage of a psychological assessment. The importance of the assessor’s taking into account potential stigma in relation to gender and sexual minorities is also discussed. In Chapter 2, we underscore the point that the identities related to gender and sexuality must be examined in the context of all of the other iden-tities that define a person. The chapter introduces the useful concept of intersec-tionality, which leads the assessor to consider multiple identities in terms of their combined effects on client experiences, perspectives, behaviors, and symptoms.

Section II focuses on the major assessment tools used by assessment psy-chologists. Consistent with the multi-method approach, we have invited con-tributions on a range of methods and instruments. Our contributors discuss the research on how gender and sexuality variables influence clients’ performance on various psychological tests and methods and the practical implications of research findings. In Chapter 3, Whitehead uses a psychoanalytic, intersubjective framework to illumine the interpersonal dynamics of the assessment situation related to gender and sex. He considers how an interviewer might broach top-ics of gender and sexuality in a way that will instigate a thoroughgoing and respectful exploration of these areas. Whitehead provides case material illustrat-ing some of the obstacles that arise in interviews when assessor and client begin to plumb gender and sexual identities, and strategies the assessor can use for the removal of these obstacles. In Chapter 4, Rourke and Bartolini look closely at cognitive assessment and identify some of the major methodological problems in using extant research to understand sex and gender differences as they relate to cognitive ability. They also consider major types of theories that have been used to explain differences among gender/sex subpopulations and draw out the practical implications of their findings for conducting cognitive assessment. In Chapter 5, Krishnamurthy talks about some of the major self-report personality tools, especially the MMPI-2, MCMI-III, and PAI. Krishnamurthy explores the gender differences obtained on particular self-report scales and their significance for evaluating clients’ self-report data. Chapter 6, by Tuber, Boesch, Gagnon, and Harrison, focuses on the Rorschach Inkblot Method, a performance-based instrument, and the implications of the fairly consistent pattern across research studies of minimal gender differences on Rorschach variables. In Chapter 7, through a series of case illustrations, Silverstein shines a light on narrative tech-niques and drawings and the new understandings that emerge when they are examined through the lens of gender and sexuality. We believe that, in total, these chapters demonstrate the importance of using the multi-method approach to capture the uniqueness of individuals of all identity statuses, irrespective of gender, sexual orientation, or gender identity.

Section III addresses personality and psychopathology through the filter of gender and sexual identity. In most psychological assessments, the assessor is asked to arrive at a diagnostic formulation. With respect to certain diagnostic conditions, are there demographic differences based on gender, gender iden-tity, and sexuality orientation? How does the assessor factor in epidemiological

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findings on various disorders and the meanings of those findings? The chapters in this section explore these issues.

In Chapter 8, Shorey considers how attachment styles may vary as a function of culture and gender. He makes the interesting point that those attachment styles that develop early in life as a consequence of interaction with caregivers may differ from attachment styles that develop subsequently through intensive interactions with peers. He develops the implications of this point for how the assessor investigates attachment style. In Chapter 9, Bornstein and McLeod take up the important topic of personality and per-sonality disorders in the context of sex and gender, and discuss the utility of a multi-method approach in order to get at the underlying dynamics that estab-lish personality style. They also consider how various personality disorders may manifest differently in men and women. In Chapter 10, Kleiger describes epidemiological differences in various types of psychosis (e.g., schizophrenia, bipolar psychosis, schizoaffective disorder) for individuals varying in gender, gender identity, and sexual orientation. He cultivates our appreciation of the fact that “the interface between psychotic and gender-related phenomena is complex, easily leading to erroneous assumptions and misdiagnosis,” and he describes how a combination of narrowband and broadband assessment tools can aid us in avoiding these negative outcomes. One problem he explores in some depth is the interpretation of psychological data pointing to psy-choticism in some transgender individuals and the importance of viewing the evidence through the lens of multiple hypotheses. In Chapter 11, Blagov and Goodman describe how variation in gender, gender identity, and sexual orientation is associated with differential base rates of depression and bipolar disorder. They talk about a range of psychological instruments that can be helpful in diagnosing depression and bipolar disorder and the special consid-erations (such as issues of bias) for using these instruments with individuals of variant gender and sexual identities. In Chapter 12, Hodgson, Preiser, and Cassano look at different anxiety disorders and how anxiety is influenced by trauma, a topic of relevance to gender and sexual minorities. They also review instruments that assess anxiety and discuss their suitability with different pop-ulations. Eating disorders and body image are areas where gender and sexual orientation are particularly important; in Chapter 13, Fallon and Lannon dis-cuss empirical findings related to eating disorders and gender and sexuality. They examine many of the major narrowband instruments for eating disor-ders and consider their use with people of diverse gender identities and sexual orientations. In the last chapter of this section, Chapter 14, Burks and Cramer consider suicidality, sexual orientation, and stigma. They discuss the research showing that the suicide rate is elevated for gender and sexual minorities and consider the various reasons for this pattern. They describe a variety of suicide assessment measures that may be helpful to psychological assessors, but they also underscore the limitations of those instruments in work with individuals with variant sexual and gender identities.

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In section IV, our contributors provide clinical illustrations of various types of problems that engage the identity areas of gender and sex in all of their com-plexity. Through an in-depth clinical example, Yalof ’s Chapter 15 explores the dance between assessor and client that unfolds as the assessment progresses, and how the identities of each stimulate transference (client reactions) and counter-transference (assessor reactions) that crucially shape the assessment process. In Chapter 16, Boyer, Schwartz, and York acknowledge that in most clinical assess-ments, gender and sexuality issues are not part of the referral question. None-theless, through these clinical illustrations they demonstrate that the assessor’s sensitivity to both the client’s experiences and his or her own evolving reac-tions to the client will allow gender and sexuality information to surface. They show how such information can be inestimably important in providing a fuller picture of the client’s struggles. In Chapter 17, Calloway helps us to recognize that gender bias can operate in different directions by presenting the forensic case of a male client who was subject to gender bias. Chapter 18 provides an example of the concept of intersectionality, introduced in Chapter 2, as Haas discusses a case of gender and immigration. She talks about the complex identity forged by immigrant women who face various types of stigma and oppression in their host society, considerations for conducting a culturally sensitive psycho-logical assessment, and the special considerations when the assessment work has a forensic aspect. Chapter 19 by Kaser-Boyd continues the discussion of gender and sexuality by illumining through forensic case illustrations the phenomenon of sexual harassment of both men and women and discussing how assessment psychologists can be helpful in identifying the effects of such harassment. In Chapter 20, gender identity takes center stage as Bullock and Wood provide case analyses of psychological assessments with trans persons. They investigate the complex issues that arise in the interpretation of psychological test data, interpretation—they argue—that requires the assessor to take into account the lived experience of persons with variant gender identities. Finally, in Chap-ter 21, Finn talks about the usefulness of Therapeutic Assessment in the context of sex reassignment surgery. After providing a brief introduction to Therapeutic Assessment, he talks about the role of the assessor and professional standards in conducting this work. He presents a case that demonstrates how the assessment work provides a vehicle for learning not only about the client but also about the assessor.

Achieving a clear sense of personality identity is, as Erik Erikson taught us, a developmental undertaking, and the chapters in Section V explore the developmental aspects of gender and sexual identities. In Chapter 22, Russ and Zyga examine the relevance of play to gender and sexuality in childhood. In Chapter 23, Wright and Nickleberry extend the developmental trajectory into adolescence, during which time intensive gender-related developmental work occurs vis-à-vis identity. Languirand, in Chapter 24, takes us to the last stages of adult development and the important sex and gender identity work that occurs within that period, particularly in the context of the increasing need to cope

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with loss, change, and death. She provides guidelines for conducting psycholog-ical assessments with this population.

Section VI features chapters designed to help the reader to take a broad view of the themes introduced throughout the book. Repeatedly, our authors call for the importance of greater graduate-level training in the areas of diversity explored in this text as it is applied to psychological assessment. Chapter 25 by Ortigo and Weiss develops the concept of psychological assessor as ally or advo-cate. They describe what formative training—didactic, experiential, and field placement—is needed for psychologists to be an effective ally and a competent provider of assessment services to the diversity of clients who need such ser-vices. Chapter 26 by Alvelo, Maguire, and Knauss shows how a principle-based ethical framework can be integrated with a feminist perspective to recognize the multiple ethical dimensions of clinical decision making when assessing indi-viduals of varied gender identities, sexual orientations, and gender expressions. They present a series of three vignettes that illustrate the varied problems and ethical conundrums that gender and sexual diversity raise. Finally, in Chapter 27, we look into the future and critically appraise what the prior chapters have taught us about what research and practice initiatives will best serve our varied clients’ needs.

ACKNOWLEDGMENTS

We are deeply appreciative of the contributions and support from people in our professional and personal environments, without whom this book would have remained only an idea. But first and foremost, we are grateful to our clients, past and present, who inspired this book. It is for you this book is written. We also thank our chapter authors for sharing their expertise, as well as the many individuals who served as consultants along the way. Among these individuals are Dennis Debiak, Courtney Slater, Natasha Go, Jacob Weisfeld, Greg Meyer, Elizabeth Foster, and Colt Meier.

Virginia thanks Widener University for a faculty grant that enabled her to obtain student assistance with the project. Thank you, Katie Lesher, for your help. Joni also thanks her undergraduate lab for their assistance—most especially Christopher Bergman, and also Morgan Goubeaux, Sriya Sureddi, and Elena Yeager.

Our gratitude goes to the Routledge staff. In particular, we thank George Zimmar, our publisher at Routledge/Taylor & Francis, for the trust he placed in us. Additionally, we have appreciated the contributions of Meira Bienstock.

Finally, we wish to thank our spouses, Arthur and Greg, for lovingly sharing with us the inevitable bursts of joy and moments of anguish that a large project such as this one brings.

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PART I

Introductory Chapters

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THE CONSTRUCTION OF GENDER AND SEX, AND THEIR IMPLICATIONS FOR PSYCHOLOGICAL

ASSESSMENT

Virginia M. Brabender and Joni L. Mihura

A female client calls a male psychological assessor to make an appointment for an assessment. From the first moment of hearing the client’s voice on the phone, the assessor registers one critical piece of information about the client—his or her gender. The assessor gauges from the caller’s tonal quality that he was speak-ing to a woman. The client probably already knows the assessor’s gender before making the call. Gender-related information possessed by client and assessor is likely to shape the assessment in many ways. From the client’s standpoint, it may affect his or her attitude in coming to the assessment. If, for that client, mascu-linity is associated with authority, then an assessor’s maleness could provide a measure of comfort and encourage the client’s willingness to appear for a first meeting. It may even affect the client’s willingness to follow through with the assessment. Another client may associate that assessor’s maleness with domi-nance and find the prospect of meeting with the assessor more intimidating than if he were to be assessed by a woman.

The assessor is also likely to think about the client in gender-based terms throughout the stages of the assessment. Based on his or her own fund of assessment experiences, knowledge of base rates, or other reading of the lit-erature, the assessor might understand the client and interact with the cli-ent based upon the assessor’s assumptions about men and women and how they differ. This phenomenon is gender bias (Crosby & Sprock, 2004; Koenig & Eagly, 2014; Sprock, Crosby, & Nielsen, 2001). For example, Samuel and Widi-ger (2009) found that when practicing clinicians rated a male or female version of a case vignette using the Diagnostic and Statistical Manual of Mental Disorders

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Virginia M. Brabender & Joni L. Mihura

(DSM-IV-TR, American Psychiatric Association [ApA]), they were less likely to see the female case as antisocial and the male case as histrionic—a finding consistent with gender bias.

Basic Terms

Sex, Gender, and Gender Identity

In using the term gender, we are differentiating it from sex. Note that the asses-sor identified the individual as a woman based upon her voice quality. In other words, he associates femaleness with particular vocal characteristics that are dif-ferent from those connected to maleness. This assignment is part of gender. It differs from sex in that a person’s sex is the label the person is given at birth and is based strictly on physical characteristics (World Health Organization [WHO], 2014). These sex characteristics usually lead to a classification of male versus female, but they are by no means the only possibilities. Individuals may manifest the physical characteristics of both males and females in varying ways, a status labeled intersex. Gender is a broader notion that includes all of those characteris-tics and roles, interests and sensibilities that members of a given society ascribe to a particular gender (McCreary & Chrisler, 2010). For example, the psycholo-gist, reflecting the views of society, might have certain assumptions about his female client, such as possessing certain interests or personality characteristics.

Over the history of psychological assessment, considerable focus has been placed on gender. Yet, to know about the client’s gender is not to know enough. That client who called the assessor for an appointment may be called Jane and may have the primary and secondary sex characteristics of a woman. Perhaps the entire world sees Jane as a woman. But this designation may feel wrong to Jane. Even though Jane has never communicated this idea to another person, she senses herself at her core to be male. Her reason for pursuing a psychological assessment is the constant malaise she feels, her lack of interest in her everyday activities. If the assessor gathers evidence from a variety of psychological tools and methods showing that Jane does have a considerable fund of emotional misery but never explores its potential link to her hidden identity, never sees her gender dissonance, then the assessment may not only fail to fulfill its potential to increase Jane’s self-understanding but also may foster a sense of alienation.

What is being described in Jane’s case is the identity variable of gender identity, which concerns how a person experiences his or her own identity. Gender iden-tity tends to be particularly inconspicuous because in the vast majority of the individuals in the population, the cisgender population, a match exists between an individual’s apparent gender, typically based on primary and secondary sex-ual characteristics, and his or her felt gender. Yet, by no means do cisgendered individuals encompass the entire population. A group of individuals referred to by the terms transgender and gender nonconforming lie outside of the cisgender population. According to the American Psychological Association (APA, 2011,

Gender and Cognitive Assessment

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2015), transgender is an umbrella term for “persons whose gender identity, gender expression, or behavior does not conform to that typically associated with the sex to which they were assigned at birth.”1 Among the subpopulations within this group are transsexuals, whose primary and secondary characteristics are incongruous with their gender identities. Cross-dressers2 are individuals who dress in a manner that differs from that customarily associated with the sex they were assigned at birth and might identify as transgender. Also present within this population are individuals who have a more flexible gender identity, either identifying with each gender simultaneously or who experience their gender identity in different ways at different times. A still separate group is constituted of those individuals who do not see themselves as relating to the male-female distinction. Individuals who do not ascribe to the gender binary are sometimes referred to as gender-queer. These individuals teach us the valuable lesson that the gender binary is more of a convenience than an accurate representation of the range of ways in which individuals identify themselves with respect to gender. They also help us to see that the gender identities of male and female are not polar in the sense that one necessarily precludes the other.

Individuals who are not among the cisgendered members of society have equal entitlement to competent psychological assessment as those who are. Such competence requires the assessor’s fine-tuned grasp of the psychological issues these subpopulations face. The broad terms of transgender and gender nonconform-ing can obscure the fact that each group has very specific stressors and challenges. Moreover, although all of these groups are vulnerable to discrimination based on their departure from gender norms, the degree of negative bias from group to group can vary greatly (APA, 2011; Serano, 2007). It is imperative that the psy-chological assessor recognizes the particular character of each group’s burdens.

Gender Expression and Related Concepts

The client’s gender identity does not tell us how that identity will be expressed. For example, a client may have a very strong sense of himself as being a male. At the same time, the client may express his maleness in ways that others regard as not highly masculine. This point speaks to the separateness of a client’s gender identity from gender expression or how the person manifests his or her gen-der identity. Two clients may each have a strong female identity but manifest that identity in completely different ways. Gender expression may or may not conform to gender stereotypes (APA, 2014), and this aspect distinguishes it from masculinity-femininity, a term that has had a very long history. In their empiri-cal work on this concept using data on the Masculine-Feminine scale of the MMPI-2, Martin and Finn (2010) found that this personality characteristic is not redundant with other characteristics that can be identified through this introspective technique. Moreover, it appears to be composed of three subfac-tors: (1) an endorsement of stereotypically feminine interests, (2) a disavowal of stereotypically masculine interests, and (3) gender identity. The construct

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gender conformity relates to the extent to which an individual embraces a gender stereotypic role. Gender conformity can produce gender role conflict in which an individual’s ascription to gender roles has negative consequences for that indi-vidual or those around him or her (O’Neil, 1990).

Sexual Orientation

Gender identity and gender expression, however, do not complete the story. Understanding gender also involves an appreciation of the client’s sexual ori-entation and how it interacts with other gender characteristics to influence a person’s fund of experiences and behaviors, including those emerging within the assessment situation. Sexual orientation is determined by the gender of the other person that elicits sexual attraction and intense positive feelings from a person. Vrangalova and Williams (2012) describe it as the “sexual attraction, iden-tity, arousals, fantasies, and behaviors individuals have for one sex, the other sex, or both sexes” (p. 5). They note that whereas researchers often place individuals into discrete categories of heterosexual, gay, or bisexual, the data suggest more of a fluid-continuum model of attraction to one or both sexes. For example, some individuals are mostly heterosexual (or mostly gay/lesbian), whereas others are wholly heterosexual (or wholly gay/lesbian) (van Lankveld, 2014), a notion that has been supported by multiple studies (e.g., Diamond, 2007; Epstein, McKinney, Fox, & Garcia, 2012). Still others may be variable in their sexuality and abstain from placing themselves on a continuum of sexual preference. Another group of individuals are distinguished by lacking sexual attraction to either men or women (Foster & Scherrer, 2014), which is termed asexuality. According to Bogaert (2015), an individual with an asexual designation might nonetheless have sexual feelings (simply not sexual attraction) or romantic inclinations. He further points out that of all of the sexual orientations, this identity status is the least studied.

An early contribution to the literature on psychological assessment and sex-ual orientation was a chapter in which Pope (1992) presented a series of cases of individuals whose sexual orientations had implications for their experience of their psychological assessment. One of his clients was seeking to gain entrée into a specialized program within mental health. Admittance required a psy-chological assessment. The candidate was gay and apprehensive about a possi-ble heterosexist bias on the part of the faculty. He believed that the (original) Minnesota Multiphasic Personality Inventory ([MMPI] Hathaway & McKinley, 1943), which was a component of the evaluation, provided information that could reveal his sexual orientation. The student carefully responded in a way that he believed would steer the committee away from recognizing his sexual orientation. In the process, he produced an elevation on scale 9 (Hypomania) that was absent on a subsequent occasion when he took the MMPI after being accepted into the program. As we will explore, the client’s sexual orientation potentially figures into the assessment in many ways. As this example illustrates, it can affect test-taking set in high-stakes testing when, in the eyes of the client,

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the outcome could be affected by sexual orientation. In assessments that are not perceived by the client as high stakes, the sexual orientation of a gay, lesbian, or bisexual client could still influence the assessment if the individual wondered how the assessor might regard him or her were the sexual orientation to be dis-closed. This uncertainty could add a level of stress to the assessment that might be absent for individuals who are not members of sexual minorities.

The Person of the Assessor

The assessor’s gender and sexual identities are also material to the assessment. Consider a lesbian psychologist who provides psychological services in a rural community with conservative values. This psychologist might harbor a worry that the client’s awareness of her lesbianism might lead that client to be more resistive than he otherwise might. Might not the assessment psychologist’s war-iness affect other behaviors, such as showing warmth and other means of build-ing rapport with the client? Likewise, an assessor’s gender role conformity may exert its influence if the demands of the assessment were experienced as at odds with the assessor’s allegiance to a gender stereotype. For example, in the clinical interview, the female assessor might refrain from asking important questions in relation to sexuality because it violated the assessor’s own sense of delicacy connected to her feminine ideal. Conversely, the assessor might be spurred by the impulse to reject a feminine stereotype and broach sexual material in an aggressively probing way.

Also pertinent to the contribution of the assessor is that assessor’s toler-ance for exploring identity facets related to gender identity and sexual orienta-tion. The assessor’s identities that are similar to or different from the client are brought to the fore for the assessor to behold. Some identities may be the source of discomfort. The assessor who has never thought deeply about his or her own gender and sexuality may fear the final destination of such explorations. In fact, for some, it may be a cause of the confusion that arises in relation to many fac-ets of identity—the way, for example, that gender expression is confused with sexual orientation. This defensive posture is of course not unique to assessors: We may find it in any professional providing services to a diverse group of cli-ents. However, for assessors, this self-protective reaction limits their capacities to garner and work productively with identity information about the client. Ultimately, it prevents the assessor from accomplishing the central task of the assessment—understanding the client.

In his or her quest to understand a person fully, the psychological assessor has the challenge of grasping all that makes up the individual’s identity and recogniz-ing the presence of different identity elements in the assessment. It entails know-ing how the client regards him or herself in terms of gender, gender identity, masculinity and femininity, and sexual orientation. It encompasses recognition of these characteristics as others, including the assessor, perceive them. However, the assessor, too, must have a cognizance of how his or her own gender characteristics

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in interaction with those of the client create a dynamic field that can both affect the quality of the assessment and be a rich terrain for harvesting insights about the client. The assessor must engage in the potentially difficult process of iden-tifying gender and sexual biases that he or she might bring to the assessment situation, biases yielding subtle cues to which the client may respond. This task is integrally related to the topic of stigma. Even the most compassionate, broad-minded assessor may be at risk for bringing stigma into the assessment situation.

Stigma as an Element Within the Client’s Life and the Psychological Assessment Process

This volume shines a light on aspects of identity that tend to figure prominently in an individual’s view of self. The last section defined these aspects—sex, gen-der, gender identity, gender expression, and sexual orientation. Over the history of personality assessment, the identities of gender identity, gender expression, and sexual orientation have been addressed minimally. When they were con-sidered, it was generally to ill effect. For example, psychological assessment was used to determine a client’s sexual orientation, sometimes using most famously the MMPI Masculinity-Femininity (Mf ) Scale (Hathaway, 1956/1980).3 How-ever, this attempt confused sexual orientation with gender expression. Psycho-logical assessors would also use assessment findings as a basis of recommending the denial of a client’s request for gender affirmation surgery. When clients gave evidence of experiencing distress, this finding was seen as an indicator of the individual’s unsuitability for surgery. Too often, the possibility that the incon-gruence between the person’s physical characteristics and gender identity gave rise to emotional symptoms was ignored, as was the role of stigma in generating psychological problems (Serano, 2007; Solomon, 2012).

These misuses of psychological assessment were not problems of assessors alone but part of a broader societal context (Pope, 1992). As Pamela Hays (2005) points out, attached to any domain of identity is variation (e.g., differences in race, sexual orientation, religion) that gives rise to subpopulations (e.g., African American, Asian American, EuroAmerican). Some groups within a particular domain of identity will, for a variety of reasons, achieve dominance over others who constitute the minority. For members of the majority, the privileges they possess are so natural that they are easily unseen. However, the lack of privilege tends to be deeply felt.

Minority status carries with it the potential for stigma, which literally means a mark and is commonly associated with disgrace. The stigmatized person is seen as morally objectionable and in need of banishment, punishment, treat-ment, or some combination of these. To stigmatize is to give that person a mark, or to call attention to an aspect that will lower the stigmatized person’s worth in the eyes of society (Goffman, 1963). As Herek (2009) elaborated, “stigma constitutes shared knowledge about which attributes and categories are valued by society, which ones are denigrated, and how these valuations vary across

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situations” (p. 66). He points out that structural stigma entails ensconcing this shared knowledge within major societal institutions such as medicine, law, gov-ernment, religion, and so on. Gender and sexual variant groups that represent subgroups of gender and sexual orientation are structurally stigmatized groups. That is, the stigmatizing of these minorities is embedded within society’s most important and influential systems. Up until 1973, the ApA viewed nonheter-osexuality as a mental disorder. Until recently, some states within the United States viewed same-sex marriage as illegal. However, in June 2015, the Supreme Court ruled that states must recognize same-sex marriages. Still, many of the major religions see same-sex sexuality activity as a sin.

Structural stigma, Herek (2009) notes, creates the context for three other types of stigma to occur, all of which are important for the psychological asses-sor to recognize: enacted stigma, felt stigma, and internalized stigma. Table 1.1

Table 1.1 Types of Stigma Using Herek’s Classification and Implications for Psychological Assessment

Type Definition Implications for Psychological Assessment

Enacted The enactment of stigma; the manifestation of discriminatory ideas and beliefs

• Assessors must be scrupulous in identifying their own discriminatory views and recognizing when they affect behavior toward a client.

• Assessors must be open to the possibility that they harbor biases against marginalized groups of which they are unaware.

• Assessors should recognize the range of enacted stigma that may have contributed to the client’s stress.

Felt The client’s beliefs about when, where, and how stigmas are enacted and how enactments can be avoided

• The assessor should develop skill in asking clients about their stigma perspective.

• The assessor should ascertain how a client’s stigma perspective affects his or her willingness to be open in the assessment.

• The assessor should analyze how the client’s stigma perspective helps, hinders, or fails to affect his or her functioning.

Internalized The individual’s conscious or unconscious acceptance of a societal point of view as part of his or her own perspective

The assessor should recognize the client’s level of internalized stigma, its conscious or unconscious presence, and its influence on the client’s self-esteem, and interpersonal behaviors.

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describes the three forms of stigma and their implications for psychological assessment. Enacted stigma is behavior directed at minority group members and their allies. For example, failing to consider job applicants because of their race, sexual orientation, or religion would be enacted stigma. To understand enacted stigma in a way that is most likely to be helpful in psychological assessment, it is useful to link it with Sue’s concept of microaggressions because it broadens the behaviors that might be considered to be enacted stigma.

Microaggressions are “everyday verbal, nonverbal, and environmental slights, snubs, or insults whether intentional or unintentional, that communicate hostile, derogatory or negative messages to target persons based solely upon their mar-ginalized group membership” (Sue, 2010, p. 3). Sue’s concept underscores that people are often unaware of stigmatizing others. To preserve their self- regard, they will not permit themselves to think that they could harbor prejudicial thoughts and feelings. Of course, not all people always have compunctions about expressing discriminatory views. A conscious direct expression of a prejudicial thought or feeling is termed, by Sue, a microassault, and pejorative name-calling would be an example. For example, to say someone throws “like a girl” is a microassault in that it directly conveys that girls are inept in particular areas. Far subtler are microinsults, which are unconscious negative communications or actions based on the target’s group membership. For example, a physician who shows a pattern of keeping individuals from a lower socioeconomic status waiting for their appointments much longer than people from a higher status might be engaging in a microinsult. Microinvalidations entail denying the reality of the experiences of a stigmatized group. For example, conveying to a client that one’s privileged membership status (e.g., high socioeconomic level) must have shielded him or her from racism, heterosexism, or some other type of dis-crimination is an example of a microinvalidation.

Like all members of society, psychological assessors have biases of which they are unaware, which can give rise to the various forms of microaggressions. What benefits the client is the assessor’s awareness that he or she has the capacity to commit a microaggression. This awareness leads to a watchful stance toward his or her own behavior, with particular attentiveness to behaviors that appear to have affected the client adversely, for example, behaviors that may have induced withdrawal or disengagement from the assessment. Upon recognizing a micro-aggression, the assessor can modify his or her behavior and work to identify the bias that gave rise to it. Sometimes clients themselves point out microaggres-sions. The assessor who knows that he or she is not immune to such behavior is better able to be open to the client’s communication, responding with neither rigid defensiveness nor paralyzing self-recrimination.

Felt stigma is the recognition of discrimination based on membership in a particular group (e.g., gender or sexual minorities) and conceptualization of the contextual factors that will control the enactment of stigma (Herek, 2009). For groups in which membership is not entirely visible, any member of society is a potential member of that group and thereby vulnerable to

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discrimination. Consequently, members of the stigmatized minority or the generally nonstigmatized majority may invest effort in discerning how to avoid discrimination. For members of the nonstigmatized majority, the way of escaping being stigmatized may be to make a show of stigmatizing others, that is, to enact stigma. In minority group members, the avoidance of enacted stigma can take the form of passing—attempting to appear as a member of the majority—but can also involve limiting one’s relationships, venues, interests, and so on to escape adverse experiences. The challenge for the psychological assessor is to ascertain to what extent such efforts are adaptive and to what extent they interfere with having a happy, productive life. The assessor must also discern how felt stigma might motivate a client to alter his or her pres-entation within the assessment.

Internalized stigma is taking into the self society’s negative view of a given group and making it one’s own view (Herek, 2009). The act of internalization need not be conscious, and frequently it is not. It springs from the natural pro-pensity human beings have to identify with one another (Racker, 1968). In fact, many of the more subtle forms of microaggression emanate from internalized views operating outside of awareness. What is crucial for clinicians to recognize is that members of a stigmatized group are also vulnerable to internalizing the stigma attached to that group. Herek (2009) refers to this phenomenon as self-stigma in that the condemnatory attitudes of society are now directed at the self. Once again, this internalized stigma may be conscious, unconscious, or have some elements of both. Furthermore, as we will discuss later in this chap-ter, this stigma may be connected to the psychological problems a client pre-sents (Meyer, 2003). For the present, it is worthwhile to note that psychological assessments, relying as they do on the multi-method approach, offer assessors tools for the detection of internalized stigma that may not be evident through mono-methods such as interviewing.

For individuals who are the victims of stigma due to their group member-ship or perceived group membership, the consequences extend far beyond the unpleasantness in the moment. Meyer (2003) has proposed the Minority Stress Model to capture the effects of experiences with marginalization. Although Meyer’s primary focus is sexual orientation, the Minority Stress Model has been applied to other marginalized groups (e.g., Wei, Ku, Russell, Mallinckrodt, & Liao [2008] applied the model to Asian international students and Orozco & Lopez [2015] used it in explaining the schooling experiences of Mexican American high school students). Meyer defined minority stress as “the excess stress to which individuals from stigmatized social categories are exposed, often as a result of their . . . minority position” (p. 675). Like others (e.g., Allport, 1954; Goffman, 1963) before him, Meyer points out that members of stigmatized groups carry a burden beyond that of members of dominant groups—a bur-den that erodes quality of life. His research and that of others points to a rela-tionship between stigma-based stress and a variety of psychological problems. For example, Wong, Weiss, Ayala, and Kipke (2010) demonstrated a relationship

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between harassment and illicit drug use over a three-month period in an eth-nically diverse group of young men who reported having sex with other men.4

The Minority Stress Model also posits that the relationship between stress and distress is moderated by the ways in which an individual copes with stigma and the degree of social support that person receives. Of significance to the psychological assessor is Meyer’s point that personality factors play an important role in how an individual copes with stress. For example, he mentions that the stigmatized person’s willingness to access external supports is important to that person’s ability to manage the stress. In this handbook, as we look at various psychological problems associated with minority stress, we will also be ques-tioning how minority stress can be buffered through the client’s acquisition of effective coping strategies, access to social resources, and awareness of person-ality strengths.

Although Meyer developed his notions on stigma to capture phenomena in relation to individuals with variant sexual orientations, his ideas are relevant to the identity domains addressed in this text. In all sectors of societies, discrimi-nation occurs based on gender. As a report of the APA (2007) notes, although society has moved toward greater equality for women and girls, significant oppression, inequality, and discrimination remain. The term sexism generally refers to male domination over women and reflects a broader societal andro-centric orientation, wherein males are views as the exemplars of human beings. Our use of the term will be consistent with this practice. Still, gender bias can occur in either direction. Wherever gender role expectations exist, one gender or the other can occupy a privileged or marginalized status. Heterosexism is the posture that sees heterosexuality as the most normal and natural way for human beings to relate romantically or sexually. The corollary to this belief is that other forms of affectional and sexual relating are abnormal, unnatural, exceedingly rare in occurrence, and even against the will of God. Biphobia is a fear of and bias against bisexual individuals. Transphobia is a response toward transgender people that encompasses one or more of the following: fear, loathing, repulsion, avoidance, and discrimination. These types of stigma need not occur in isolation. For example, a client may be transgender, female, and lesbian, and each of these identities can be a source of minority stress. As we will see in Chapter 2, other identities, such as those related to race, ethnicity, and religion, can add to the stress burden even further.

The concepts presented in this section, such as types of stigma, provide ter-minology for describing, and a framework for understanding, material that is presented subsequently in this chapter and in the other chapters of this text. This material is relevant to psychological assessors in at least three ways. First, it provides insight into the early history of psychological assessment in relation to marginalized groups and invites a conversation among psychological asses-sors about the possible manifestations of stigma in our current assessment and research practices. Second, it reveals the importance of psychological assessors engaging in their own practices of self-examination, as well as exploration in

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supervision and therapy, to identify and address any internalized stigma and corresponding enactments that may affect their work with marginalized groups. Third, the framework provides a lens through which to appreciate our clients’ lived experiences more fully and to empathically convey our appreciation. For example, being sensitive to the presence of internalized stigma enables assessors to understand a client’s low self-esteem in the midst of his or her professed pride in membership in a stigmatized group.

Status of Assessment and Diagnostic Literature

We now have some tools to examine some of the research efforts that have occurred in the last 50 years or so to explore the identity areas that are the focus of this text: gender, gender identity, and sexual orientation. Changes in how society regards majority and marginalized subgroups in each area of identity are paralleled by changing research questions, and in some cases, differences in how results are interpreted. What is offered in this section is a thumbnail sketch of each area. However, ensuing chapters elaborate on many of the areas upon which we touch.

Identity Domain: Gender

Of all identity areas considered in this text, that which has spawned the greatest amount of research over the decades is gender (to get a sense of the extensive-ness of this research, see the two-volume handbook on gender research edited by Chrisler & McCreary, 2010). Until very recently, the lack of awareness of the distinction between gender and gender identity led to an emphasis on the former. If, in a research study, a client were asked to identify as male or female, that participant could respond based on gender or gender identity. For most of the population, the cisgendered subpopulation, they are the same. However, for individuals in the trans population, a difference can exist between the two concepts. Whether particular gender study findings from a primarily cisgender population apply to a transgender population can only be determined by future research.

Searching for Differences

One question concerning gender has elicited more attention than any other: Are boys and girls, men and women, different from one another on a host of psychological test variables—cognitive, emotional, personality, and variables reflecting psychological symptoms? This question has been primarily posed in a quantitative way: Does the test performance of one gender exceed that of another? Psychological assessors have a particular interest in those stud-ies that have focused on psychological test variables. The outcomes of these studies can affect public policy decisions, attitudes toward men and women,

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and self-perceptions. Consequently, how findings of significant differences are treated when they are obtained is very important.

As Baker and Mason (2010) point out, at least three different strategies exist for treating differences between men and women, or boys and girls, on psychological test variables. A first strategy is to provide gender-based norms. For example, in the development of MMPI, Hathaway and McKinley’s (1943) discovery of differences between the raw scores of men and women in the normative sample induced them to create gender-based norms, a practice that has continued with the MMPI-2. However, Ben-Porath (2012) points out that whether such differences should lead to separate norms depends upon whether the differences are attributable to style or substance. If, for example, women were more open to acknowledging particular personality features, then having gender-specific norms could lessen this response style difference. If, however, a particular personality feature were more characteristic of women than men, then gender- specific norms would hide this feature. To allow for the possibility of differences in substance, not simply response style, Ben-Porath argues for non-gendered norms, a strategy that Baker and Mason identify as Gender-Irrelevant.

Ben-Porath’s (2012) distinction between style and substance is a worthwhile one. Of course, style and substance can operate together in the creation of gender differences for any given test scale. Furthermore, even if gender dif-ferences are due to substance more than style, the psychological assessor may find gender-based norms might be useful in particular instances. For example, a client who is being assessed for her undue aggressive style at work may yield a score on an aggression scale that is well within the nongendered population norm. Yet, she may be deviant when her performance is compared to a norma-tive group of women. This disparity between her status vis-à-vis gendered and nongendered norms may reveal that her co-workers are viewing her behavior through gender-based lenses (i.e., she is responding aggressively in contrast with other women). Any discussion of gender—be it of a group or an individual—must reference the environment because social environments see individual behaviors through the lens of gender.

The third strategy in the treatment of gender is to construct the scales so that no differences between girls and boys or men and women emerge (Baker & Mason, 2010), as is done in the construction of many cognitive tests. As Baker and Mason note, this approach eliminates gender bias but does not preclude the possibility that individuals of one gender or the other may be disadvantaged at the extremes of the continuum. For example, if girls or boys more commonly engage in an activity that is highly similar to the task used to measure a given cognitive process, that subgroup may be advantaged at the high end of the con-tinuum of performance.

Different test constructors have made different decisions about what nor-mative material is available for a given instrument. It would seem helpful and healthy for a broader discussion to take place among psychological test construc-tors and psychological assessors about how gender differences are handled. Such

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a conversation should center upon how gender bias can be eliminated, or at least minimized, while recognizing that in particular circumstances, gender-specific information might be useful.

Explaining Differences

Apart from how gender differences are used, ignored, or eliminated, psycho-logical assessment research can make a contribution to how gender differences can be understood. Costa, Terracciano, and McCrae (2001), who examined data from the Revised Neo-Personality Inventory (Costa & McCrae, 2008) of indi-viduals from 26 cultures (over 23,000 participants), provide an example of such a study and highlight the complexity of interpreting gender differences. Across cultures, the investigators found consistent differences in the personality traits endorsed by males and females. Men scored higher on Assertiveness, Excitement Seeking, and Openness to Ideas. Women tended to score higher on measures of Neuroticism, Agreeableness, Warmth, and Openness to Feelings. One important aspect of their findings was that although these differences between men and women were consistent, the male and female score distributions were highly overlapping.

The investigators interpret their findings in the context of two sets of the-ories that have been advanced to account for gender differences. According to evolutionary theory (Buss, 1995), such differences are rooted in the different adaptive challenges faced by men and women. Women, facing the tasks of child-bearing and breastfeeding, develop the personality characteristics suited to nur-turing children. Personality traits such as Openness to Feelings enable optimal responsiveness to children’s emotional needs. With women focused internally, men must fulfill the responsibilities of protecting the family from threats in the external environment and bringing resources to the family, and personality traits such as Assertiveness support these roles. Costa et al. (2001) point out that if these role-based differences are engrained, species-level phenomena, then a high level of consistency should be observed from culture to culture. Yet, although the pattern was universal from country to country (consistent with evolutionary theory), the extent of the gender differences varied greatly (at odds with evo-lutionary theory). For example, in Zimbabwe the difference was slight and in Belgium and Croatia, it was relatively large.

From the perspective of a contrasting set of theories, social role theory (Eagly, Wood, & Diekman, 2000), men and women acquire different personality fea-tures based upon social conditioning or what tendencies are reinforced for each gender. One would expect, then, that in those countries in which behav-iors corresponding to gender stereotypes are highly valued, gender differences would be great. This finding was not obtained: In countries such as the United States, which is known for prizing individualism, gender differences were rel-atively greater than in many of the countries with more collectivist cultures. One possibility, as Costa et al. (2001) point out, is that in rating traits, responders

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may have different frames of references. For example, in collectivist countries, particular behaviors may simply be seen as conformity to cultural expectations, whereas in cultures emphasizing individuality, the same behavior may be per-ceived as reflective of the responder’s own unique personality. The point they raise about frame of reference is one that has broader relevance beyond explain-ing ethnic differences or similarities. In any self-report method, the respond-ent assumes a particular frame of reference in crafting his or her response and, at times, different subgroups of the population may adopt different frames. Research demonstrating gender differences based on introspective data can be most clearly interpretable if the possibility of differences in frame of reference are either ruled out or recognized as having an effect in a particular direction and of a particular magnitude.

Identity Domain: Gender Identity

Until very recently, gender identity, as distinct from gender, was not acknowl-edged as a basic domain of identity. Pathology was ascribed to any departure from a cisgendered status and societal gender norms (Borden, 2015). Research was done with individuals who were seeking one or more medical interven-tions in order to bring their sexual characteristics in greater alignment with their gender identity. However, these individuals were often placed in a posi-tion of having to prove to the medical practitioner their gender identities—a test-taking set not conducive to the clear and direct manifestation of partici-pants’ psychological situation (Lev, 2005).

As the recognition emerged of the distinctiveness of gender identity as one of the core identity facets and a natural type of diversity among people (Borden, 2015; World Professional Association for Transgender Health, 2010), investiga-tors have undertaken research that holds great promise in aiding the psycholog-ical assessor in his or her work. A first line of investigation (Institute of Medicine [IOM], 2011) entails the inclusion of gender identity in some of the large-scale national studies, an effort that will enable the construction of a much more detailed picture of the transgender population. This work holds the promise of helping assessors to understand some of the physical and psychological risks that accompany this status and its barriers to obtaining care. A limitation of most existing studies is that they fail to distinguish among subgroups of transgender individuals, such as individuals identifying as male-to-female versus female-to-male, or generalize from one subgroup to the other (Namaste, 2000). Assessors must be aware that extant research is fairly broad brush, but they should none-theless be sensitive to how subgroup differences may make a difference in a client’s difficulties, coping possibilities, and so on.

The second line is the study of the development of a sense of gender identity and the factors influencing the coming-out process (e.g., Moller, Schreier, Li, & Romer, 2009). This information assists the assessor in situating his or her child or adolescent client within his or her reference group. For example, Moller et

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al.’s finding that today’s generation of children typically come out in childhood or preadolescence may be useful for the assessor working with parents who assume that their eight-year-old child’s declared gender identity could not pos-sibly be trustworthy.

A third line of investigation is the study, through both quantitative and qualita-tive methodologies, of the various factors that are associated with good adjustment in a transgender and gender nonconforming population. For example, Singh and McKleroy (2011) conducted a phenomenological and feminist investigation of 11 transgender people of color—individuals coping with at least double minority statuses—who had experienced traumatic life events in relation to stigma. They found that among the factors that fostered their resilience were pride in one’s gender identity and racial identity, involving themselves with activist groups of transgender individuals of color, and immersion in spirituality. Connected to this line of research are those studies that demonstrate the effects of healthcare (e.g., sexual reassignment surgery or cross-sex hormones) that assists with the transi-tioning process (e.g., Johansson, Sundbom, Hojerback, & Bodlund, 2009; Meier, 2013). For example, Meier found that female-to-male transexuals experienced a decrease in gender dysphoria over their initial year of taking testosterone.

These lines of research will be useful to the psychological assessor who encounters gender-variant clients who have as great a range of concerns and presenting issues as any other group. Assessors are sometimes asked to evaluate the client’s readiness for gender transition treatment, particularly surgery (Cool-hart, Provancher, Hager, & Wang, 2008). Providing guidance for this type of assessment is beyond the scope of this text. However, the reader can obtain an introduction to it through Stephen Finn’s Chapter 21 in this volume.

Identity Domain: Sexual Orientation

On December 15, 1973, the ApA declassified homosexuality as a form of men-tal disorder, and in 1975, the APA followed suit (Garnets, Hancock, Cochran, Goodchilds, & Peplau, 1991). Prior to those reversals, mental health disciplines regarded departures from heterosexuality as forms of psychopathology. The very early roots of the categorization of homosexuality as a non-normal condition were those religions that saw it as a form of immorality, and the behaviors associ-ated with it were broadly termed sodomy (Jordan, 1998). However, in the 1800s, some scientists such as Ulrichs pursued the study of male inverts, males who had the qualities of men and women but who were attracted to women (IOM, 2011). The German psychologist Benkert supplanted invert with homosexual (Pickett, 2011), a term adopted by Freud, who had a major role in understanding this area of identity. Freud was ambivalent about the status of homosexuality. On the one hand, in his Three Essays on the Theory of Sexuality, Freud saw homosexuality as a part of all human development and wrote that all human beings are capable of a homosexual5 object choice, and have made such choices unconsciously (Freud, 1905). On the other hand, Freud saw a heterosexual object choice as the apex

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of human development (Robinson, 2001). Despite this position, he did not see homosexuality as psychopathology, and in fact, saw the repression of homosex-ual urges as one forerunner of neurosis.

Later psychoanalysts such as Rado (1969) advanced the notion of homosex-uality qua abnormality saying that homosexuality was the result of disturbances in children’s relationships with their parents. Studies showing manifestations of symptoms in a homosexual sample, difficulties in their upbringing, or both were seen as evidence of this point. For example, Bieber (1962) developed a 27-item questionnaire that tapped aspects of the participants’ childhoods. The question-naire was completed by clients’ analysts, who reported more disturbances in the childhoods of their homosexual versus heterosexual analysands. Bieber con-cluded that homosexuality emerged as a compensatory adaptation for difficul-ties experienced in the child’s relationships with parents, siblings, and same-sex peers. Studies such as those conducted by Bieber and others were criticized for tapping into primarily clinical populations or settings where we might expect an overrepresentation of individuals with psychological difficulties (Gonsiorek, 1991; Hancock & Greenspan, 2010). This critique, the increased awareness that psychological problems exhibited by homosexual individuals are likely due to prejudice, and the burgeoning realization that the prevalence of psychological problems in a group does not mean that the group itself is pathological (no more than it is pathological to be male or female, black or white, rich or poor) led to a shift toward seeing sexual orientation as a normal variation in human relationships. Notably, contributing to this emerging awareness were the Ror-schach findings of Hooker (1958), who demonstrated that homosexual males were as well-adjusted as heterosexual males.

As gay/lesbian/bisexuality came to be regarded within the mental health professions as a type of identity rather than a disease category, the research effort on lesbian, gay men, and bisexual individual (LGB) populations flagged. Mul-tiple factors may be responsible for this neglect, among which are three. First, this avoidance may have been due to the association of research on the possible mental health issues of this population with the pathologizing of diverse sex-ual orientations (Meyer, 2003). Second, this near neglect may be due, as Ste-phen Morin noted in his 1977 American Psychologist article, to a heterosexist bias within psychology that is derivative of a broader societal bias. In 1991, Herek, Kimmel, Amaro, and Melton wrote an article summarizing the work of the APA Task Force on Non-Heterosexist Research. Like Morin, they noted that the gay, lesbian, and bisexual individuals continued to be ignored in the research litera-ture, and what existed reflected the broader heterosexist orientation of society. Third, the paucity of research may be due to internalized stigma of heterosexual researchers, who are apprehensive about their own sexual orientations being challenged.

Just as in all other areas associated with mental health, the research on psy-chological assessment and sexual orientation has been quite minimal. Two types of exploration would be particularly helpful to the advancement of assessors’

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ability to provide psychological assessments that do justice to the multiple iden-tities of the client. The first is to learn to what extent the gender/sex identity facets of the client relate to the client’s performance across the methods of the multi-method approach, both in isolation and in interaction. That these identity aspects may influence a client’s performance is suggested by findings in other areas of research that demonstrate interactions between different gender and sexual characteristics. For example, Steffens, Landmann, and Mecklenbräuker (2013) examined the interactive effects of gender with sexual orientation on facial recognition, an important everyday activity. Past research has found that women show more accurate facial recognition of female faces over male faces, whereas for men, no conclusive trend has been detected. However, sexual ori-entation was shown by these investigators to be a moderating variable, which clarified trends. Whereas heterosexual women, heterosexual men, and lesbians showed more accurate facial recognition of female faces, gay men showed more accurate recognition of male faces. These patterns suggest that different gender variables interact on those psychological tests that engage such processes as per-ceptual recognition.

Also missing from the literature are strong qualitative investigations look-ing at how the assessor’s and client’s sexual orientations influence their experi-ence of one another and of the assessment process: For both gender and sexual minorities, we need to know how the assessment is experienced. What aspects promote openness? What activities evoke stereotype threat—the anxiety that the assessment is requiring performance in an area in which the client is expected to be weak or strong? How do the assessor’s characteristics (e.g., whether he or she appears to the client to be heterosexual, gay, lesbian, or bisexual) influence the client? What assessor behaviors enable the client to feel that his or her strengths are recognized? Are certain types of feedback more helpful than others? In con-ducting such research, the investigator does well to appreciate the tremendous heterogeneity among sexual minorities (Herek et al., 1991). Furthermore, as we discuss in Chapter 2, factors such as race, ethnicity, and socioeconomic status are likely to interact with sexual orientation in shaping a person’s experience within the psychological assessment.

Even though the research on psychological assessment and sexual orienta-tion is quite limited, still, research initiatives are well underway in areas con-cerning sexual orientation that are relevant to psychological assessment. First, a considerable accrual of findings has occurred in the last decade on prevalence rates of various symptom patterns in individuals of different sexual orientations. This research is summarized in a subsequent subsection of this section. Second, we know some of the factors influencing the emergence of certain symptom patterns, such as the presence of particular types of stigma. Third, protective fac-tors such as spiritual and religious coping (e.g., Mizock & Mueser, 2014) have been identified. Fourth, the developmental stages of sexual orientation aware-ness, how these stages map onto broader developmental trajectories such as that described by Erikson (1968), and the vicissitudes of well-being in those who are

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nonheterosexual versus heterosexual have been outlined. For example, Becker, Cortina, Tsai, and Eccles (2014) conducted a longitudinal study of individuals who were followed from ages 12 to 18 via five waves of data collection. They found, for example, that depressive symptoms and social alienation declined from ages 16 to 28, and suicidal ideation declined from ages 20 to 28. However, alcohol consumption increased with age. Although nonheterosexual individuals experienced greater depression and suicidal symptoms in adolescence than did heterosexual individuals, the scores converged in early adulthood. Interestingly, self-esteem for the two groups did not differ, although women overall exhibited lower self-esteem than men.

Future research on sexual orientation and psychological assessment is useful only to the extent that adequate methodological rigor characterizes the studies on its status as a moderating or mediating variable. The little past research that has been conducted has been characterized by a set of methodological prob-lems. First, a major problem is the difficulty conducting research with probabil-ity samples wherein the sample obtained is representative of the population at large. For example, in a probability sample for a study on depression, members of the gay community would be sampled in correspondence to their proportion in the population, and a cross-section of gay individuals would be assessed for depression. This approach contrasts with a nonprobability sample in which, for example, individuals who frequent gay bars are interviewed. These individuals may or may not represent a cross-section of the gay population. Fortunately, recently, national surveys are soliciting some information in relation to sexual attraction or behavior (IOM, 2011), and secondary analyses can be performed on this data (e.g., see Cochran, Sullivan, & Mays, 2003). However, information on a variety of topics, including that related to sexual and gender identity sta-tuses, is generally unrequested (Mayer et al., 2008). One recent encouraging finding is that when sexual orientation information is requested, respondents are increasingly providing it (Jans et al., 2015).

Second, a problem identified by Cochran (2001) is the use of sexual behav-iors as a proxy for sexual orientation. For example, a teen who experiments with sexual relations with other male and female adolescents might be inappropri-ately characterized as bisexual when, ultimately, a designation of homosexual was more appropriate.

Third, research is biased in the direction of looking at the ends of the con-tinuum of sexual orientation (i.e., wholly heterosexual or homosexual) while missing the many other points in between (Van Lankveld, 2014). Fourth, an unusually large, well-designed group of studies go unpublished. Bartos, Berger, and Hegarty (2014) examined a pool of published and unpublished papers on the topic of sexual prejudice. They found in their corpus of studies an unusually large number of unpublished papers. The unpublished papers were largely dis-sertations of high quality. The investigators looked at a number of hypotheses to explain this phenomenon, but the one that seemed to fit the data best was the operation of courtesy stigma (Goffman, 1963), the notion that researchers by

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association with their topics would be subjected to stigma. Courtesy stigma has been observed in a sample of front-line service providers whose work with gen-der and sexual minorities led them to be accorded reduced resources to perform their jobs (Phillips, Benoit, Hallgrimsdottir, & Vallance, 2012). The extent to which courtesy stigma limits the flow of research merits further study through a method that would directly tap researchers’ expectations about the social response to their work and their decision-making attached to these expectations (e.g., to submit or withhold a manuscript).

Psychopathology and Diagnostic Issues

In the last 15 years, the attention to LGB status and the diagnosis of men-tal health conditions has increased greatly, while research on the prevalence of psychological problems in transgender individuals is far more limited (IOM, 2011). Recall that Meyer’s (2003) Minority Stress Model holds that gender and sexual minority groups would show greater psychological difficulties than the broader population, a prediction that has generally been confirmed. Over-all, research on LGB individuals has suggested that sexual orientation minority status can be a risk factor for some psychological difficulties such as depression (e.g., Fergusson, Horwood, Ridder, & Beautrais, 2005; Meyer, 2013). According to Meyer’s (2003) meta-analysis, LGB persons are three times as likely as heter-osexual persons to warrant a current mood disorder diagnosis. Cochran (2001) reports that LGB individuals have poorer health outcomes than do heterosexual individuals, and Blosnich et al. (2014) found that all sexual minority groups were more likely than their heterosexual counterparts to be smokers. They are also one and a half times as likely to suffer from an anxiety or substance-related disorder (Cochran, Sullivan, & Mays, 2003). Population surveys in the United States and the United Kingdom indicate that they are more likely to be diag-nosed with a psychotic disorder than is the heterosexual population (Bolton & Sareen, 2011; Chakraborty, McManus, Brugha, Bebbington, & King, 2011). Although the risk of some types of psychopathology is greater in a population with diverse sexual orientations, research has also found that the majority of individuals with diverse sexual orientations do not meet the criteria for a men-tal disorder (Cochran, 2001). It would behoove the psychological assessor, who is typically asked to provide a diagnostic formulation, to be aware of the research that has accrued in this area. Recognizing, for example, that sexual and gender minorities are afflicted with particular types of stigma enables the assessor to explore whether stigma is one root of the distress of which the psychological assessment provides evidence.

Studies that have found a greater risk for psychological problems in sexual minority groups bear replication given the rapidity of changes in societal atti-tudes toward these groups. Certainly, society’s increased acceptance of these forms of diversity has some potential for ameliorating the negative effects of prejudice. Still, societal support for changes in social policy often precedes

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change at an individual level. As Herek (2009) explains, members of the public may support particular changes in order to embrace the notion of themselves as tolerant, enlightened, and progressive. However, on an individual level, when faced with personal decision-making, less tolerant attitudes are often in evi-dence and continue to produce the ill effects of stigmatization.

Bias in Assessing and Diagnosing

Clients are always regarded through some perspective. A perspective may be created by (a) the capabilities of an instrument to reveal particular phenomena and not others, (b) the theoretical orientation of the assessor/diagnostician, or even (c) the purpose for which an assessment is done. When a lens employed in an assessment results in privileging one group or another or when it leads to a more accurate view of one group over another with respect to the problem at hand, then the phenomenon is correctly deemed as bias. Bias is a negative phenomenon in its own right, but it can lead to other negative consequences: incorrect case conceptualizations, misdiagnoses, and misguided recommenda-tions. When the manifestation of bias is evident to clients, it lessens the regard they have for the value of psychological assessment.

The types of bias that can enter into a diagnosis and psychological assessment are various. In an important article on this topic, Hartung and Widiger (1998) point out that whereas gender differences occur in most psychiatric diagnoses, differential prevalence rates could be ascribable—at least in part—to various sources of error. They point out two sources of error in particular: biased sam-pling and biases in the construction of the diagnostic categories. Biased sam-pling occurs when individuals are disproportionately sampled, a phenomenon that can readily occur in clinical settings wherein different subgroups have dif-ferent levels of willingness to seek treatment, divulge difficulties, or both. Har-tung and Widiger give the example that men are far more likely than women to present for treatment for gambling problems. In contrast, epidemiological find-ings from community samples report no difference between men and women. One factor may be the possibly greater stigma attached to gambling for women than for men. For other disorders, sampling bias may take the form of women being overrepresented. For example, women may tolerate the acknowledg-ment of depression more than men, a difference that may contribute to the greater number of depressed women in clinical settings than depressed men. This self-presentation interpretation is consistent with a body of developmental research showing consistent differences in the parenting and education of boys versus girls, wherein boys are discouraged from manifesting reactions that are at odds with the presentation of self-sufficiency (Clearfield & Nelson, 2006; Dukmak, 2010; Martin, 1998).

The second type of gender bias concerns the diagnostic criteria themselves (Hartung & Widiger, 1998). Greater access to one gender may lead to the estab-lishment of diagnostic criteria based upon how that gender manifests a form of

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disturbance. If women, for example, are studied disproportionately to men, then diagnostic criteria may be established based upon how women behave, think, and feel when depressed. If diagnostic criteria are keyed to how women expe-rience depression, then they may be insensitive to men’s depression, resulting in men being underdiagnosed for this condition.

These same factors can operate in the assessment process as well. Instruments can be based disproportionately on male and female samples. For example, Baker and Mason (2010) point out that the Psychopathy Checklist—Revised (PCL-R; Hare, 2003) was originally developed through testing male prisoners who were judged to be psychopathic. Subsequent work has been needed to establish its diagnostic accuracy with women. Such research, particularly on dif-ferent age groups such as adolescents (e.g., Kosson et al.’s study on the adolescent version, 2013), is ongoing.

The types of biases thus far described are those that concern the diagnos-tic systems and assessment tools themselves. However, other forms of bias can emerge within a client’s assessment process. For example, a particular client may fail to express his or her capabilities because of the influence of a social stereo-type on how that client perceives a given task. One of the authors introduced the Arithmetic subtest to an adolescent girl. In contrast to her rather neutral reaction to the other tasks, she immediately exclaimed, “I can’t do this kind of thing!” Indeed, she went on to perform relatively poorly on this subtest. One factor that may have influenced her performance was stereotype threat—a sense that this kind of activity is not one in which members of her gender typically excel (APA, 2007). Such a contributor could be identified through the assessor’s sensitivity to its possible presence and discussion with the clients of its possible effects. Other test data might also provide corroboration for its presence. Other biases may come from the assessor him and herself, and these will be described in the subsequent section.

Sexual orientation and gender identity are areas of the self not immune to the kinds of biases previously outlined in relation to gender. Are these individ-uals included in adequate numbers in standardization samples? Stigma factors may lead to their underrepresentation in large-scale data collection projects and in particular clinical settings. Although we know about comparative inci-dence of various types of disorders based on gender (even if the interpretation is ambiguous), this information is far less available for sexual orientation and gen-der. Psychological instruments, too, have been standardized primarily on heter-osexual and cisgendered populations. Future research that provides evidence of whether sexual and gender minorities perform differently than cisgendered and heterosexual individuals would be extremely useful.

An example of the type of study that is needed is Birnholz and Young’s (2012) investigation of the Center for Epidemiological Studies Depression Scale (CES-D; Radloff, 1977), a 20-item self-report instrument with robust psycho-metric properties. The instrument was administered online to 273 women—45% heterosexual, 29% bisexual, and 25% lesbian. The investigators were able to

24


demonstrate minimal bias in the instrument, with the exception of a single item, “Feeling that others dislike you.” This item figured in the severity of depres-sion more heavily for bisexual than for lesbian women. The authors saw their results as supporting the usefulness of this instrument for women who are sexual minorities, but they cautioned that researchers and clinicians should remain alert to subtle differences in the importance of particular items for assessing severity of depression.

Stages of the Psychological Assessment

Research on the nexus of gender and sexual identity and psychological assess-ment is still limited. Despite the absence of a robust research base in this area, assessors are called upon to render helpful services to clients regardless of their identity status in these core areas. In this section, we examine the stages of a psychological assessment and consider how issues of gender and sex—both as presented and experienced by the assessor and the client—may shape the process. We consider nine stages: meeting the client, conducting the interview, framing the problem, choosing the test instruments, administering the tasks, coding, interpretation and integration, developing recommendations, and feed-back (see Table 1.2).

Meeting the Client

Whether the first contact between the assessor and client is on the telephone or in person, that assessor conveys information to the client that will give the client some basis of determining what level of trust should be placed in the assessor. To the extent that the assessor evinces respectfulness of the client’s per-son, the client will feel able to be open with the assessor and thereby provide the assessor with the information he or she needs to understand the client. One way in which the assessor demonstrates respectfulness is refraining from making assumptions about the client’s status on any identity variable until the client has shared that information with the assessor. The assessor should embrace and convey an agnostic attitude, even if third parties have shared with the assessor defining information about the client.

For example, suppose the client’s therapist has told the assessor that the client is having marital conflict with her husband. Although this communication may lead the assessor to believe that the client is heterosexual, such an inference may prove to be wrong. The client may be homosexual, bisexual, primarily heter-osexual, or asexual. If the assessor communicates a classification to the client without the latter having an opportunity to categorize herself, that assessor may foreclose on the opportunity to learn something important about the client. The assessor may also damage the rapport to an extent that makes the assess-ment a mere exercise. Once that client does self-identify, it is crucial that the assessor use the appropriate pronoun to refer to that person. For example, even

Tabl

e 1.

2 St

ages

of t

he P

sych

olog

ical

Ass

essm

ent

Stag

eA

sses

sor P

itfal

lsH

elpf

ul A

sses

sor A

ttitu

des

and

Beh

avio

rs

Mee

ting

the

clie

nt•

Man

ifest

ing

exce

ssiv

e an

xiet

y in

mee

ting

the

clie

nt b

ecau

se

of a

n un

fam

iliar

ity w

ith t

he c

lient

’s id

entit

y st

atus

.•

Mak

ing

cisg

ende

red

or h

eter

osex

ist a

ssum

ptio

ns a

bout

the

cl

ient

’s st

atus

on

an id

entit

y di

men

sion.

• A

ddre

ssin

g th

e pe

rson

in a

ccor

danc

e w

ith h

is or

her

ge

nder

iden

tity.

• C

onfu

sing

sexu

al o

rien

tatio

n w

ith g

ende

r id

entit

y.•

Ass

umin

g th

at w

hen

the

clie

nt s

ays

he/s

he la

cks

sexu

al

attr

actio

n to

any

one ,

tha

t th

e cl

ient

sim

ply

has

not

figur

ed

out

wha

t hi

s or

her

sex

ual o

rien

tatio

n is.

• Pr

ovid

ing

an a

tmos

pher

e in

whi

ch t

he c

lient

is a

b le

to

iden

tify

him

or

hers

elf o

n im

port

ant

iden

tity

dim

ensio

ns.

• R

elat

ing

to t

he c

lient

in a

rel

axed

but

res

pect

ful m

anne

r.

Con

duct

ing

the

inte

rvie

w•

Giv

ing

evid

ence

of m

isund

erst

andi

ng o

f the

clie

nt’ s

lifes

tyle

.

• Fa

iling

to

ask

criti

cal q

uest

ions

out

of l

ack

of k

now

ledg

e ab

out

an a

rea

of d

iver

sity.

• U

nkno

win

gly

com

mitt

ing

mic

roag

gres

sions

suc

h as

co

nvey

ing

judg

men

t ab

out

the

clie

nt’s

lifes

tyle

.

• C

laim

ing

to b

e an

exp

ert

abou

t th

e cl

ient

’s id

entit

y st

atus

.•

Upo

n di

scov

erin

g el

emen

ts in

the

case

(in

clud

ing

thos

e re

late

d to

gen

der

and

sexu

ality

) th

at a

re b

eyon

d th

e as

sess

or’s

know

ledg

e or

ski

ll se

t, fa

iling

to r

emed

y th

is pr

oble

m.

• R

ecog

nizi

ng g

aps

in k

now

ledg

e an

d at

tem

ptin

g to

rec

tify

them

.•

Bei

ng s

uffic

ient

ly in

form

ed a

bout

diff

eren

t ar

eas

of

dive

rsity

to

appr

ecia

te w

hat

core

are

as m

ust

be c

over

ed.

• R

ecog

nizi

ng t

hat

no r

elat

ions

hip

is im

mun

e to

m

icro

aggr

essio

ns, e

ngag

e in

sel

f-m

onito

ring

and

clie

nt

obse

rvat

ion

to d

etec

t th

em, a

nd a

ckno

wle

dgin

g th

em

whe

n th

ey o

ccur

.•

Obt

aini

ng c

onsu

ltatio

n an

d su

perv

ision

for

part

s of

a c

ase

that

may

be

unfa

mili

ar t

o th

e as

sess

or.

(Con

tinue

d )

Stag

eA

sses

sor P

itfal

lsH

elpf

ul A

sses

sor A

ttitu

des

and

Beh

avio

rs

Fram

ing

the

prob

lem

• In

suffi

cien

tly e

ngag

ing

the

clie

nt in

a c

olla

bora

tion

in

prob

lem

form

ulat

ion.

• R

ecog

nizi

ng t

hat

pow

er d

iffer

entia

ls in

itial

ly m

ay h

inde

r th

e cl

ient

’s en

gage

men

t in

pro

blem

form

ulat

ion

and

supp

ortin

g th

e cl

ient

in o

verc

omin

g re

sista

nce

to a

mor

e ac

tive

post

ure.

• K

now

ing

that

all

part

ies

(incl

udin

g th

ird

part

ies)

can

al

low

bia

s to

col

or o

bser

vatio

ns.

Cho

osin

g th

e in

stru

men

ts•

Obt

aini

ng o

nly

a lim

ited

pers

pect

ive

on t

he c

lient

by

negl

ectin

g to

use

mul

tiple

met

hods

in c

olle

ctin

g da

ta.

• In

clud

ing

inst

rum

ents

tha

t ha

ve g

ende

r or

het

eros

exist

bia

s.•

Faili

ng t

o us

e na

rrow

band

inst

rum

ents

tha

t w

ould

ena

ble

the

asse

ssor

to

obta

in h

ighl

y sp

ecifi

c in

form

atio

n pe

rtai

ning

to

gen

der

and

sexu

al id

entit

y iss

ues.

• U

sing

a m

ulti-

met

hod

appr

oach

.•

Sele

ctin

g in

stru

men

ts w

ith li

ttle

or

no b

ias.

• U

sing

a fle

xibl

e ba

tter

y ap

proa

ch w

here

in in

stru

men

ts

can

be in

trod

uced

as

the

emer

ging

dat

a re

veal

s th

eir

need

.

Adm

inist

erin

g th

e ta

sks

• E

xhib

iting

beh

avio

r ch

arac

teri

zed

by a

loof

ness

and

lack

of

war

mth

.•

Adm

inist

erin

g ite

ms

with

wor

ding

tha

t is

cisg

ende

red

and

hete

rose

xist

.•

Ref

usin

g to

att

end

to s

ubtle

ties

in t

he c

lient

’s re

actio

ns a

s ta

sks

are

bein

g ad

min

ister

ed o

r to

exp

lore

the

ir s

igni

fican

ce.

• T

hrou

ghou

t ad

min

ister

ing

the

task

s, co

n vey

ing

war

mth

an

d re

late

dnes

s.•

Ack

now

ledg

ing

whe

n th

e w

ordi

ng o

f par

ticul

ar it

ems

for

inst

rum

ents

use

d m

ay m

ake

inap

prop

riat

e as

sum

ptio

ns

abou

t ge

nder

or

sex.

• K

eyin

g in

to t

he c

lient

’s re

actio

ns t

o th

e va

riou

s st

imul

i of

the

task

s.C

odin

g•

Faili

ng t

o re

cogn

ize

how

one

’s pr

esup

posit

ions

may

in

fluen

ce t

he n

uanc

es o

f cod

ing.

• Fa

iling

to

unde

rsta

nd t

he id

entit

y su

bcul

ture

’s id

iom

s an

d th

ereb

y m

akin

g sc

orin

g m

istak

es.

• B

eing

sel

f-aw

are

to p

reve

nt b

iase

s fr

om in

fluen

cing

ap

prai

sal o

f clie

nt’s

perf

orm

ance

.•

Stri

ving

to

lear

n ab

out

the

clie

nt’ s

cultu

re, i

nclu

ding

the

id

iom

s th

at m

ay b

e pa

rt o

f the

tes

t m

ater

ial.

Tabl

e 1.

2 (C

ontin

ued)

Stag

eA

sses

sor P

itfal

lsH

elpf

ul A

sses

sor A

ttitu

des

and

Beh

avio

rs

Inte

rpre

tatio

n an

d in

tegr

atio

n of

da

ta

• N

egle

ctin

g to

con

sider

how

the

clie

nt’s

test

-tak

ing

set

base

d up

on e

xper

ienc

es w

ith s

tigm

a sh

aped

the

kin

ds o

f res

pons

es

the

clie

nt p

rodu

ced.

• C

onte

xtua

lizin

g th

e te

st d

ata

in t

erm

s of

the

clie

nt’s

test

-ta

king

set

.•

Bei

ng a

war

e of

ass

esso

r bi

ases

whe

n ex

amin

ing

the

test

da

ta.

• Fa

iling

to

give

ade

quat

e ac

know

ledg

men

t to

the

rea

l st

ress

ors

in t

he c

lient

’s lif

e an

d pl

acin

g ex

cess

ive

wei

ght

upon

the

clie

nt’s

defe

nsiv

enes

s.•

Allo

win

g th

e cl

ient

’s di

v ers

ity s

tatu

s to

ove

rsha

dow

the

dat

a.

• G

ivin

g ad

equa

te w

eigh

t to

the

con

trib

utio

n of

stig

ma

in

unde

rsta

ndin

g th

e cl

ient

’s di

fficu

lties

.

Dev

elop

ing

reco

mm

enda

tions

• Fa

iling

to

colla

bora

te w

ith t

he c

lient

in id

entif

ying

cop

ing

stra

tegi

es fo

r re

spon

ding

to

enac

ted

stig

ma

spec

ific

to t

he

clie

nt’s

iden

tity .

• Ig

nori

ng t

he s

uppo

rt s

truc

ture

s in

the

clie

nt’s

com

mun

ities

.•

Faili

ng t

o pr

ovid

e re

com

men

datio

ns t

hat

tak e

into

acc

ount

th

e re

aliti

es o

f the

clie

nt’s

situa

tion.

• E

duca

ting

him

or

hers

elf o

n th

e ki

nds

of c

opin

g st

rate

gies

th

at h

ave

been

foun

d to

be

effe

ctiv

e w

ith s

peci

fic t

ypes

of

stig

ma

whe

n w

orki

ng w

ith m

argi

naliz

ed g

roup

s.•

Lear

ning

abo

ut t

he c

lient

’s co

mm

unity

and

wha

t r e

sour

ces

are

avai

labl

e to

him

or

her.

• D

evel

opin

g a

real

istic

rat

her

than

idea

listic

set

of

reco

mm

enda

tions

.Pr

ovid

ing

feed

back

• R

eact

ivat

ing

pow

er d

iffer

entia

ls th

at t

he c

lient

exp

erie

nces

ou

tsid

e of

the

ass

essm

ent

insid

e by

tak

ing

an a

utho

rita

tive

role

in t

he fe

edba

ck s

essio

n.

• C

reat

ing

a fe

edba

ck s

essio

n th

at is

who

lly c

olla

bora

tive,

co

ntin

ually

tap

ping

the

clie

nt’s

expe

rtise

abo

ut h

im o

r he

rsel

f, in

clud

ing

the

clie

nt’s

iden

tity

stat

us.

28


though the client may appear to the assessor to be female, if that client identifies as male, masculine pronouns are appropriate (APA, 2002).

Conducting the Interview

The interview is important in that through the assessor’s communication of interest in and empathy for the client during the interview, the assessor forges a therapeutic alliance with the client that bolsters the client’s motivation to participate collaboratively and openly. The interview is important, too, for the opportunity it provides the assessor to obtain essential information about the client, including information related to the client’s identity in the domains of gender and sexuality. In order for the potential of the interview to be realized and the assessment as a whole to be successfully launched, the assessor must exhibit an affirmative stance toward all aspects of the client’s identity, includ-ing sexual orientation and gender identity (Bieschke, Perez, & DeBord, 2007; Chazin & Klugman, 2014). Such affirmation is conveyed by an unconditionally accepting attitude and a sense of ease and confidence in engaging in the inter-view and in pursuing all steps of the assessment process.

Particularly with gender and sexual minority clients, the assessor may encoun-ter obstacles to realizing the potential of the interview. The forms the client completes may convey bias (Hwang & Danoff-Burg, 2010) or the assessor may make heterosexist assumptions. A second obstacle is the conveyance of major misunderstandings about the lifestyle of the gender- or sexual-variant client. For example, the assessor might assume that because the lesbian client is not married, she is not in a relationship with a degree of commitment commensurate with a marital bond. In the face of such errors, the client understandably wonders how the assessor could achieve an accurate picture of his or her life given that the assessor is unknowing about fundamental aspects of her core identities.

A third obstacle is conveyed by the following example:

Martin came to an assessment to gain insight into his constant sense of malaise. The student assessor, Ralph, found that he had an intro-jective depression characterized by constant self-fault-finding. Martin had mentioned that he was gay during the clinical interview. Although the assessor briefly asked about his family’s reactions to Martin’s coming-out process, the assessor did not inquire how Martin felt about coming out. The assessor also failed to open a line of inquiry that might have revealed internalized homophobia on Martin’s part. When Ralph’s supervisor asked Ralph about this gap, he revealed his own discomfort about pursuing this discussion and pointed out that nothing in his doctoral training had prepared him to have it.

The truth is unfortunate: Although the majority of clinical and counseling programs today provide students with training on LGB issues (Sherry,

29


Whilde, & Patton, 2005), many midcareer and senior assessors who are in practice today have received little by way of supervision or graduate training that has assisted them in providing effective assessment services to individuals who represent diversities of various sorts, including gender and sexual diver-sity. In fact, Ralph was fortunate in having a supervisor who had an attune-ment to Ralph’s discomfort so that it could be explored and, hopefully, not be an obstacle in subsequent assessments.

Some assessors may respond in a very different way from Ralph. An assessor might express disproportionate interest in any facet that establishes the client as a minority because it is intriguing or entertaining to the assessor. A variation on this problem is when the assessor assumes that whatever difficulty the client has must in some way be connected to his or her sexual orientation or gender identity (Garnets, Hancock, Cochran, Goodchilds, & Peplau, 1991).

Still another obstacle is the conveyance of judgment about the client’s lifestyle:

During the clinical interview, an assessor asked about aspects of the client’s social life. She established that the client, a gay man, was unhappy that his intimate relationships lacked longevity. In summa-rizing the client’s longings, the assessor implied that what the client wanted was a monogamous long-term relationship. In fact, the client never talked about a wish for monogamy. The therapist’s addition of this element communicated to the client that, in her view, an expec-tation of monogamy was normal and that he was wrong to want something else.

Within assessment, the power differential between assessor and client typi-cally makes it extremely difficult for the latter to acknowledge a microag-gression. However, what the client can do, consciously or unconsciously, is adopt a stance of self-protectiveness that makes accomplishing whatever goals have been established for the assessment well nigh impossible. Even the best- intended assessor may not avoid the commitment of microaggressions. For many clients, the effects lie not in the commission as much as the handling of the breach. Assessors who recognize the limits of their awareness of others and their own capacities to make mistakes are on the lookout for changes in the client’s behavior that may bespeak of an assessor microaggression.

In the interview, the assessor may learn of certain aspects of the client’s iden-tities that were not evident in the initial contact. These aspects may be ones with which the assessor has little familiarity. For example, the assessor may learn that the client is a trans person, although this fact was not shared at the time of the initial telephone conversation. At this juncture, the assessor is confronted with the ethical quandary of whether to proceed with the case. Assessors have an eth-ical obligation to recognize the bounds of their competence (APA, 2002). One important step would be securing a consultation from another psychological

30


assessor who has the knowledge base to guide the assessor through the new terri-tory. If the assessor ascertains that he or she is not equipped to move forward with the case, then an obligation remains to assist the client in obtaining effective ser-vices. On the other hand, if the assessor upon consultation and reflection believes that moving forward is feasible, then obtaining supervision on areas of unfamili-arity will help the assessor to provide the best possible services to the client.

Framing the Problem

The pioneers in collaborative and Therapeutic Assessment (Finn, 2007; Fischer, 1994) have helped the assessment community to recognize that although the referral source and the assessor can play important roles in defining the prob-lem, the client—in most contexts—must have a crucial say in identifying those questions that the assessment is designed to answer. Individuals who have expe-rienced stigma or a lack of power in relationships at the outset of the assessment process may be reluctant to enter into an assessment alliance. Internalized stigma (Herek, 2009) may allow the assessor to accept unwittingly the client’s hesitancy to participate actively in framing the purpose of the assessment, a hesitancy that can then pervade the entire assessment process. In fact, many clients begin an assessment with only a vague sense of what the assessment can accomplish. It often requires considerable effort on the part of the assessor to engage the client in a genuine collaboration (Fischer, 1994). That effort can vary based upon the assessor’s unconscious assumptions about societally based power dynamics.

Static Versus Dynamic Questions

Regarding the client’s questions as dynamic is helpful. As Fischer notes,

clarification of the referral is not . . . a once-and-for-all accomplishment. Upon meeting a stranger (the assessor), the client is not yet sure how much and in what ways to share. Moreover, early sharing typically is in the form of what the client knows explicitly. As a relationship develops, the client becomes aware of additional or deeper concerns.

(1994, p. 67)

The identity aspects of gender and sex can be ones that the client is willing to broach only after having achieved some familiarity with, and trust in, the asses-sor. The assessor, then, must have openness to revising his or her understanding of what the client may wish to garner from the assessment:

An assessor encountered a teenage girl who came to the assessment ostensibly to discover why she was feeling anxious. Over the course of the assessment, her trust in the assessor grew such that eventually she could reveal to her that she was a lesbian. However, she revealed

31


that only her parents and a few other adults knew this fact. It emerged that she was contemplating coming out of the closet to her friends but wondered if she would fall apart if some of her friends responded unfavorably. This worry was connected to the anxiety that originally brought her to the assessment. However, the revelation somewhat refocused the work on helping the client recognize her own resources, the circumstances that might make it difficult to tap into them, and the possible coping strategies she could summon to enable her to gain access to those resources.

Third-Party Referrals

Third-party referral sources typically have their own questions that serve as the basis for the referral. The position of the assessor can be a delicate one in how the third-party referral source’s perspective is incorporated into the planning of the assessment. In some cases, the third party may define the question in a way that draws upon stereotypic notions about men and women, sexual orientations, and gender identity:

An employer referred a female employee for a psychological assess-ment. He indicated that she was a member of a research team and always seemed to strive for control. She interrupted her co- workers when they were speaking and often failed to incorporate their ideas into her thinking. The employer asked whether psychotherapy could help her to enter fully in the give-and-take of work relationships. When the employee was interviewed, she noted that the other researchers were men. She believed that she was given less latitude in her responses and that what would be seen as appropriate from her male colleagues was viewed as undue aggressiveness from her. For her part, she wanted to know how she could be a vital and active member of the team and true to herself, without alienating others.

Were the assessor to embrace the perspective of the assessee or the employer to the exclusion of the other party, the assessment may not fulfill its potential for elucidating a conflictual situation. Assessors should be cognizant of the possi-bility of bias. However, they should not assume it in the absence of evidence.

Choosing the Instruments

The assessor who seeks to be responsive to clients’ multiple identities must pose to her or himself a number of questions when approaching the task of selecting assessment methods. The first question is how the examiner can select instru-ments in a way that best satisfies the gold standard of psychological assessment, the multi-method approach, in a way that best serves the needs of clients who

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are diverse in gender and sexuality. The multi-method approach is the gold standard of psychological assessment because it recognizes that the information culled from any one method is inherently limited (Campbell & Fiske, 1959; Mihura & Graceffo, 2014). Among the tools that assessors use to characterize personality are introspective methods in which the client offers self- descriptive comments as in the clinical interview or endorses descriptive statements as in self-report tests such as the Personality Assessment Inventory (PAI) or Millon Clinial Multiaxial Inventory (MCMI). To the extent that the client has appre-hension, self-consciousness, or shame about revealing aspects of gender iden-tity or sexuality, to that same extent the client may invest energy in erecting walls against self-disclosure. Performance tasks such as the Rorschach Inkblot Method (Rorschach, 1921/1942) or narrative methods, both of which con-tain structural and metaphorical information, are not invulnerable but are less vulnerable to the client’s self-presentational efforts. It is precisely in bringing together the data yielded from these different methods that the power of the multi-method approach is seen for individuals whose gender, gender identity, and sexual orientation issues are part of what is important to address in a psy-chological assessment. The contrasts among the pictures provided by different measures reveal to the clinician the tensions within a person related to gender and sexuality and the conflicts the person perceives between his or her own inclinations and the dictates of the social world.

The assessor, too, should select instruments that are free of gender or heterosexist bias. Bias may occur in the set of assumptions underlying test construction. For example, is the instrument predicated on the notion that gender-stereotyped attitudes, interests, and behaviors are what constitute men-tal health? From a philosophy on health and psychopathology emanate more specific decisions about how items are worded, norms developed, and data interpreted.

An assessor who is attuned to gender-related aspects of the client’s identity will be able to employ data emerging from the assessment to recognize what additional instruments might be introduced to complete the picture of the cli-ent. Today, a variety of narrowband instruments provide a close look at various aspects of gender and sexuality. In some cases, the assessor may realize at the outset their germaneness to the case, but in many others, the awareness of the need for further exploration may unfold over time (Bram & Peebles, 2014). For example, an assessor may begin to suspect that a given client’s distress is related to the maintenance of a posture of secrecy with family members about his sexual orientation. An instrument such as the Outness Inventory (Mohr & Fassinger, 2000) can be added to the battery to help the assessor conceptualize the client’s status on degree of outness. As will be discussed in Chapter 2, individuals who have two or more minority statuses, one of which may concern sexual orien-tation or gender identity, are at risk for exceedingly high levels of stress. Instru-ments such as the recently developed LGBT People of Color Microaggressions Scale (Balsam, Molina, Beadnell, Simoni, & Walters, 2011) provide the assessor

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with an appraisal of that stress specifically associated with racial/sexual/gender statuses. Although a plethora of gender-related instruments have been devel-oped, the assessor must be careful: Many instruments have been insufficiently studied, and their psychometric characteristics are largely unknown (Smiler & Epstein, 2010).

Administering the Tasks

No matter how prescribed the administration of a psychological test is, it is vul-nerable to the attitudes and sets of the test-taker and test-giver. Groth- Marnat (2009) cites studies showing the power of the assessor’s emotional stance: Whereas the assessor’s evident friendliness and warmth can lead to an increase in IQ scores in children, signs of disapproval can lead to lower levels of perfor-mance. Individuals who have been subject to minority stress are likely to be highly attuned to the assessor’s attitude toward him or her. The instruments the assessor uses are an extension of the assessor. Individuals with gender-variant identities may or may not be inured to the difficulty posed in everyday life when asked to declare themselves male or female. Yet, when asked to do so within a context of a psychological assessment—a task in which they are assured that the assessor’s aim is to understood who they are—the gender-binary format may be especially unnerving. So, too, might items in which the client is asked about reactions to “the opposite sex” beget perplexity, annoyance, or some other negatively tinged affect.

Coding

The assessor’s accurate scoring of a protocol can be affected by the client’s gen-der and sexual status in a number of ways. Potentially affecting the assessor are his or her own attitudes and beliefs toward the category of which a client is a member and awareness of the experiences of the client based upon knowledge of cultural factors related to the client’s status. An assessor may have particular beliefs, for instance, about the relative strengths of men and women. In scoring a part of a protocol that represents a particular area of strength in a given gender, when the client is of that gender, the assessor may practice leniency, and in the area of assumed weakness, stringency. In this way, the assessor confirms his or her preexisting beliefs to the detriment of the client.

Individuals who are sexual and gender minorities often find protection from the ill effects of social stigma by immersing themselves in communities that share the stigmatized facet of identity. Such communities develop cultures with their own idioms. For example, while taking the Rorschach Inkblot Test, a les-bian identifies a percept as a “Lavender family.” In coding, the assessor fails to realize that this term refers to an LGB concept rather than the actual color of the blot. The examiner codes the response incorrectly based on the lack of knowledge of relevant terms and idioms.

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Interpretation and Integration of Data

Always falling on the assessor is the task of integrating the data by discovering common findings across instruments and reconciling apparent inconsistencies and contradictions. Sensitivity to gender and sexual diversity demands that the assessor be thoughtful about how the client’s attitude toward self-revelation based on his or her identity may differentially affect how the client responds to various types of tasks.

A client who is known to the assessor to be a lesbian participates in a psychological assessment to help a therapist establish treatment goals. On the Psychological Assessment Inventory ([PAI], Morey, 2003), the client demonstrates a minimum of distress. On the Thematic Apper-ception Test ([TAT], Murray, 1943), the stories the client produces have a consistent negative tone. On the Rorschach, the client produces a large number of Morbid responses, Color-Shading Blends, and Vista responses. In considering the obvious disparity between the MMPI and Rorschach/TAT findings, the assessor recognized that as a more face valid instrument, the client could mount a successful effort to deny difficulties on the MMPI. At the same time, it seemed odd to the assessor that the client would deny difficulties at the time she is seeking the assistance of a therapist.

What might assist this assessor is the realization that an individual’s responses to cumulative stigma (Herek, 2009) can become engrained. This client might have made a very genuine effort to be true to her own self-construal. Yet, a sense of vulnerability based upon past negative experiences may compel her unwittingly to take on a defensive posture so as to prevent enacted stigma on the part of the assessor. If this interpretation were supported by other data, it could be very useful to the therapist who may be struggling with the same issue as the assessor: Why is this individual not sufficiently forthcoming about her difficulties to enable us to establish goals for treatment?

Developing Recommendations

If an assessor has demonstrated acceptance of the client’s identity throughout the assessment, then he or she is favorably positioned to formulate, in collab-oration with the client, recommendations that will be helpful. Psychological assessments are often conducted to advise the therapist, determine the potential usefulness of treatment, establish goals for treatment and intervention strategies through which these goals might be pursued, or some combination of these. A helpful consideration with gender and sexual minorities is how the client’s experiences with stigma are likely to influence his or her willingness to enter therapy and establish a therapeutic alliance with the therapist. Certainly, the

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client’s capacity to do so with the assessor serves as a trial run for a client not yet in treatment. For example, the client who worried that the assessor was going to judge some aspect of her identity may well have that same apprehension about a new therapist. Still, even when the assessment process has proceeded smoothly, the client may see particular dangers in the therapeutic relationship that are not as salient in the assessment relationship. To the extent that the assessor can help the therapist to form a reasonable anticipation of what might be the challenges in the therapist’s building a relationship of trust and the reasons for these chal-lenges, that assessor will be catalyzing the work between therapist and client.

In some cases, the assessor’s task may be to recognize when systems-level interventions are needed. Consider the following situation:

A gay man, Sam, was referred for testing by his workplace because he had had what appeared to his employer as an atypical number of absences. His employer wondered if some psychological difficulty pre-vented his uninterrupted presence at work. In the clinical interview, it came to light that this individual had significant childcare responsi-bilities. Although Sam and his husband alternated time off, the health issues of one child necessitated frequent absences. Sam described that his conversations with female co-workers had led to the conclusion that he was being treated differently. Female employees had taken off as much time as he did without reprisal. The assessor failed to find any issues that illumined the pattern of absences except that the individual possesses a degree of empathy and responsibility taking that would prevent him from not wanting to fulfill his parental obligations.

In some cases, assessments may expose enacted stigma (Herek, 2009), which constitutes actions that directly or indirectly undermine the well-being of the individual stigmatized for being a minority (in this case, for being a man). Sam was being subjected to workplace mistreatment (Magley, Gallus, & Bunk, 2010) in that his need to fulfill his parental obligations was denied based upon identity facets. In this circumstance, rather than a treatment recommendation being in order, what was needed was education of the employer. In doing so, the assessor would be acting in accordance with the principle of justice, embraced by the Ethical Code of the American Psychological Association ([APA], 2010), calling for psychologists’ efforts to ensure that all individuals are treated equally and fairly.

Finally, the recommendations made by the assessor must take into account the realities of the client’s situations. According to a 2011 report of the Institute of Medicine (IOM), LGBT individuals commonly lack health insurance. For example, Ponce, Cochran, Pizer, and Mays (2010) found that “partnered gay men were less than half as likely (42 percent) as married heterosexual men to receive employer-sponsored dependent coverage, and partnered lesbians were 28 percent less likely to receive such coverage than married women” (p. 66). An

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assessor making a recommendation for therapy must consider what resources the client can realistically access (Wagoner, 2014).

Providing Feedback

For individuals who may have repeatedly encountered being placed in a lesser position vis-à-vis others, the circumstance of traditional assessment is chal-lenging. Within a traditional assessment, the assessor accumulates a great deal of data, develops a picture of a client, and then presents that feedback in the context of one or two feedback sessions (Fischer, 1994). In this model, the assessor holds the power by holding knowledge. The client can easily and rea-sonably experience this arrangement as a recapitulation of past experiences of disempowerment. By embracing a collaborative approach to the feedback process, the assessor stands to avert this possibility and to garner client reac-tions to emerging hypotheses, reactions that may contribute to the hypotheses’ refinement.

Although a psychological assessment may identify personality features that predispose an individual to develop symptom patterns, individuals who are sex-ual minorities also suffer from the ill effects of stigma (Meyer, 2003). Feedback sessions that address the role of stigma and how the client can fortify him or herself in coping with it are likely to be more beneficial than those that ignore its effects. One means by which members of a minority group fortify themselves is through affiliation with other similarly situated individuals. Sam from our earlier example may benefit from participation in a parenting group for same-sex partners, particularly if that group contains individuals who struggle with balancing home and work responsibilities. The assessor can augment his or her usefulness by having an awareness of the diverse resources for, and approaches (e.g., see Pachankis, 2014) to, assisting individuals who have dealt with or are currently coping with the presence of stigma in their lives.

Practical Points

• The assessor should be attuned to the multifaceted aspects of the client’s gender and sexual identity and consider how they figure into the client’s experience of self and other.

• By having an awareness of how gender and sexual biases may enter into various stages of a psychological assessment, the assessor may identify ways to mitigate them.

• The assessor should consider the ways in which stigma may influence the client’s response to the assessment situation.

• In understanding the client, the assessor should look at the interactions between personality characteristics, intellectual strengths, environmental stressors (particularly those related to stigma), and environmental supports to explain psychological difficulties and ways to ameliorate them.

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Annotated Bibliography

American Psychological Association. (2011). Practice guidelines for LGB clients. Retrieved from http://www.apa.org/pi/lgbt/resources/guidelines.aspxComment: These guidelines are extremely helpful. They provide a set of useful defini-tions and also include an extensive list of references.

Chrisler, J. C., & McCreary, D. R. (2010). Handbook of gender research in psychology (Vols. 1 & 2). New York, NY: Springer.Comment: These volumes contain not only recent research on gender roles in general but also material relating to psychological assessment specifically. It gives ample attention to the methodological and statistical issues that are present in gen-der research, and thereby provides useful guidance for new researchers in this area.

Notes

1 This same document acknowledges that not all individuals who vary in the respects described will identify with the term transgender as applied to them. Terminology in this area of identity is in flux, and many views on appropriate terms exist.

2 Cross-dressers were formally labeled transvestites, a term no longer in use due to its connotation of pathology.

3 Whether the Mf scale was originally designed for this purpose is not entirely clear, as Friedman, Lewak, Nichols, and Webb 2001 note. They point out that whereas Dahl-strom, Welsh, and Dahlstrom (1972) saw the scale as designed to “identify the personal-ity features related to the disorder of male sexual inversion” (p. 201), Colligan, Osborne, Swensen, and Offord (1983) saw it as capturing tendencies toward masculinity and femininity.

4 Wong et al. do not describe their sample as “gay” because in their recruitment they asked if clients were gay or bisexual and/or had sex with other men. Consequently, the participants could have been somewhat heterogeneous in terms of sexual orientation.

5 The term homosexuality was used during this time but more recently has fallen into disuse because of the newer connotations attached to it.

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Hidden in Plain Sight: Gender and Sexuality in the ClinicalAssessment Interview Brown, L. S. (1990). Taking account of gender in the clinical assessment interview.Professional Psychology: Research and Practice, 21(1), 12–17. Comment: Brown's specificdiscussion of gender and the clinical interview is a useful and accessible primer in identifyingthe need for attending to gender issues in the clinical interview. She offers a useful outline tohelp clinicians consider important aspects of the clinical interview process and how theyintersect with gender. Donatone, B., & Rachlin, K. (2013). An intake template for transgender, transsexual,genderqueer, gender nonconforming, and gender variant college students seeking mentalhealth services. Journal of College Student Psychotherapy, 27(3), 200–211. Comment: Thediscussion of the initial interview with transgender clients provided by Donatone and Rachlinis an incredibly useful guide that will quickly familiarize readers with the unique needs andareas of concern among transgender clients. The authors provide affirmative and supportive

questions that are sensitively worded and easily adapted for practice. Heck, N. C., Flentje, A., & Cochran, B. N. (2013). Intake interviewing with lesbian, gay,bisexual, and transgender clients: Starting from a place of affirmation. Journal ofContemporary Psychotherapy, 43(1), 23–32. Comment: Heck, Flenjte, and Cochran providea very helpful introduction to interviewing LGBT clients and address specific areas of focus orconcern for gay men, lesbians, bisexuals, and transgender clients. A continuous emphasis isplaced on affirmation, which is helpful in that they convey how to express affirmation andsupport clients while discussing important concerns relevant to these communities. American Psychological Association. (2008). Transgender, gender identity, & genderexpression non-discrimination. Retrieved fromhttp://www.apa.org/about/policy/transgender.aspx American Psychological Association. (2011). Practice guidelines for LGB clients. Retrievedfrom http://www.apa.org/pi/lgbt/resources/guidelines.aspx Aron, L. (1991). The patient's experience of the analyst's subjectivity. PsychoanalyticDialogues, 1(1), 29–51. doi: 10.1080/10481889109538884 Baker, N. L., & Mason, J. L. (2010). Gender issues in psychological testing of personality andabilities. In J. C.Chrisler & D. R.McCreary (Eds.), Handbook of gender research inpsychology, Vol. 2: Gender research in social and applied psychology (pp. 63–88). New York,NY: Springer Science & Business Media. doi: 10.1007/978–1–4419–1467–5_4 Bandura, A., Lipsher, D. H., & Miller, P. E. (1960). Psychotherapists approach-avoidancereactions to patients’ expressions of hostility. Journal of Consulting Psychology, 24(1), 1–8.doi: 10.1037/h0043403 Brown, L. S. (1986). Gender-role analysis: A neglected component of psychologicalassessment. Psychotherapy: Theory, Research, Practice, Training, 23(2), 243–248. doi:10.1037/h0085604 Brown, L. S. (1990). Taking account of gender in the clinical assessment interview.Professional Psychology: Research and Practice, 21(1), 12–17. doi:10.1037/0735–7028.21.1.12 Burlew, L. D., & Shurts, W. M. (2013). Men and body image: Current issues and counselingimplications. Journal of Counseling & Development, 91(4), 428–435. doi: 10.1002/j.1556–6676.2013.00114.x Catania, J. A., Binson, D., Canchola, J., Pollack, L. M., & Hauck, W. (1996). Effects ofinterviewer gender, interviewer choice, and item wording on responses to questionsconcerning sexual behavior. Public Opinion Quarterly, 60(3), 345–375. doi: 10.1086/297758 Chasin, C. D. (2011). Theoretical issues in the study of asexuality. Archives of SexualBehavior, 40, 713–723. doi: 10.1007/s10508–011–9757-x Coleman, E., Bockting, W., Botzer, M., Cohen-Kettenis, P., DeCuypere, G., Feldman, J., …Zucker, K. (2012). Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. International Journal of Transgenderism, 13(4), 165–232.doi: 10.1080/15532739.2011.700873 Craig, R. J. (2005). The clinical process of interviewing. In R. J.Craig (Ed.), Clinical anddiagnostic interviewing (2nd ed., pp. 21–41). Lanham, MD: Jason Aronson. Craig, R. J. (2009). The clinical interview. In J. N.Butcher (Ed.), Oxford handbook ofpersonality assessment (pp. 201–225). New York, NY: Oxford University Press. doi:10.1093/oxfordhb/9780195366877.013.0012 Donatone, B., & Rachlin, K. (2013). An intake template for transgender, transsexual,genderqueer, gender nonconforming, and gender variant college students seeking mentalhealth services. Journal of College Student Psychotherapy, 27(3), 200–211. doi:10.1080/87568225.2013.798221 Dorland, J. M., & Fischer, A. R. (2001). Gay, lesbian, and bisexual individuals’ perceptions:An analogue study. The Counseling Psychologist, 29(4), 532–547. doi: 10.1177/0011000001294004 Eriksen, K., & Kress, V. E. (2008). Gender and diagnosis: Struggles and suggestions forcounselors. Journal of Counseling & Development, 86(2), 152–162. doi:10.1002/j.1556–6678.2008.tb00492.x Finn, S. E. (2007). In our clients’ shoes: Theory and techniques of Therapeutic Assessment.New York, NY: Routledge.

Fischer, C. T. (1970). The testee as co-evaluator. Journal of Counseling Psychology, 17(1),70–76. doi: 10.1037/h0028630 Fischer, C. T. (1994). Individualizing psychological assessment. Mahwah, NJ: LawrenceErlbaum. Fiske, D. W. (1967). The subject reacts to tests. American Psychologist, 22(4), 287–296. doi:10.1037/h0024523 Foster, A. B., & Scherrer, K. S. (2014). Asexual-identified clients in clinical settings:Implications for culturally competent practice. Psychology of Sexuality Orientation andGender Diversity, 1(4), 422–430. doi: 10.1037/sgd0000058 Gelso, C. J., Fassinger, R. E., Gomez, M. J., & Latts, M. G. (1995). Countertransferencereactions to lesbian clients: The role of homophobia, counselor gender, andcountertransference management. Journal of Counseling Psychology, 42(3), 356–364. doi:10.1037/0022-0167.42.3.356 Goldner, V. (2003). Ironic gender/authentic sex. Studies in Gender and Sexuality, 4(2),113–139. doi: 10.1080/15240650409349219 Groth-Marnat, G. (2009). Handbook of psychological assessment (5th ed.). Hoboken, NJ:Wiley. Hamilton, R. G., & Robertson, M. H. (1966). Examiner influence on the Holtzman inkblottechnique. Journal of Projective Techniques & Personality Assessment, 30(6), 553–558. Harris, A. (2005). Gender as soft assembly. Mahwah, NJ: Analytic Press. Hayes, J. A., & Gelso, C. J. (1993). Male counselors’ discomfort with gay and HIV-infectedclients. Journal of Counseling Psychology, 40(1), 86–93. doi: 10.1037/0022–0167.40.1.86 Hays, P. A. (2008). Addressing cultural complexities in practice: Assessment, diagnosis, andtherapy (2nd ed.). Washington, DC: American Psychological Association. doi:10.1037/11650–000 Heck, N. C., Flentje, A., & Cochran, B. N. (2013). Intake interviewing with lesbian, gay,bisexual, and transgender clients: Starting from a place of affirmation. Journal ofContemporary Psychotherapy, 43(1), 23–32. doi: 10.1007/s10879–012–9220-x Hoffman, I. Z. (1983). The patient as interpreter of the analyst's experience. ContemporaryPsychoanalysis, 19(3), 389–422. Karg, R. S., Wiens, A. N., & Blazei, R. W. (2013). Improving diagnostic and clinicalinterviewing. In G. P.Koocher, J. C.Norcross, & B. A.Greene (Eds.), Psychologists’ deskreference (3rd ed., pp. 22–26). New York, NY: Oxford University Press. Klein, N. L. (2011). Doing gender categorization: Non-recognitional person reference and theomnirelevance of gender. In S. A.Speer & E.Stokoe (Eds.), Conversation and Gender (pp.64–82). Cambridge: Cambridge University Press. Lanyon, R. I., & Goodstein, L. D. (1997). Personality assessment (rd ed.). Oxford, England:John Wiley & Sons. Lewis, R. J., Kholodkov, T., & Derlega, V. J. (2012). Still stressful after all these years: Areview of lesbians’ and bisexual women's minority stress. Journal of Lesbian Studies, 16,30–44. doi: 10.1080/10894160.2011.557641 Machado, P., Beutler, L. E., Harwood, T. M., & Pratt, D. (2011). The integrative clinicalinterview. In T. M.Harwood, L. E.Beutler, & G.Groth-Marnat (Eds.), Integrative assessment ofadult personality (3rd ed., pp. 80–115). New York, NY: Guilford Press. MacNeela, P., & Murphy, A. (2015). Freedom, invisibility, and community: A qualitative studyof self-identification with asexuality. Archives of Sexual Behavior, 44(3), 799–812. doi:10.1007/s10508–014–0458–0 Maruish, M. E. (2008). The clinical interview. In R. P.Archer & S. R.Smith (Eds.), Personalityassessment (pp. 37–80). New York, NY: Routledge/Taylor & Francis. McConaughy, S. H. (2013). Clinical interviews for children and adolescents: Assessment tointervention (2nd ed.). New York, NY: Guilford Press. Mitchell, S. A. (1997). Influence and autonomy in psychoanalysis. Mahwah, NJ: AnalyticPress. Neukrug, E., Britton, B. S., & Crews, R. C. (2013). Common health-related concerns of men:Implications for counselors. Journal of Counseling & Development, 91(4), 390–397. doi:10.1002/j.1556–6676.2013.00109.x

Nichols, M. (2011). Variations on gender and orientation in Scott's first interview. InC.Silverstein (Ed.), The initial psychotherapy interview: A gay man seeks treatment (pp.71–96). Amsterdam, The Netherlands: Elsevier. Person, E. S. (2006). Masculinities, plural. Journal of the American PsychoanalyticAssociation, 54(4), 1165–1186. Rogers, R. (2003). Standardizing DSM-IV diagnoses: The clinical application of structuredinterviews. Journal of Personality Assessment, 81(3), 220–225. doi:10.1207/S15327752JPA8103_04 Rogers, R. (2010). Structured interview of reported symptoms (2nd ed.). Lutz, FL:Psychological Assessment Resources. Rudolph, B. A. (2005). Teaching diagnostic and clinical interviewing. In R. J.Craig (Ed.),Clinical and diagnostic interviewing (2nd ed., pp. 3–20). Lanham, MD: Jason Aronson. Shepard, D. S., & Rabinowitz, F. E. (2013). The power of shame in men who are depressed:Implications for counselors. Journal of Counseling & Development, 91(4), 451–457. doi:10.1002/j.1556–6676.2013.00117.x Silverstein, C. (2011a). The initial psychotherapy interview. In C.Silverstein (Ed.), The initialpsychotherapy interview: A gay man seeks treatment (pp. 37–69). Amsterdam, TheNetherlands: Elsevier. Silverstein, C. (2011b). The initial psychotherapy interview: A gay man seeks treatment.Amsterdam, The Netherlands: Elsevier. Singer, E. (1965). Key concepts in psychotherapy. New York, NY: Crown PublishingGroup/Random House. Smart, R. (2010). Counseling competencies with women: Understanding gender in thecontext of multiple dimensions of identity. In J.A.E.Cornish, B. A.Schreier, L. I.Nadkarni, L.H.Metzger, & E. R.Rodolfa (Eds.), Handbook of multicultural counseling competencies (pp.475–512). Hoboken, NJ: Wiley Stolorow, R. D., & Atwood, G. E. (1992). Contexts of being: The intersubjective foundationsof psychological life. Hillsdale, NJ: Analytic Press. Suzuki, L. A., & Ahluwalia, M. K. (2003). Gender issues in personality, cognitive, andvocational assessment of women. In M.Kopala & M. A.Keitel (Eds.), Handbook of counselingwomen (pp. 119–130). Thousand Oaks, CA: Sage. Suzuki, L. A., Onoue, M. A., Fukui, H., & Ezrapour, S. (2012). Foundations of counselingpsychology: Assessment. In N. A.Fouad, J. A.Carter, & L. M.Subich (Eds.), APA handbook ofcounseling psychology, Vol. 1: Theories, research, and methods (pp. 167–199). Washington,DC: American Psychological Association. doi: 10.1037/13754–007 Widiger, T. A., & Samuel, D. B. (2009). Evidence-based assessment of personality disorders.Personality Disorders: Theory, Research and Treatment, S(1), 3–17. doi:10.1037/1949–2715.S.1.3 Worell, J., & Robinson, D. A. (2009). Issues in clinical assessment with women. In J.N.Butcher (Ed.), Oxford handbook of personality assessment (pp. 415–431). New York, NY:Oxford University Press. doi: 10.1093/oxfordhb/9780195366877.013.0022

A Framework for Considering Gender in the Cognitive AssessmentProcess Ardila, A. (2005). Cultural values underlying psychometric cognitive testing.Neuropsychology Review, 15(4), 185–195. doi: 10.1007/s11065–005–9180-y Comment:Ardila presents a conceptual framework for understanding how cultural variables caninfluence neuropsychological assessment. He presents eight different values that underlietesting and can affect the relationship between the examiner and the examinee, which can inturn affect test results. It is a thoughtful consideration of how variables other than those beingassessed can affect outcomes. Halpern, D. F., Straight, C. A., & Stephenson, C. L. (2011). Beliefs about cognitive genderdifferences: Accurate for direction, underestimated for size. Sex Roles, 64, 336–347. doi:

10.1007/s11199–010–9891–2 Comment: This article is one of the few that explores genderstereotyping and the accuracy of what adults believe about gender differences. Theresearchers compare adult ratings of gender differences to published data and show thatadults are aware of common gender differences but underestimate their size. The data arediscussed in terms of a rich conceptual framework for understanding how these beliefs mightaffect performance or interpretations of others’ performance. Rahman, Q., Bhanot, S., Emrith-Small, H., Ghafoor, S., & Roberts, S. (2012). Gendernonconformity, intelligence, and sexual orientation. Archives of Sexual Behavior, 41,623–630. doi: 10.1007/s10508–011–9737–1 Comment: This is one of the few studies thatlooks at how gendered behavior might relate to performance on measures of IQ. The authorslook at intelligence measures in gay men and heterosexual men and women, and theypresent data that explore relationships among intelligence, sexual orientation, and gendernonconformity. Spelke, E. (2005). Sex differences in intrinsic aptitude for mathematics and science? A criticalreview. American Psychologist, 60(9), 950–958. doi: 10.1037/0003–066X.60.9.950Comment: This article represents a strongly constructed critical review of a literature that hasdocumented gender differences in math and science. Spelke's compelling commentary and areview of additional research, taken together, suggest that prior conclusions about thesegender differences are not supported by the scientific findings. American Psychiatric Association. (2013). Diagnostic and statistical manual of mentaldisorders (5th ed.). Washington, DC: Author. Ardila, A. (2005). Cultural values underlying psychometric cognitive testing. NeuropsychologyReview, 15(4), 185–195. doi: 10.1007/s11065–005–9180-y Ardila, A., Rosselli, M., Matute, E., & Inozemstseva, O. (2011). Gender differences incognitive development. Developmental Psychology, 47(4), 984–990. doi: 10.1037/a0023819 Bembenutty, H. (2008). The last word: The scholar whose expectancy-value theorytransformed the understanding of adolescence, gender differences and achievement: Aninterview with Jacquelynne S. Eccles. Journal of Advanced Academics, 19(3), 531–550. doi:10.4219/jaa-2008–811 Bianco, M., Harris, B., Garrison-Wade, D., & Leech, N. (2011). Gifted girls: Gender bias ingifted referrals. Roeper Review, 33, 170–181. doi: 10.1080/02783193.2011.580500 Brown, L. S. (1990). Taking account of gender in the clinical assessment interview.Professional Psychology: Research and Practice, 21(1), 12–17. doi:10.1037/0735–7028.21.1.12 Coutinho, M. J., & Oswald, D. P. (2005). State variation in gender disproportionality in specialeducation. Remedial and Special Education, 26(1), 7–15. doi: 10.1177/07419325050260010201 Dragowski, E. A. (2014). Let's talk about gender. NASP Communique, 43(3), 1, 21–23.Retrieved from http://www.nasponline.org/publications/cq/43/3/gender.aspx Dragowski, E. A., Scharron-Del, M. R. Rio, & Sandigorsky, A. L. (2011). Childhood genderidentity … disorder? Developmental, cultural, and diagnostic concerns. Journal of Counselingand Development, 89, 360–366. doi: 10.1002/j.1556–6678.2011.tb00100 Eccles, J. S., Barber, B., & Jozefowicz, D. (1999). Linking gender to educational,occupational, and recreational choices: Applying the Eccles et al. model of achievement-related choices. In W. B.Swann, J. H.Langois, & L. A.Gilbert (Eds.), Sexism and stereotypesin modern society (pp. 153–191). Washington, DC: American Psychological Association. doi:10.1037/10277–007 Else-Quest, N. M., Mineo, C. C., & Higgins, A. (2013). Math and science attitudes andachievement at the intersection of gender and ethnicity. Psychology of Women Quarterly,37(3), 293–309. doi: 10.1177/0361684313480694 Feingold, A. (1994). Gender differences in variability in intellectual abilities: A cross-culturalperspective. Sex Roles, 30(1/2), 81–92. Retrieved fromhttp://link.springer.com/article/10.1007/BF01420741#page-1 Franceschini, G., Galli, S., Chiesi, F., & Primi, C. (2014). Implicit gender-math stereotype andwomen's susceptibility to stereotype threat and stereotype lift. Learning and IndividualDifferences, 32, 273–277. http://dx.doi.org/10.1016/j.lindif.2014.03.020

Fredricks, J. A., & Eccles, J. S. (2002). Children's competence and value beliefs fromchildhood through adolescence: Growth trajectories in two male sex-typed domains.Developmental Psychology, 38, 519–533. doi: 10.1037/0012–1649.38.4.519 Galdi, S., Cadinu, M., & Tomasetto, C. (2014). The roots of stereotype threat: Whenautomatic associations disrupt girls’ math performance. Child Development, 85(1), 250–263.doi: 10.1111/cdev.12128 Ganley, C. M., Mingle, L. A., Ryan, A. M., Ryan, K., & Vasilyeva, M. (2013). An examinationof stereotype threat effects on girls’ mathematics performance. Developmental Psychology,49(10), 1886–1897. doi: 10.1037/a0031412 Good, J. J., Woodzicka, J. A., & Wingfield, L. C. (2010). The effects of gender stereotypic andcounter-stereotypic textbook images on science performance. The Journal of SocialPsychology, 150(2), 132–147. Gur, R. C., Alsop, D., Glahn, D., Petty, R., Swanson, C. L., Maldijian, J. A., … Gur, R. E.(2000). An fMRI study of sex differences in regional activation to a verbal and a spatial task.Brain and Language, 74, 157–170. doi: 10.1006/brln.2000.2325 Gur, R. C., Richard, J., Calkins, M. E., Chiavacci, R., Hansen, J. A., Bilker, W. B., … Gur, R.E. (2012). Age group and sex differences in performance on a computerized neurocognitivebattery in children age 8–21. Neuropsychology, 26(2), 251–265. doi: 10.1037/a0026712 Halpern, D.F. (2000). Sex differences in cognitive abilities. New York, NY: Taylor & Francis. Halpern, D. F., Straight, C. A., & Stephenson, C. L. (2011). Beliefs about cognitive genderdifferences: Accurate for direction, underestimated for size. Sex Roles, 64, 336–347. doi:10.1007/s11199–010–9891–2 Hawke, J.K., Olson, R. K., Willcutt, E. G., Wadsworth, S. J., & DeFries, J. C. (2009). Genderratios for reading disabilities. Dyslexia, 15(3), 239–242. doi: 10.1002/dys.389 Herrnstein, R., & Murray, C. (1994). The bell curve: Intelligence and class structure inAmerican life. New York, NY: Free Press. Hirnstein, M., Andrews, L. C., & Hausmann, M. (2014). Gender-stereotyping and cognitivesex differences in mixes- and same-sex groups. Archives of Sexual Behavior, 43,1663–1673. doi: 10.1007/s10508–014–0311–5 Hyde, J. (2005). The gender similarities hypothesis. American Psychologist, 60(6), 581–592.http://dx.doi.org/10.1037/0003–066X.60.6.581 Ingalhalikar, M., Smith, A., Parker, D., Satterthwaite, T. D., Elliott, M. A., Ruparel, K., … &Verma R. (2014). Sex differences in the structural connectome of the human brain.Proceedings of the National Academy of Sciences, 111(2), 823–828. doi:10.1073/pnas.1316909110 Lynn, R. (1994). Sex differences in brain size and intelligence. A paradox resolved.Personality and Individual Differences, 17, 257–271. doi: 10.1016/0191–8869(94) 90030–2 Lynn, R. (1999). Sex differences in intelligence and brain size: A developmental hypothesis.Intelligence, 27, 1–12. doi: 10.1016/S0160–2896(99)00009–4 Lynn, R., & Kanazawa, S. (2011). A longitudinal study of sex differences in intelligence atages 7, 11 and 16 years. Personality and Individual Differences, 51, 321–324. doi:10.1016/j.paid.2011.02.028 Irwing, P. (2012). Sex differences in g: An analysis of the US standardization sample of theWAIS-III. Personality and Individual Differences, 53, 126–131. doi:10.1016/j.paid.2011.05.001 National Association of School Psychologists (NASP). (2014). Safe schools for transgenderand gender diverse students [Position statement]. Bethesda, MD: NASP. Perry, M. J. (2013). 2013 SAT test results show that a huge math gender gap persists with a32-point advantage for high school boys. AEIDeas: The public policy blog of the AmericanEnterprise Institute. Retrieved January 3, 2015, from http://www.aei.org/publication/2013-sat-test-results-show-that-a-huge-math-gender-gap-persists-with-a-32-point-advantage-for-high-school-boys/ Rahman, Q., Bhanot, S., Emrith-Small, H., Ghafoor, S., & Roberts, S. (2012). Gendernonconformity, intelligence, and sexual orientation. Archives of Sexual Behavior, 41,623–630. doi: 10.1007/s10508–011–9737–1 Robinson-Cimpian, J. P., Lubienski, S. T., Ganley, C. M., & Copur-Gencturk, Y. (2014).Teachers’ perceptions of students’ mathematics proficiency may exacerbate early gender

gaps in achievement. Developmental Psychology, 50(4), 1262–1281. doi: 10.1037/a0035073 Riegel-Crumb, C., & Humphries, M. (2012). Exploring bias in math teachers’ perceptions ofstudents’ ability by gender and race/ethnicity. Gender & Society, 26(2), 290–322. doi:10.1177/0891243211434614 Savage-McGlynn, E. (2012). Sex differences in intelligence in younger and older participantsof the Raven's Standard Progressive Matrices Plus. Personality and Individual Differences,53, 137–141. doi: 10.1016/j.paid.2011.06.013 Share, D. L., & Silva, P. A. (2003). Gender bias in IQ-discrepancy and post-discrepancydefinitions of reading disability. Journal of Learning Disabilities, 36(1), 4–14. doi:10.1177/00222194030360010201. Shaywitz, B. A., Lyon, G. R., & Shaywitz, S. E. (2006). The role of functional magneticresonance imaging in understanding reading and dyslexia. Developmental Neuropsychology,30(1), 613–632. http://dx.doi.org/10.1207/s15326942dn3001_5 Simpkins, S. D., Fredricks, J. A., & Eccles, J. S. (2012). Charting the Eccles’ expectancy-value model from mothers’ beliefs in childhood to youths’ activities in adolescence.Developmental Psychology, 48(4), 1019–1032. doi: 10.1037/a0027468 Spelke, E. (2005). Sex differences in intrinsic aptitude for mathematics and science? A criticalreview. American Psychologist, 60(9), 950–958. doi: 10.1037/0003–066X. 60.9.950 Steele, C.M. (1997). A threat in the air: How stereotypes shape intellectual identity andperformance. American Psychologist, 52(6), 613–629. http://dx.doi.org/10.1037/0003-066X.52.6.613 Steinberg, J. R., Okun, M. A., & Aiken, L. S. (2012). Calculus GPA and math identificationand moderators of stereotype threat in highly persistent women. Basic and Applied SocialPsychology, 34, 534–543. doi: 10.1080/01973533.2012.727319 Szymanowicz, A., & Furnham, A. (2012). Gender and gender role differences in self- andother-estimates of multiple intelligences. The Journal of Social Psychology, 153(4), 399–423.doi: 10.1080/00224545.2012.754397 Tomasetto, C., Alparone, F. R., & Cadinu, M. (2011). Girls’ math performance understereotype threat: The moderating role of mothers’ gender stereotypes. DevelopmentalPsychology, 47(4), 943–949. doi: 10.1037/a0024047 Wilder, G. Z. (1996). Correlates of gender differences in cognitive functioning (College BoardReport No. 96–03). New York, NY: College Entrance Examination Board. Retrieved fromhttps://research.collegeboard.org/sites/default/files/publications/2012/7/researchreport-1996–3-correlates-gender-differences-cognitives-functioning.pdf

Gender Considerations in Self-Report Personality AssessmentInterpretation Baker, N. L., & Mason, J. L. (2010). Gender issues in psychological testing of personality andabilities. In J. C. Chrisler & D. R. McCreary (Eds.), Handbook of gender research inpsychology (pp. 63–88). New York, NY: Springer. Comment: This chapter offers an excellentoverview of gender implications in personality assessment, addressing issues of testselection, norms, and various sources of bias. Importantly, it discusses contexts andassumptions in assessment and offers useful directions for practice. Feingold, A. (1994). Gender differences in personality: A meta-analysis. PsychologicalBulletin, 116, 429–456. http://dx.doi.org/10.1037/0033–2909.116.3.429 Comment: The meta-analytic findings presented in this article include several self-report personality inventoriesbeyond those addressed in the current chapter. It discusses the agentic versus communaldivide in men and women's personality test scores and the constancy in gender differencesacross ages, generations, educational level, and nationality. Fuentes, M. A., & Adames, H. Y. (2014). Theories, models, and practices for understandinggender, race, and ethnicity in clinical assessment. In M. L. Miville & A. D. Ferguson (Eds.),Handbook of race-ethnicity and gender in psychology (pp. 313–328). New York, NY:Springer. Comment: This chapter delves into intersections of sociocultural factors as theyimpact assessment processes. The authors offer new directions for thinking about gender,

race, and ethnicity, illustrated through a case example, and provide a thoughtful set ofrecommendations. Moradi, B., & Parent, M. C. (2013). Assessment of gender-related traits, attitudes, roles,norms, identity, and experiences. In K. F. Geisinger (Ed.), APA handbook of testing andassessment in psychology, Vol. 2: Testing and assessment in clinical and counselingpsychology (pp. 467–488). Washington, DC: American Psychological Association. Comment:For the reader interested in learning more about gender constructs, this chapter discussesgendered personality dimensions and goes into assessment of gender role ideology,attitudes toward transgender individuals, gender identity, and gender-role conflict. Topics ofsexism and discriminatory practices are also covered. Addis, M. E., & Mahalik, J. R. (2003). Men, masculinity, and the contexts of help seeking.American Psychologist, 58, 5–14. http://dx.doi.org/10.1037/0003–066X.58.1.5 Alterman, A. I., Zaballero, A. R., Lin, M. M., Siddiqui, N., Brown, L. S., Rutherford, M. J., &McDermott, P. A. (1995). Personality Assessment Inventory (PAI) scores of lower-socioeconomic African American and Latino methadone maintenance patients. Assessment,2, 91–100. http://dx.doi.org/10.1177/1073191195002001009 Archer, E. M., Hagan, L. D., Mason, J., Handel, R., & Archer, R. P. (2012). MMPI-2-RFcharacteristics of custody evaluation litigants. Assessment, 19, 14–20.http://dx.doi.org/10.1177/1073191110397469 Baker, N. L., & Mason, J. L. (2010). Gender issues in psychological testing of personality andabilities. In J. C.Chrisler & D. R.McCreary (Eds.), Handbook of gender research inpsychology (pp. 63–88). New York, NY: Springer. Ben-Porath, Y. S., & Forbey, J. D. (2003). Non-gendered norms for the MMPI-2. Minneapolis,MN: University of Minnesota Press. Ben-Porath, Y. S., & Tellegen, A. (2008/2011). MMPI-2-RF (Minnesota MultiphasicPersonality Inventory-2 Restructured Form): Manual for administration, scoring, andinterpretation. Minneapolis, MN: University of Minnesota Press. Blood, L. (2008). The use of the MCMI-III in completing parenting capacity assessments.Journal of Forensic Psychology Practice, 8, 24–38.http://dx.doi.org/10.1080/15228930801947286 Butcher, J. N., Arbisi, P. A., Atlis, M. M., & McNulty, J. L. (2008). The construct validity of theLees-Haley Fake Bad Scale: Does this scale measure somatic malingering and feignedemotional distress? Archives of Clinical Neuropsychology, 23, 855–864.http://dx.doi.org/10.1016/j.acn.2008.10.001 Butcher, J. N., Dahlstrom, W. G., Graham, J. R., Tellegen, A., & Kaemmer, B. (1989).Minnesota Multiphasic Personality Inventory-2 (MMPI-2): Manual for administration andscoring. Minneapolis, MN: University of Minnesota Press. Butcher, J. N., Gass, C. S., Cumella, E., Kally, Z., & Williams, C. L. (2008). Potential for biasin MMPI-2 assessments using the Fake Bad Scale (FBS). Psychological Injury and Law, 1,191–209. Retrieved from http://search.proquest.com/docview/900620510?accountid=27313 Cantrell, J. D., & Dana, R. H. (1987). Use of the Millon Clinical Multiaxial Inventory (MCMI) asa screening instrument at a community mental health center. Journal of Clinical Psychology,43, 366–375. Retrieved fromhttp://search.proquest.com/docview/617357004?accountid=27313 Cherepon, J. A., & Prinzhorn, B. (1994). Personality Assessment Inventory (PAI) profiles ofadult female abuse survivors. Assessment, 1, 393–399. Retrieved fromhttp://search.proquest.com/docview/618661236?accountid=27313 Cook, E. P. (1990). Gender and psychological distress. Journal of Counseling &Development, 68, 371–380. Retrieved fromhttp://search.proquest.com/docview/617750398?accountid=27313 Costa, P. T., Jr., & McCrae, R. R. (1992). Revised NEO Personality Inventory (NEO PI-R)and NEO Five-Factor Inventory (NEO-FFI) professional manual. Odessa, FL: PsychologicalAssessment Resources. Deisinger, J. A., Cassisi, J. E., & Whitaker, S. L. (1996). Relationships between coping styleand PAI profiles in a community sample. Journal of Clinical Psychology, 52, 303–310.Retrieved from http://search.proquest.com/docview/618795251?accountid=27313

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Sex and Gender Distinctions and the Rorschach Inkblot Method Bornstein, R. F. (1996). Sex differences in objective and projective dependency tests: Ameta-analytic review. Assessment, 2(4), 319–331. doi: 10.1177/1073191195002004003Comment: The authors of this article conducted a meta-analysis of all published studies since1950, looking at sex differences in scores on various tests, including performance-basedtechniques. The authors looked at 97 studies in total, finding that women obtain higherdependency scores than men on objective tests while the reverse is true on projectivedependency tests. Mayman, M. (1967). Object-representations and object-relationships in Rorschachresponses. Journal of Projective Techniques and Personality Assessment, 31(4), 17–24. doi:10.1080/0091651X.1967.10120387 Comment: Mayman's classic article is an excellentintroduction to the theory underlying personality assessment using the RIM. Meyer, G. J., Giromini, L., Viglione, D. J., Reese, J. B., & Mihura, J. L. (2015). Theassociation of gender, ethnicity, age, and education with Rorschach scores. Assessment, 22,46–64. doi: 10.1177/1073191114544358 Comment: This article examined the role of gender,ethnicity, age, and education on the RIM scores of children and adults in both clinical andnonclinical populations. Their analyses determined that age and education may each have asubtle effect on RIM scores in certain populations. However, their gender hypothesis wasconfirmed: In both the clinical and nonclinical samples, no significant correlations betweenRIM scores and gender could be made. Tuber, S., & Meehan, K. (2014). Projective measures of personality/psychopathology. In R.Cautin & S. Lilienfeld (Eds.), Encyclopedia of clinical psychology. Hoboken, NJ: Wiley.Comment: This concise review places the use of four major projective methods in historicalcontext and argues persuasively for the inclusion of such methods in any in-depthpsychological assessment process. Allport, G. W. (1942/1947). The use of personal documents in psychological science. NewYork, NY: Social Science Research Council. doi: 10.1037/11389–000

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Ryan, R. M., Avery, R. R., & Grolnick, W. S. (1985). A Rorschach assessment of children'smutuality of autonomy. Journal of Personality Assessment, 49(1), 6–12. doi:10.1207/s15327752jpa4901_2 Sappenfield, B. R. (1961). Perception of masculinity-femininity in Rorschach blots andresponses. Journal of Clinical Psychology, 17(4), 373–376. doi:10.1002/1097–4679(196110)17:4<373::AID-JCLP2270170409>3.0.CO;2-J (broken) Shafer, R. (1948). The clinical application of psychological tests: Diagnostic summaries andcase studies. New York, NY: International Universities Press. Singh, S., & Singh, D. (2000). Sex differences: Correlates of Rorschach measure of hostility.Journal of the Indian Academy of Applied Psychology, 26(1–2), 95–101. Stangor, C., Lynch, L., Duan, C., & Glass, B. (1992). Categorization of individuals on thebasis of multiple social features. Journal of Personality and Social Psychology, 62(2),207–218. doi: 10.1037/0022–3514.62.2.207 Stricker, G., & Healey, B. J. (1990). Projective assessment of object relations: A review of theempirical literature. Psychological Assessment: A Journal of Consulting and ClinicalPsychology, 2(3), 219–230. doi: 10.1037/1040-3590.2.3.219 Tuber, S. (1983). Children's Rorschach scores as predictors of later adjustment. Journal ofConsulting and Clinical Psychology, 51, 379–385. doi: 10.1037/0022–006X.51.3.379 Tuber, S. B. (1989). Children's Rorschach object representations: Findings for a nonclinicalsample. Psychological Assessment: A Journal of Consulting and Clinical Psychology, 1(2),146–149. doi: 10.1037/1040–3590.1.2.146. Tuber, S. (1992). Empirical and clinical assessments of children's object relations and objectrepresentations. Journal of Personality Assessment, 58(1), 179–197. doi:10.1207/s15327752jpa5801_16 Tuber, S., & Coates, S. (1985). Interpersonal phenomena in the Rorschach's of extremelyfeminine boys. Psychoanalytic Psychology, 2(3), 251–265. doi: 10.1037/0736–9735.2.3.251 Tuber, S., & Coates, S. (1989). Indices of psychopathology in the Rorschach's of boys withsevere gender identity disorder: A comparison with normal control subjects. Journal ofPersonality Assessment, 53(1), 100–112. doi: 10.1207/s15327752jpa5301_11 Tuber, S., & Meehan, K. (2015). Projective measures of personality/psychopathology. In R.L.Cautin & S. O.Lilienfeld (Eds.), The Encyclopedia of Clinical Psychology. Hoboken, NJ:Wiley-Blackwell. doi: 10.1002/9781118625392.wbecp035 (advance online publication) Tuma, J. M., & McRaw, R. K. (1975). Influences of examiner differences on Rorschachproductivity in children. Journal of Personality Assessment, 39(4), 362–368. doi:10.1207/s15327752jpa3904_6 unconscious. (n.d.). In Merriam-Webster's online dictionary (11th ed.). Retrieved fromhttp://www.merriam-webster.com/dictionary/unconscious Urist, J. (1977). The Rorschach Test and the assessment of object relations. Journal ofPersonality Assessment, 41(1), 3–9. doi: 10.1207/s15327752jpa4101_1 Weiner, I. B. (1994). The Rorschach Inkblot Method (RIM) is not a test: Implications for theoryand practice. Journal of Personality Assessment, 62(3), 498–504. doi:10.1207/s15327752jpa6203_9 Yanovski, A., Menduke, H., & Albertson, M. G. (1995). Analysis by gender and visual imageryreactivity of conventional and imagery Rorschach. Perceptual and Motor Skills, 80,1319–1340. doi: 10.2466/pms.1995.80.3c.1319 Zax, M., & Benham, F. G. (1961). The stimulus value of the Rorschach inkblots as perceivedby children. Journal of Projective Techniques, 25(2), 233–237. doi:10.1080/08853126.1961.10381031 Zucker, K. J., Lozinski, J. A., Bradley, S. J., & Doering, R. W. (1992). Sex-typed responses inthe Rorschach protocols of children with gender identity disorder. Journal of PersonalityAssessment, 58(2), 295–310. doi: 10.1207/s15327752jpa5802_9

Human Figure Drawings and Thematic Apperception Test Narratives Handler, L. (1996). The clinical use of drawings: Draw-A-Person, House-Tree-Person, andKinetic Family Drawings. In C. S. Newmark (Ed.), Major psychological assessmentinstruments. (2nd ed., pp. 206–293). Boston, MA: Allyn & Bacon. Comment: This chapterprovides a comprehensive overview to interpreting figure drawings. Kissen, M. (1986). Assessing object relations phenomena. Madison, CT: InternationalUniversities Press. Comment: This text offers a sophisticated approach to usingpsychodynamic theory, specifically here object relations theory, in interpreting narrative testresponses. Aronoff, D. N., & McCormick, N. B. (1990). Sex, sex role identification, and college students’projective drawings. Journal of Clinical Psychology, 46, 460–466. doi:10.1002/1097–4679(199007)46:4<460::AIDJCLP2270460414>3.0.CO;2-S Bellak, L., & Abrams, D. M. (1997). The T.A.T., the C.A.T., and the S.A.T. in clinical use (6thed.). Boston, MA: Allyn & Bacon. Bem, S. L. (1981). Bem Sex-Role Inventory: A professional manual. Palo Alto, CA:Consulting Psychologists Press. Brems, C. B., Adams, R. L., & Skillman, G. D. (1993). Person drawings by transsexualclients, psychiatric clients, and nonclients compared: Indicators of sex-typing and pathology.Archives of Sexual Behavior, 22, 253–264. doi: 10.1007/BF01541770 Butcher, J. N., Graham, J. R., Ben-Porath, Y. S., Tellegen, A., Dahlstrom, W. G., &Kaemmer, B. (2001). MMPI-2: Manual for administration and scoring (rev. ed.). Minneapolis,MN: University of Minnesota Press. Cramer, P. (1991). The development of defense mechanisms: Theory, research andassessment. New York, NY: Springer-Verlag. Cramer, P. (1996). Storytelling, narrative, and the Thematic Apperception Test. New York,NY: Guilford Press. Dana, R. H. (1996). The Thematic Apperception Test (TAT). In C. S.Newmark (Ed.), Majorpsychological assessment instruments (2nd ed., pp. 166–205). Boston, MA: Allyn & Bacon. Dickson, J. M., Saylor, C. F., & Finch, A. J. (1990). Personality factors, family structure, andsex of drawn figure on the Draw-A-Person Test. Journal of Personality Assessment, 55,362–366. doi: 10.1207/s15327752jpa5501&2_33 Fleming, M., Koocher, G., & Nathans, J. (1979). Draw-A-Person Test: Implications for genderidentification. Archives of Sexual Behavior, 8, 55–61. doi: 101541213 Goodenough, F. (1926). Measurement of intelligence by drawings. New York, NY: WorldBook. Hammer, E. (1986). Graphic techniques with children and adolescents. In A.Rabin (Ed.),Projective techniques for adolescents and children (pp. 230–258). New York, NY: Springer. Handler, L. (1996). The clinical use of drawings: Draw-A-Person, House-Tree-Person, andkinetic family drawings. In C. S.Newmark (Ed.), Major psychological assessment instruments(2nd ed., pp. 206–293). Boston, MA: Allyn & Bacon. Handler, L., & Reyher, J. (1965). Figure drawing anxiety indexes: A review of the literature.Journal of Personality Assessment, 29, 305–313. doi: 10.1080/0091651X.1965 .10120213 Hibbard, S., & Porcerelli, J. (1998). Further validation for the Cramer Defense MechanismManual. Journal of Personality Assessment, 70, 460–483. doi: 10.1207/s15327752jpa7003_6 Holt, R. R. (1978). Methods in clinical psychology, Vol. 1: Projective assessment. New York,NY: Plenum Press. Houston, A. N., & Terwilliger, R. (1995). Sex, sex roles, and sexual attitudes: Figure genderin the Draw-A-Person test revisited. Journal of Personality Assessment, 65, 343–357. doi:10.1207/s15327752jpa6502_9 Jenkins, S. R. (2008). A handbook of clinical scoring systems for thematic apperceptivetechniques. Mahwah, NJ: Lawrence Erlbaum. Johnston, F., & Johnston, S. (1986). Differences between human figure drawings of childmolesters and control groups. Journal of Clinical Psychology, 42, 638–647. doi:10.1002/1097–4679(198607)42:4<638::AID JCLP2270420418& gt;3.0.

Kissen, M. (1986). Assessing object relations phenomena. Madison, CT: InternationalUniversities Press. Kohut, H. (1984). How does analysis cure? (A.Goldberg & P. E.Stepansky, Eds.). Chicago,IL: University of Chicago Press. Koppitz, E. (1983). Psychological evaluation of human figure drawings by middle schoolpupils. New York, NY: Grune & Stratton. Lerner, P. M. (1991). Psychoanalytic theory and the Rorschach. Hillsdale, NJ: Analytic Press. Machover, K. (1949). Personality projection in the drawing of the human figure. Springfield,IL: Charles C. Thomas. Marsh, D. T., Linberg, L. M., & Smeltzer, J. K. (1991). Human Figure Drawings of adjudicatedand nonadjudicated adolescents. Journal of Personality Assessment, 57, 77–86. doi:10.1207/s15327752jpa5701_10 May, R. R. (1980). Sex and fantasy: Patterns of male and female development. New York,NY: Norton. McAdams, D. P., Lester, R. M., Brand, P. A., McNamara, W. J., & Lensky, D. B. (1988). Sexand the TAT: Are women more intimate than men? Do men fear intimacy? Journal ofPersonality Assessment, 52, 397–409. doi: 10.1207/s15327752jpa 5203_1 Murray, H. A. (1943). Thematic apperception test: Manual. Cambridge, MA: HarvardUniversity Press. Piotrowski, Z. A. (1950). A new evaluation of the Thematic Apperception Test. PsychoanalyticReview, 37, 101–127. Rapaport, D., Gill, M. M., & Schafer, R. (1968). Diagnostic psychological testing (rev. ed., Ed.R.R.Holt). New York, NY: International Universities Press. (Original work published 1946) Rierdan, J. K., Koff, E., & Heller, H. (1982). Gender, anxiety, and human figure drawings.Journal of Personality Assessment, 46, 594–596. doi: 10.1207/s 15327752jpa4606_6 Schafer, R. (1954). Psychoanalytic interpretation in Rorschach testing: Theory andapplication. New York, NY: Grune & Stratton. Schafer, R. (1967). Projective testing and psychoanalysis: Selected papers. New York, NY:International Universities Press. Schultheiss, O. C., & Brunstein, J. C. (2001). Assessment of implicit motives with a researchversion of the TAT. Journal of Personality Assessment, 77, 71–86. doi:10.1207/S15327752JPA7701_05 Silverstein, M. L. (2013). Personality assessment in depth: A casebook. New York, NY:Routledge. Weiner, I. B. (2003). Principles of Rorschach interpretation (2nd ed.). New York, NY:Routledge. Worchel, F. T., Aaron, L. L., & Yates, D. F. (1990). Gender bias on the ThematicApperception Test. Journal of Personality Assessment, 55, 593–602. doi:10.1207/s15327752jpa5503&4_15 Zaback, T. P., & Waehler, C. A. (1994). Sex of human figure drawings and sex-roleorientation. Journal of Personality Assessment, 62, 552–558. doi: 10.1037/t00748–000 Zucker, K. J., Finegan, J. K., Doering, R. W., & Bradley, S. J. (1983). Human figure drawingsof gender-problem children: A comparison to sibling, psychiatric, and normal controls. Journalof Abnormal Child Psychology, 11, 287–298. doi: 10.1007/BF00912092

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warrant further research regarding the role of certain social or psychological factors or theunique set of stressors that bisexual individuals face. Overall, the findings from this articlesuggest the need for new theories and frameworks incorporating multiple, overlappingidentities and their interplay with multiple, overlapping levels of influence that explain therelationship between discrimination and health outcomes within the LGBT population. Lewinsohn, P. M., Gotlib, I. H., Lewinsohn, M., Seeley, J. R., & Allen, N. B. (1998). Genderdifferences in anxiety disorders and anxiety symptoms in adolescents. Journal of AbnormalPsychology, 107(1), 109–117. doi: 10.1037/0021–843X.107.1.109 Comment: This studyexplored gender differences in anxiety in a sample of adolescents. The authors hypothesizedthat certain psychosocial variables mediated the association between anxiety and gender (inwhich females have been shown to be more likely than males to experience anxiety). Thefindings did not support the hypothesis, as it was not shown that gender differences in anxietycan be explained by differing social roles and experiences for boys versus girls. Rather, theauthors suggested that the results were in line with the contention that gender differences inanxiety are influenced by genetics. Silverman, W. K., & Ollendick, T. H. (2005). Evidence-based assessment of anxiety and itsdisorders in children and adolescents. Journal of Clinical Child and Adolescent Psychology,34(3), 380–411. doi: 10.1207/s15374424jccp3403_2 Comment: This article summarizes the“state of the field” with respect to evidence-baaed assessment measures of anxiety forchildren and adolescents. It also uncovers certain gaps that provide a direction for futureresearch and increased knowledge on the topic. The authors conclude that there are anumber of sound instruments and methods, including structured and semistructureddiagnostic interviews, self-rating scales, direct behavioral observation systems, and self-monitoring forms. The article offers twelve “tentative evidence-based recommendations”based on the authors’ review of the literature. Achenbach, T. (1991). Manual for the child behavior checklist/4–18 and 1991 profile.Burlington, VT: University of Vermont Department of Psychiatry. Achenbach, T. (1992). Manual for the child behavior checklist/2–3 and 1992 profile.Burlington, VT: University of Vermont Department of Psychiatry. Affatati, V., Grattagliano, I., Todarello, O., & Catanesi, R. (2012). Utilizing the Rorschach testin the diagnosis of gender identity disorder and in the evaluation of eligibility for sexreassignment surgery [Abstract]. Rivista di Psichiatria, 47(4), 337–344. doi:10.1708/1139.12562. Antony, M. M., & Stein, M. B. (2009). Oxford handbook of anxiety and related disorders. NewYork, NY: Oxford University Press. Beck, A. T. (1990). Beck Anxiety Inventory (BAI). Bloomington, MN: NCS Pearson. Beck, A. T., & Steer, R. A. (1993). Beck Anxiety Inventory manual. San Antonio, TX:Psychological Corporation. Bellak, L., & Bellak, S. (1949). Children's Apperception Test. New York, NY: C.P.S. Co. Berg, M. B., Mimiaga, M. J., & Safren, S. A. (2008). Mental health concerns of gay andbisexual men seeking mental health services. Journal of Homosexuality, 54(3), 293–306. doi:10.1080/00918360801982215 Bostwick, W. B., Boyd, C. J., Hughes, T. L., & McCabe, S. (2010). Dimensions of sexualorientation and the prevalence of mood and anxiety disorders in the United States. AmericanJournal of Public Health, 100(3), 468–475. doi: 10.2105/AJPH.2008.152942 Bostwick, W. B., Boyd, C. J., Hughes, T. L., West, B. T., & McCabe, S. (2014). Discriminationand mental health among lesbian, gay, and bisexual adults in the United States. AmericanJournal of Orthopsychiatry, 84(1), 35–45. doi: 10.1037/h0098851 Buck, J. N. (2002). House-tree-person projective drawing technique H-T-P manual andinterpretive guide (rev. ed.). Los Angeles, CA: WPS. Budge, S. L., Adelson, J. L., & Howard, K. S. (2013). Anxiety and depression in transgenderindividuals: The roles of transition status, loss, social support, and coping. Journal ofConsulting and Clinical Psychology, 81(3), 545–557. doi: 10.1037/a0031774 Butcher, J. N., Dahlstrom, W. G., Graham, J. R., Tellegen, A., & Kaemmer, B. (1989). TheMinnesota Multiphasic Personality Inventory-2 (MMPI-2): Manual for administration andscoring. Minneapolis, MN: University of Minnesota Press.

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Issues of Gender in the Assessment of Feeding and Eating Disorders Bankoff, S. M., & Pantalone, D. W. (2014). Patterns of disordered eating behavior in womenby sexual orientation: A review. Eating Disorders: The Journal of Treatment & Prevention, 22, 261–274. Comment: The authors noted that most previous research on ED has beenconducted with white, heterosexual women and that more empirical studies are indicated withwomen from diverse backgrounds. They provided a general discussion of methodologicalissues when studying sexual orientation followed by a review of the literature on theinteraction of sexual orientation with ED. Research to date has produced inconsistent results,with some studies noting less body dissatisfaction in sexual minority women, while otherstudies have found increased ED behaviors related to obesity and binge eating. Severalfactors to explain differences in disordered eating related to sexual orientation with someempirical support were discussed, including sexual attraction, gender-related traits, andfeminist beliefs. Jones, W. R., & Morgan, J. F. (2010). Eating disorders in men: A review of the literature.Journal of Public Mental Health, 9, 23–31. Comment: Jones and Morgan provided a review ofthe literature about ED in men, including similarities and differences to women and theoreticalsuppositions regarding gender discrepancies. Issues included age of onset, bodydissatisfaction, methods of weight control, sexual orientation, social learning and muscledysmorphia, bias in diagnosis, biological findings, psychiatric comorbidity, and treatmentconsiderations. The article is helpful as a brief overview of the above issues, to raiseawareness regarding signs and symptoms for clinicians working with men both for evaluationand treatment of potential eating disorders, and the references provide ample furtherreadings from both empirical and theoretical perspectives. MacDonald, D. E. (2011). Impossible bodies, invisible battles: Feminist perspectives on thepsychological research on and treatment of eating disorders in queer women. Journal of Gay& Lesbian Social Services, 23, 452–464. Comment: MacDonald presented a literature reviewregarding ED and queer women, which indicated a scarcity of research and stereotypicalideas. EDs have traditionally been conceptualized as impacting mainly middle- and upper-class white heterosexual women, with the assumption that queer women were insulated. Theheterosexism within the ED literature was discussed as related to heterogeneity of genderrole orientations, cultural beauty standards and queer women, and the etiology of EDs. Thearticle is beneficial as a theoretical view of the interaction of EDs and gender in women, forclinicians who are interested in a discussion of the possibility of a treatment protocol with thepotential for culturally competent modifications, and for researchers who may want to furtherdevelop an area with a scarcity of conclusive knowledge. Although assessment was notdirectly addressed, consideration of issues such as gender role and sexual orientation withinthe assessment and treatment process would be an essential component adaptation oftreatment for queer clients. Abou-Saleh, M. T., Younis, Y., & Karim, L. (1998). Anorexia nervosa in an Arab culture.International Journal of Eating Disorders, 23(2), 207–212. http://doi.org/10.1002/(SICI)1098-108X(199803)23:2<207::AID-EAT11>3.0.CO;2-X Ackard, D. M., & Neumark-Sztainer, D. (2003). Multiple sexual victimizations amongadolescent boys and girls: Prevalence and associations with eating behaviors and

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Butler, J. (1995). Melancholy gender—refused identification. Psychoanalytic Dialogues, 5(2),165–180. doi: 10.1080/10481889509539059 Chodorow, N. J. (1999). The reproduction of mothering. Berkeley, CA: University of CaliforniaPress. Cochran, S. V. (2005). Evidence-based assessment with men. Journal of ClinicalPsychology, 61(6), 649–660. doi: 10.1002/jclp.20100 Conners, C. K., Erhardt, D., & Sparrow, E. (1999). Conners Adult ADHD Rating Scales.(CAARS) technical manual. Toronto, Ontario, Canada: Multi-Health Systems. Corbett, K., Dimen, M., Goldner, V., & Harris, A. (2015). Talking sex, talking gender—Aroundtable. Studies in Gender and Sexuality, 15, 295–317. doi:10.1080/15240657.2014.970493 Delis, D. C., Kramer, J. H., Kaplan, E., & Ober, B. A. (2000). California Verbal LearningTest—Second Edition (CVLT-II). San Antonio, TX: Pearson. Dimen, M., & Goldner, V. (2005). Gender and sexuality. In E.Person, A.Cooper, & G.Gabbard(Eds.), Textbook of Psychoanalysis (pp. 93–111). Washington, DC: American PsychiatricPublishing. Egan, S. K., & Perry, D. G. (2001). Gender identity: A multidimensional analysis withimplications for psychosocial adjustment. Developmental Psychology, 27(4), 451–463. doi:10.1037/0012–1649.37.4.451 Exner, J. E. (2000). Rorschach workbook for the comprehensive system. Asheville, NC:Rorschach Workshops. Finn, S. (2011). Handbook of Therapeutic Assessment. Mahwah, NJ: Lawrence Erlbaum. Friedman, A.S., Lewak, R., Nichols, D. S., & Webb, J. T. (2001). Psychological assessmentwith the MMPI-2. Mahwah, NJ: Lawrence Erlbaum. Harris, A. (2009). Gender as soft assembly. New York, NY: Routledge. Kamanao, D. K. (1960). Symbolic significance of Rorschach cards IV and VII. Journal ofClinical Psychology, 16(1), 50–52. doi: 10.1002/1097–4679(196001)16:1<50::AID-JCLP2270160120>3.0.CO;2–2 Kernberg, O. (1984). Severe personality disorders. New Haven, CT: Yale University Press. Kroenke, K., & Spitzer, R. L. (2002). The PHQ-9: A new depression and diagnostic severitymeasure. Psychiatric Annals, 32(9), 509–521. doi: 10.3928/0048–5713–20020901–06 Kroenke, K., Spitzer, R. L., & Williams, J. B. (2003). The Patient Health Questionnaire–2:Validity of a two-item depression screener. Medical Care, 41(11), 1284–1292. doi:10.1097/01.mlr.0000093487.78664.3c Maccoby, E. E. (1980). Social development: Psychological growth and the parent-childrelationship. New York, NY: Harcourt Brace. Mahalik, J. R. (2001). Cognitive therapy for men. In G.Brooks & G.Good (Eds.), The newhandbook of psychotherapy and counseling with men (pp. 544–564). San Francisco, CA:Jossey-Bass. Meyer, G. J., Viglione, D. J., Mihura, J. L., Erard, R. E., & Erdberg, P. (2011). RorschachPerformance Assessment System: Administration, coding, interpretation, and technicalmanual. Toledo, OH: Rorschach Performance Assessment System. Mitchell, S. A. (1988). Relational concepts in psychoanalysis: An integration. Cambridge, MA:Harvard University Press. Molczanow, A. (2012). Quantification: Transcending beyond Frege's boundaries: A casestudy in transcendental-metaphysical logic (p. xi). Leiden, The Netherlands: Koninklijke BrillNV. Morey, L. C. (2007). The Personality Assessment Inventory professional manual (2nd ed.).Odessa, FL: Psychological Assessment Resources. Murray, H. (1943). The Thematic Apperception Test: Plate and manual. Cambridge, MA:Harvard University Press. Peterson, C. D., & Dahlstrom, W. G. (1992). The derivation of gender role scale GM and GFfor the MMPI-2 and their relationship to Scale 5 (Mf). Journal of Personality Assessment,59(3), 486–499. doi: 10.1207/s15327752jpa5903_5 Rabinowitz, F. E., & Cochran, S. V. (2002). Deepening psychotherapy with men. Washington,DC: American Psychological Association.

Rorschach, H. (1921). Psychodiagnostics. Bern, Switzerland: Verlag Hans Huber. Rotter, J. B., Lah, M. I., & Rafferty, J. E. (1992). Rotter incomplete sentences blank manual(2nd ed.). San Antonio, TX: Psychological Corporation. Sandford, J. A., & Turner, A. (1995). Manual for the Integrated Visual and AuditoryContinuous Performance Test. Richmond, VA: Braintrain. Wechsler, D. (1999). Wechsler Abbreviated Scale of Intelligence. New York, NY: ThePsychological Corporation: Harcourt Brace & Company. Whitehead, M. L. (2006). Unmanageable desires: Toward a relational psychoanalyticapproach to the conceptualization and treatment of compulsive sexual behavior (Doctoraldissertation). Retrieved from ProQuest Dissertations and Theses database. (UMI No.3334269)

A Case of Gender Bias from Indictment to Disposition Bartholomew, K., Cobb, R. J., & Dutton, D. G. (2015). Established and emergingperspectives on violence in intimate relationships. In M. Mikulencer & P. Shaver (Eds.), APAHandbook of Personality and Social Psychology, Interpersonal Relations (Vol. 3, pp.605–630). Washington, DC: American Psychological Association. Comment: This bookchapter provided a comprehensive overview and history of different perspectives of partnerviolence (PV), with discussion about the limits and varying contributions of the differentperspectives. There was considerable research cited to enable the reader to pursueadditional reading on specific points and to demonstrate the range and depth of empiricallyderived support for various conclusions. The discussion of multifactor models was educativeand compelling in the integration of a host of variables related to PV, without becoming miredin potentially distracting details. The cultural context for PV is unusual to find in many studiesof PV and was helpful with regard to the present case study. The authors of this chapterclearly found a feminist perspective on PV to be lacking and provided considerable empiricaldata to support their conclusions. Cummings, A., Gonzalez-Guarda, R. M., & Sandoval, M. F. (2013). Intimate partner violenceamong Hispanics: Review of the literature. Journal of Family Violence, 28(2), 153–171.Comment: This article was a literature review of articles published since 2000 regarding riskand protective factors of IPV experienced by Hispanics. The authors selected 29 articles froma literature search of PsychInfo, PubMed, and Google Scholar. The authors used the Centersfor Disease Control and Prevention's four level social-ecological model of prevention toexamine risks and protections at the individual, relationship, community, and societal factorlevels. Their tables were most helpful in clarifying the individual factors involved in IPV forthese Hispanic samples. The authors also included a table that listed the studies reviewed,sample characteristics, methodologies, and results. The authors concluded that men andwomen share many similar risk factors for both perpetration and victimization of IPV.However, they noted that there were a number of conflicting results for the various studiesand provided attention to thoughtfully detailing these. Their discussion of conflicting resultsregarding cultural factors was presented sensitively and was informative regardingstereotyping. Additionally, what these authors made clear is that different intraethnic groupswere not well represented, making conclusions shaky for a unified picture of individuals fromvarious Hispanic countries. Hence, one area of future research they identified was toaccumulate more information about intraethnic variations among Hispanics from differingcountries of origin. The authors noted the need for research on preventive factors for IPV,especially as this information would undermine stereotyping and would focus on positiveaspects of Hispanic culture that prevent IPV. Hines, D. A., & Douglas, E. M. (2011). Symptoms of post traumatic stress disorder in menwho sustain intimate partner violence: A study of helpseeking and community samples.Psychology of Men and Masculinity, 12(2), 112–127. Comment: This article addressed theeffects of domestic violence resulting in post-traumatic stress disorder (PTSD). Findingsregarding PTSD for women who have suffered intimate partner violence (IPV) is welldocumented in prior research, although the authors of this article remark that such findingsfor men are not well researched. Some differences among types of partner violence are

given, and differences between community versus help-seeking samples are described. Theprimary focus of these authors was in examining the differences between communitysamples and help-seeking samples of men. The limitations of this article include the lack ofsupporting research in the field prior to publication of this study and the fact that this is onlyone study providing these results. If these results are replicated and supported by otherstudies, then these findings support notions that trauma from violent relationships crossesgender lines and is central to symptoms of PTSD, regardless of gender. Radford, L., Abbey, A., Sugarman, D., Rennison, C., & Cuevas, C. A. (2014). Commentary:Best violence research of 2013: Selections from an invited panel of researchers. Psychologyof Violence, 4(3), 241–252. Comment: This article was one requested by journal editor SherryHamby, who invited five senior researchers to identify the best violence research articleswritten in 2013. One of those articles identified was a review article by A. Cummings, R. M.Gonzalez-Guarda, and M. F. Sandoval. This previously cited article was selected for inclusionin the bibliography for this case study because it was a review article, and it examinedintimate partner violence (IPV) in a cultural context and from a social-ecological framework.The importance of this article is due to its focus on the fastest growing minority in the UnitedStates, Hispanics, and due to the lack of studies with this minority group. Additionally, theauthors presented a literature review and incorporated a social-ecological framework fordiscussion of their findings. Many findings, detailed in the review, were congruent withfindings from other studies of risk and protective factors for IPV and for individual-levelfactors. Cultural factors, on the other hand, were mixed with regard to firm conclusions. American Psychiatric Association. (2000). Diagnostic and statistical manual of mentaldisorders (4th ed., text rev., DSM-IV-TR). Washington, DC: American Psychiatric Association. American Psychological Association Presidential Task Force. (1996). Violence and thefamily. Washington, DC: American Psychological Association. Bartholomew, K., Cobb., R., & Dutton, D. (2015). Established and emerging perspectives onviolence in intimate relationships. In M.Mullincer & P.Shaver (Eds.), APA Handbook ofPersonality and Social Psychology, Vol. 3: Interpersonal Relations (pp. 605–630).Washington, DC: American Psychological Assocation. Briere, J. (2001). Detailed Assessment of Post-Traumatic Stress (DAPS). Lutz, FL:Professional Assessment Resources. Butcher, J. N., Ben Porath, Y. S., Dahlstrom, W. G., Graham, J. R., Kaemmer, B., & Tellegen,A. (2001). Minnesota Multiphasic Personality Inventory–2: Manual for administration andscoring (2nd ed.). Minneapolis, MN: University of Minnesota Press. Cummings, A., Gonzalez-Guarda, R. M., & Sandoval, M. F. (2013). Intimate partner violenceamong Hispanics: Review of the literature. Journal of Family Violence, 28(2), 153–171. Drozd, L. (2007). DVCC protocol. Journal of Child Custody, 4(3–4), 19–31. Dutton, D. G. (2007). The abusive personality: Violence and control in intimate relationships(2nd ed.). New York, NY: Guilford Press. Dutton, D. G., & Bodnarchuk, M. (2005). Through a psychological lens: Personality disorderand spouse assault. In D. R.Loseke, R. J.Gelles, & M. M.Cavanaugh (Eds.), CurrentControversies on Family Violence (pp. 5–18). Thousand Oaks, CA: Sage. Dutton, D. G., & Corvo, K. (2006). Transforming a flawed policy: A call to revive psychologyand science in domestic violence research and practice. Aggression and Violent Behavior,11, 457–483. Exner, J. E. (2001). A Rorschach workbook for the comprehensive system (5th ed.).Asheville, NC: Rorschach Workshops. Graham-Kevan, N. (2007). Domestic violence: Research and implications for battererprogrammes in Europe. European Journal on Criminal Policy and Research, 13, 213–225. Greenberg, S. A., Shuman, D., & Meyer, R. G. (2004). Unmasking forensic diagnosis.International Journal of Law & Psychiatry, 27(1), 1–15. Hines, D. A., & Douglas, E. M. (2011). Alcohol and drug abuse in men who sustain intimatepartner violence. Aggressive Behavior, 38(1), 31–46. Johnson, M. P. (2008). A typology of domestic violence: Intimate terrorism, violent resistance,and situational couple violence. Boston, MA: Northeastern University Press. Johnson, M. P., & Ferraro, K. J. (2000). Research on domestic violence in the 1990's: Makingdistinctions. Journal of Marriage & Family, 62(Nov), 948–963.

Johnson, M. P., & Leone, J. M. (2005). The differential effects of intimate terrorism andsituational couple violence: Findings from the national violence against women survey.Journal of Family Issues, 26(3), 322–349. Johnston, J. R., & Campbell, L. E.G. (1993). Parent-child relationships in domestic violencefamilies disputing custody. Family Court Review, 31(3), 282–298. Kelly, J. B., & Johnson, M. P. (2008). Differentiation among types of intimate partner violence:Research update and implications for interventions. Family Court Review, 46(3), 476–499. Millon, T. (1997). Millon Clinical Multiaxial Inventory-III manual (2nd ed.). Minneapolis, MN:National Computer Systems. Meyer, G. J., Viglione, D. J., Mihura, J. L., Erard, R. E., & Erdberg, P. (2001). RorschachPerformance Assessment System: Administration, coding, interpretation and technicalmanual. Toledo, OH: Rorschach Performance Assessment System. Moffitt, T. E., Caspi, A., Krueger, R. F., Magdol, L., Margolin, G., Silva, P. A., & Sydney, R.(1997). Do partners agree about abuse in their relationship? A psychometric evaluation ofinterpartner agreement. Psychological Assessment, 9, 47–56. Morey, L. C. (2007). Personality Assessment Inventory (PAI), professional manual (2nd ed.).Lutz, FL: Professional Assessment Resources. Radford, L., Abbey, A., Sugarman, D., Rennison, C., & Cuevas, C. A. (2014). Commentary:Best violence research of 2013: Selections from an invited panel of researchers. Psychologyof Violence, 4(3), 241–252. Riggs, D. S., Caulfield, M. B., & Fair, K. (2009). Risk of intimate partner violence: Factorsassociated with perpetration and victimization. In P. M.Klesspies (Ed.), Behavioralemergencies: An evidence based resource for evaluating and managing risk of suicide,violence and victimization (pp. 189–208). Washington, DC: American PsychologicalAssociation. Rorschach, H. (1934). Psychodiagnostik (Hans HuberVerlag, Trans.). Bern, Switzerland:Bircher. Samuel, D. B., & Widiger, T. A. (2009). Comparative gender biases in models of personalitydisorder. Personality and Mental Health, 3(1), 12–25. Sciara, A. (1998). Forensic client history and checklist. Asheville, NC: The Grove Clinic. Smith, M. D., & Zahn, M. A. (Eds.). (1999). Homicide: A sourcebook of social research (pp.149–164). Thousand Oaks, CA: Sage.

The Intersection of Gender and Immigration in the PersonalityAssessment of Women American Psychological Association, Presidential Task Force on Immigration. (2012).Crossroads: The psychology of immigration in the new century. Report of the PresidentialTask Force on Immigration. Washington, DC: Author. Comment: This document constitutesthe most overarching review of literature regarding immigrants in the United States and theimmigrant experience. It includes guidelines for the psychologist regarding any type ofpsychological services with this population and includes an impressive list of references. Hays, P. (2008). Addressing cultural complexities in practice: Assessment, diagnosis, andtherapy (2nd ed.). Washington, DC: American Psychological Association. Comment: In thisbook, Hays provides numerous suggestions and guidelines for the clinical practice to ensurethat issues of race, ethnicity, and gender are addressed and integrated. Miville, M. L., & Ferguson, A. D. (Eds.). (2014). The handbook of race-ethnicity and gender inpsychology. New York, NY: Springer. Comment: Within the framework of intersectionality,this book provides an excellent review of the impact of gender and ethnicity in clinicalpractice, including assessment. Acevedo-Polakovich, I. D., Reynaga-Abiko, G., Garriot, P. O., Derefinko, M. K., Wimsatt,L.C.G., & Brown, T. L. (2007). Beyond instrument selection: Cultural considerations in thepsychological assessment of U.S. Latinas/os. Professional Psychology, Research andpractice, 38(4), 375–384. doi: 10.1037/0735–7028.38.4.375

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Psychological Assessment of the Effects of Sexual Harassment Foote, W. E., & Goodman-Delahunty, J. (2005). Evaluating sexual harassment. Washington,DC: American Psychological Association. Comment: This book is a comprehensive guide tothe forensic evaluation of sexual harassment. The authors review the legal framework ofsexual harassment and describe harassers and harassment contexts. They outline thepractical, legal, and ethical contours of the forensic evaluation and discuss assessing liabilityand damages. The addition of two complete forensic psychological reports is especiallyuseful. Gold, L. H. (2004). Sexual harassment: Psychiatric assessment in employment litigation.Washington, DC: American Psychiatric Publishing, Inc. Comment: This book is also focusedon evaluation for the forensic context. The author provides a non-test-based methodology forevaluating the idea of “welcomeness” that must be evaluated in Federal Court and also forevaluating credibility. She also discusses the assessment of emotional injury and damages. Anastasi, A., & Urbina, S. (1997). Psychological testing (7th ed.) Upper Saddle River, NJ:Prentice-Hall. Armstrong, J., & Kaser-Boyd, N. (2003). Projective assessment of trauma. In M.Hilsenroth &D.Segal (Eds.), Objective and projective assessment of personality and psychopathology.Volume 2 in M.Herson (Ed.-in-Chief), Comprehensive handbook of psychological assessment(pp. 500–512). New York, NY: John Wiley & Sons. Beck, A. T., & Steer, R. A. (1993). Beck Anxiety Inventory manual. San Antonio, TX: HarcourtBrace & Company. Berdahl, J. L., Magley, V., & Waldo, C. R. (1996). The sexual harassment of men? Exploringthe concept with theory and data. Psychology of Women Quarterly, 20, 527–547. doi:10.1111/j.1471–6402.1996.tb00320.x Briere, J. (1995). Trauma symptom inventory. Odessa, FL: Psychological AssessmentResources. Briere, J. (2001). Detailed assessment of posttraumatic stress. Odessa, FL: PsychologicalAssessment Resources. Briere, J., & Elliott, D. M. (1997). Psychological assessment of interpersonal victimizationeffects in adults and children. Psychotherapy, 34, 353–364. doi: 10.1037/h0087848 Butcher, J. N., Dahlstrom, W. G., Graham, J. R., Tellegen, A., & Kaemmer, B. (1989). MMPI-2: Manual for administration and scoring. Minneapolis, MN: University of Minnesota Press. Code of Federal Regulations. (2000). Vol. 29, Section 1604.11. Washington, DC: U.S.Government Printing Office. Cook, D. J., Liutkus, J. F., Risdon, C. L., Griffith, L. E., Guyatt, G. H., & Walter, S. D. (1996).Residents’ experiences of abuse, discrimination and sexual harassment during residencytraining. Canadian Medical Association Journal, 154(11), 1657–1665. Retrieved fromhttp://www.cmaj.ca/content/154/11/1657.abstract Dansky, B. S., & Kilpatrick, D. G. (1997). Effects of sexual harassment. In W.O’Donohue(Ed.), Sexual harassment: Theory, research, and treatment (pp. 152–174). Boston, MA: Allynand Bacon. Dansky, B. S., Kilpatrick, D. G., Saunders, B. E., Resnick, H. S., Best, C. L., Hanson, R. F., &Saladin, M. E. (1992, August). Sexual harassment: I can't define it but I know it when I see it.Poster presented at the Annual Meeting of the American Psychological Association,Washington, DC. de Ruiter, C., & Kaser-Boyd, N. (2015). Forensic report writing: The science and the story. InForensic psychological assessment in practice: Case studies (pp. 237–265). New York, NY:Routledge. DeSouza, E. R., & Solbert, J. (2003). Incidence and dimensions of sexual harassment acrosscultures. In M.Paludi & C.Paludi, Jr. (Eds.), Academic and workplace sexual harassment (pp.3–30). Westport, CT: Praeger.

DuBois, C.L.Z., Knapp, D.Z., Faley, R. H., & Kustis, G. (1998). An empirical examination ofsame- and opposite-sex sexual harassment in the workplace. Unpublished manuscript,Graduate School of Management, Kent State University, Kent, OH. Dziech, B. W. (2003). Sexual harassment on college campuses. In M.Paludi & C. A.Paludi,Jr. (Eds.), Academic and workplace sexual harassment: A handbook of cultural, socialscience, management, and legal perspectives (pp. 147–171). Westport, CT: Praeger. Feldman-Schorrig, S. P. (1996). Factitious sexual harassment. Bulletin of the AmericanAcademy of Psychiatry and Law, 24(3), 387–392. Retrieved fromhttp://www.jaapl.org/content/24/3/387.full.pdf+html?sid=84a08fe4–1dd3–47d6-b399–65fb66fd0e75 Feldman-Schorrig, S. P., & McDonald, J. J. (1992). The role of forensic psychiatry in thedefense of sexual harassment cases. Journal of Psychiatry and Law, 20(1), 5–33. Retrievedfrom http://www.sagepub.com/journals/Journal202380 Fitzgerald, L. F., Buchanan, N. T., Collingsworth, L. L., Magley, V. J., & Ramos, A. M. (1999).Junk logic: The abuse defense in sexual harassment litigation. Psychology, Public Policy andLaw, 5, 730–759. doi: 10.1037/1076–8971.5.3.730 Fitzgerald, L. F., Drasgow, F., & Magley, V. J. (1999). Sexual harassment in the armedforces: A test of an integrated model. Military Psychology, 11, 329–349. doi:10.1207/s15327876mp1103_7 Fitzgerald, L. F., Gelfand, M., & Drasgow, F. (1995). Measuring sexual harassment:Theoretical and psychometric advances. Basic and Applied Social Psychology, 17, 425–445.doi: 10.1207/s15324834basp1704_2 Fitzgerald, L. F., & Hesson-McInnis, M. (1989). The dimensions of sexual harassment: Astructural analysis. Journal of Vocational Behavior, 35, 309–326. doi:10.1016/0001–8791(89)90032–8 Fitzgerald, L. F., Magley, V. J., Drasgow, F., & Waldo, C. R. (1999). Measuring sexualharassment in the military: The sexual experiences questionnaire. Military Psychology, 11,243–263. doi: 10.1207/s15327876mp1103_3 Fitzgerald, L. F., & Ormerod, M. (1993). Breaking silence: The sexual harassment of womenin academia and the workplace. In F.Denmark & M.Paludi (Eds.), Handbook of thepsychology of women (pp. 553–581). New York, NY: Greenwood Press. Fitzgerald, L. F., & Shullman, S. L. (1993). Sexual harassment: A research analysis andagenda for the 1990's. Journal of Vocational Behavior, 42, 5–27. doi:10.1006/jvbe.1993.1002 Fitzgerald, L. F., Swan, S., & Magley, V. J. (1997). But was it really sexual harassment?Legal, behavioral, and psychological definitions of the workplace victimization of women. InW.O’Donohue (Ed.), Sexual harassment: Theory, research, and treatment (pp. 5–28).Boston, MA: Allyn & Bacon. Fontana, A., Litz, B., & Rosenheck, R. (2000). Impact of combat and sexual harassment onthe severity of posttraumatic stress disorder among men and women peacekeepers inSomalia. Journal of Nervous and Mental Disease, 188, 163–169. doi:10.1097/00005053–200003000–00006 Foote, W. E., & Goodman-Delahunty, J. (2005). Evaluating sexual harassment. Washington,DC: American Psychological Association. Friedman, A. F., Lewak, R., Nichols, D. S., & Webb, J. T. (2001). Psychological assessmentwith the MMPI-2. Mahwah, NJ: Lawrence Erlbaum. Gold, L. H. (2004). Sexual harassment: Psychiatric assessment in employment litigation.Washington, DC: American Psychiatric Publishing. Gutek, B. (1985). Sex and the workplace. San Francisco, CA: Jossey-Bass. Gutek, B., & O’Connor, M. (1995). The empirical basis for the reasonable woman standard.Journal of Social Issues, 51, 151–166. doi: 10.1111/j.1540–4560.1995.tb01314.x Hamilton, J. A., Alagna, S. W., King, L. S., & Lloyd, C. (1987). The emotional consequencesof gender-based abuse in the workplace: New counseling programs for sex discrimination.Women and Therapy, 6, 155–182. doi: 10.1300/J015V06N01_13 Harris v. Forklift Systems, 510 U.S. 17 (1993). Hopwood, C. J., Morey, L. C., Rogers, R., & Sewell, K. (2007). Malingering on the PersonalityAssessment Inventory: Identification of specific feigned disorders. Journal of Personality

Assessment, 88, 43–48. doi: 10.1207/s15327752jpa8801_06 Kabat-Farr, D., & Cortina, L. M. (2014). Sex-based harassment in employment: New insightsinto gender and context. Law and Human Behavior, 38, 58–72. doi:10.1037/lhb0000045 Kilpatrick, D. G., Dansky, B. S., & Saunders, B. E. (1994). Sexual harassment in theworkplace: Results from the National Women's Study. Charleston, SC: Crime VictimsResearch and Treatment Center, Department of Psychiatry and Behavioral Sciences MedicalUniversity of South Carolina. Leskinen, E. A., Cortina, L. M., & Kabat, D. B. (2011). Gender harassment: Broadening ourunderstanding of sex-based harassment at work. Law and Human Behavior, 35, 25–39. doi:10.1007/s10979–010–9241–5 Loranger, A. W., Sartious, N., & Janca, A. (1996). International Personality DisorderExamination (IPDE). White Plains, NY: World Health Organization. Loy, P. H., & Stewart, L. P. (1984). The extent and effects of sexual harassment on workingwomen. Sociological Focus, 17, 31–43. doi: 10.1080/00380237.1984.10570460 Lundberg-Love, P., & Marmion, S. (2003). Sexual harassment in the private sector. InM.Paludi & C. A.Paludi, Jr. (Eds.), Academic and workplace sexual harassment: A handbookof cultural, social science, management, and legal perspectives (pp. 77–101). Westport, CT:Praeger. Magley, V. J., Waldo, C. R., Drasgow, F., & Fitzgerald, L. F. (1999). The impact of sexualharassment on military personnel: Is it the same for men and women? Military Psychology,11, 283–302. doi: 10.1207/s15327876mp1103_5 Martindale, M. (1990). Sexual harassment in the military: 1988. Arlington, VA: DefenseManpower Data Center. McDermut, J. F., Haaga, D.A.F., & Kirk, L. (2000). An evaluation of stress symptomsassociated with academic sexual harassment. Journal of Traumatic Stress, 13, 397–411. doi:10.1023/A:1007725022534 McDonald, J. J., & Feldman-Schorrig, S. P. (1994). The relevance of childhood sexual abusein sexual harassment cases. Employee Relations Labor Journal, 20(2), 221–236. Retrievedfrom http://www.wklawbusiness.com/store/products/employee-relations-law-journal-prod-000000000010011163/internet-item-1–000000000010011163 Miller, J. B., & Stiver, I. P. (1997). The healing connection: How women form relationships intherapy and in life. Boston, MA: Beacon Press. Morey, L. (1991). Personality Assessment Inventory. Odessa, FL: Psychological AssessmentResources. Murray, H. (1943). Thematic Apperception Test manual. Cambridge, MA: Harvard UniversityPress. Oncale v. Sundowner Offshore Services, 523 U.S. 75 (1998). Parmerlee, M. A., Near, J. P., & Jensen, T. C. (1982). Correlates of whistle-blower'sperceptions of organizational retaliation. Administrative Science Quarterly, 27(1), 17–34.Retrieved from http://asq.sagepub.com/ Palmieri, P. A., & Fitzgerald, L. F. (2005). Confirmatory factor analysis of posttraumatic stresssymptoms in sexually harassed women. Journal of Traumatic Stress, 18, 657–666. doi:10.1002/jts.20074 Pryor, J. B. (1995). The phenomenology of sexual harassment: Why does sexual behaviorbother people in the workplace? Consulting Psychology Journal: Practice & Research, 47(3),160–168. doi: 10.1037/1061–4087.47.3.160 Quart, A. (2013, May 17). When Geeks attack. Marie Claire. Retrieved fromhttp://www.marieclaire.com/career-advice/tips/a7664/geeks-attack/ Richman, J. A., Rospenda, K., Nawyn, S., Flaherty, J., Fendrich, M., Drum, M., & Johnson, T.(1999). Sexual harassment and generalized workplace abuse among university employees:Prevalence and mental health correlates. American Journal of Public Health, 89, 358–363.doi: 10.2105/AJPH.89.3.358 Richman, J. A., Shinsako, S. S., Rospenda, K. M., Flaherty, J. A., & Freels, S. (2002).Workplace harassment/abuse and alcohol-related outcomes and the mediating role ofpsychological distress. Journal of Studies on Alcohol, 63(4), 412–419. Retrieved fromhttp://www.jsad.com/

Rogers, R., Sewell, K. W., & Gillard, N. D. (2010). SIRS-2, Structured interview of reportedsymptoms (2nd ed.). Odessa, FL: Psychological Assessment Resources. Rogers, R., Sewell, K. W., Martin, M. A., & Vitacco, M. J. (2003). Detection of feigned mentaldisorders: A meta-analysis of the MMPI-2 and malingering. Assessment, 10, 160–177. doi:10.1177/1073191103010002007 Rosenthal, R. R., & Rosnow, R. L. (2009). Artifacts in behavioral research. New York, NY:Oxford University Press. Salisbury, J., Ginorio, A. B., Remick, H., & Stringer, D. M. (1986). Counseling victims ofsexual harassment. Psychotherapy, 23, 316–324. doi: 10.1037/h0085616 Saunders, B. E. (1992, October). Sexual harassment of women in the workplace: Resultsfrom the National Women's Study. Presentation at the Eighth Annual North Carolina/SouthCarolina Labor Law Seminar, Asheville, NC. Stockdale, M. S., Visio, M., & Batra, L. (1999). The sexual harassment of men: Evidence for abroader theory of sexual harassment and sex discrimination. Psychology, Public Policy, andLaw, 5, 630–664. doi: 10.1037/1076–8971.5.3.630 Till, F. J. (1980). Sexual harassment: A report on the sexual harassment of students.Washington, DC: National Advisory Council on Women's Educational Program. U.S. Merit Systems Protection Board (USMSPB). (1981). Sexual harassment of federalworkers: Is it a problem? Washington, DC: Government Printing Office. U.S. Merit Systems Protection Board (USMSPB). (1995). Sexual harassment in the federalworkplace: Trends, progress, and continuing challenges. Washington, DC: U.S. GovernmentPrinting Office. Waldo, C. R., Berdahl, J. L., & Fitzgerald, L. F. (1998). Are men sexually harassed? If so, bywhom? Law and Human Behavior, 22, 59–79. doi: 10.1023/A:1025776705629 Weathers, F. W., Litz, B. T., Herman, D. S., Huska, J. A., & Keane, T. M. (1993, October).The PTSD Checklist: Reliability, validity, and diagnostic utility. Paper presented at the annualmeeting of the International Society for Traumatic Stress Studies, San Antonio, TX. Westen, D. (1991a). Clinical assessment of object relations using the TAT. Journal ofPersonality Assessment, 56, 56–74. doi: 10.1207/s15327752jpa5601_6 Westen, D. (1991b). Social cognition and object relations. Psychological Bulletin, 109,429–455. doi: 10.1037/0033–2909.109.3.429

Psychological Assessment with Trans People Anton, B. S. (2009). Proceedings of the American Psychological Association for thelegislative year 2008: Minutes of the annual meeting of the Council of Representatives.American Psychologist, 64, 372–453. http://dx.doi.org/10.1037/a0015932 Comment: This isthe text of the American Psychological Association's resolutions regarding the need forpsychologists to work effectively with trans people. It details the systemic biases against transpeople and proposes ways psychologists can address them. Hendricks, M. L., & Testa, R. J. (2012). A conceptual framework for clinical work withtransgender and gender nonconforming clients: An adaptation of the minority stress model.Professional Psychology: Research and Practice, 43(5), 460–467.http://dx.doi.org/10.1037/a0029597 Comment: This article provides a comprehensiveoverview of the Minority Stress Model as applied to trans people. This will help the assessorto approach the assessment experience with greater empathy, to better select assessmentinstruments, to interpret findings within the social, cultural, and familial context of the transperson, and to make recommendations that consider the intersectionality of multiple minoritystatus. Nadal, K. L., Skolnik, A., & Wong, Y. (2012). Interpersonal and systemic microaggressionstoward transgender people: Implications for counseling. Journal of LGBT Issues inCounseling, 6, 55–82. http://dx.doi.org/10.1080/15538605.2012.648583 Comment: Thisarticle provides concrete examples of microaggressions and biases experienced by transpeople, offering the assessor clear guidance on how not to enact these in the assessmentexperience.

American Psychological Association. (2014). Answers to your questions about transgenderpeople, gender identity and gender expression. Retrieved fromhttp://www.apa.org/topics/lgbt/transgender.pdf Anderson, M. Z., Croteau, J. M., Chung, Y. B., & DiStefano, T. M. (2001). Developing anassessment of sexual identity management for lesbian and gay workers. Journal of CareerAssessment, 9, 243–260. http://dx.doi.org/10.1177/106907270100900303 Anton, B. S. (2009). Proceedings of the American Psychological Association for thelegislative year 2008: Minutes of the annual meeting of the Council of Representatives.American Psychologist, 64, 372–453. http://dx.doi.org/10.1037/a0015932 Aronson, E. (2011). The social animal. New York, NY: Worth Publishers. Balsam, K. F., Beadnell, B., & Molina, Y. (2013). The daily heterosexist questionnaire:Measuring minority stress among lesbian, gay, bisexual, and transgender adults.Measurement and Evaluation in Counseling and Development, 46(1), 3–25.http://dx.doi.org/10.1177/0748175612449743 Balsam, K. F., Molina, Y., Beadnell, B., Simoni, J., & Walters, K. (2011). Measuring multipleminority stress: The LGBT people of color microaggressions scale. Cultural Diversity andEthnic Minority Psychology, 17(2), 163–174. http://dx.doi.org/10.1037/a0023244 Beck, A. T., & Steer, R. A. (1993). BAI: Beck Anxiety Inventory manual. San Antonio, TX:Psychological Corporation. Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck Depression Inventory(2nd ed.). San Antonio, TX: Psychological Corporation. Borg, M. B. (2011). Heist-ing the analyst's penis (at gunpoint): Community enactment in thetreatment of an FtM transgendered analysand. International Journal of Transgenderism, 13,77–90. http://dx.doi.org/10.1080/15532739.2011.623652 Bram, A., & Peebles, M. R. (2014). Psychological testing that matters: Creating a road mapfor effective treatment. Washington, DC: American Psychological Association. Brewster, M. E., Velez, B., DeBlaere, C., & Moradi, B. (2012). Transgender individuals’workplace experiences: The applicability of sexual minority measures and models. Journal ofCounseling Psychology, 59, 60–70. http://dx.doi.org/10.1037/a0025206 Bromberg, P. M. (1996). Standing in the spaces: The multiplicity of self and thepsychoanalytic relationship. Contemporary Psychoanalysis, 32(4), 509–535.http://dx.doi.org/10.1080/00107530.1996.10746334 Corbett, K. (2009). Boyhoods: Rethinking masculinities. New Haven, CT: Yale UniversityPress. DeVinney, H. (2014, March). (Trans)lating results: Reconsidering how we understandpersonality assessment with individuals who identify as gender non-conforming ortransgender. Paper presented at the annual convention of the Society for PersonalityAssessment, Arlington, VA. de Vries, A. L., Kreukels, B. P., Steensma, T. D., Doreleijers, T. A., & Cohen-Kettenis, P. T.(2011). Comparing adult and adolescent transsexuals: An MMPI-2 and MMPI-A study.Psychiatry Research, 186(2), 414–418. http://dx.doi.org/10.1016/j.psychres.2010.07.033 Drescher, J., & Byne, W. (2012). Gender dysphoric/gender variant (GD/GV) children andadolescents: Summarizing what we know and what we have yet to learn. Journal ofHomosexuality, 59, 501–510. http://dx.doi.org/10.1080/00918369.2012.653317 Drewlo, M. (2011). The Riddle Scale adapted for transphobia. Retrieved fromhttp://www.servicegrowth.net/documents/Riddle%20Scale%20for%20Transphobia.net.pdf Gamarel, K. E., Reisner, S. L., Laurenceau, J. P., Nemoto, T., & Operario, D. (2014). Genderminority stress, mental health, and relationship quality: A dyadic investigation of transgenderwomen and their cisgender male partners. Journal of Family Psychology, 28(4), 437–447.http://dx.doi.org/10.1037/a0037171 Gender Equity Resource Center. (2014). Definition of terms. Retrieved fromhttp://geneq.berkeley.edu/lgbt_resources_definiton_of_terms GLAAD. (2014). 2014 where we are on TV. Retrieved fromhttp://www.glaad.org/files/GLAAD-2014-WWAT.pdf Goldner, V. (2011a). Trans: Gender in free fall. Psychoanalytic Dialogues, 21, 159–171.http://dx.doi.org/10.1080/10481885.2011.562836

Goldner, V. (2011b). Transgender subjectivities: Introduction to papers by Goldner, Suchet,Saketopoulou, Hansbury, Salamon & Corbett, and Harris. Psychoanalytic Dialogues, 21,153–158. http://dx.doi.org/10.1080/10481885.2011.562833 Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J., Herman, J. L., & Keisling, M. (2011).Injustice at every turn: A report of the national transgender discrimination survey.Washington, DC: National Center for Transgender Equality and National Gay and LesbianTask Force. Griffin, L. (2011). The other dual role: Therapist as advocate with transgender clients. Journalof Gay & Lesbian Mental Health, 15, 235–236.http://dx.doi.org/10.1080/19359705.2011.553777 Hansbury, G. (2011). King Kong & Goldilocks: Imagining transmasculinities through the trans-trans dyad. Psychoanalytic Dialogues, 21, 210–220.http://dx.doi.org/10.1080/10481885.2011/562846 Harris, A. (2011). Gender as a strange attractor: Discussion of the transgender symposium.Psychoanalytic Dialogues, 21, 230–238. http://dx.doi.org/10.1080/10481885.2011.562849 Hendricks, M. L., & Testa, R. J. (2012). A conceptual framework for clinical work withtransgender and gender nonconforming clients: An adaptation of the minority stress model.Professional Psychology: Research and Practice, 43(5), 460–467.http://dx.doi.org/10.1037/a0029597 Kassoff, B. (2004). The queering of relational psychoanalysis: Who's topping whom? Journalof Lesbian Studies, 8(1/2), 159–176. http://dx.doi.org/10.1300/J155v08n01_10 Liddle, B. J., Luzzo, D. A., Hauenstein, A. L., & Schuck, K. (2004). Construction andvalidation of the lesbian, gay, bisexual, and transgendered climate inventory. Journal ofCareer Assessment, 12(1), 33–50. http://dx.doi.org/10.1177/1069072703257722 Mascis, A. N. (2011). Working with transgender survivors. Journal of Gay & Lesbian MentalHealth, 15, 200–210. http://dx.doi.org/10.1080/19359705.2011.553782 McGuire, J. K., Anderson, C. R., Toomey, R. B., & Russell, S. T. (2010). School climate fortransgender youth: A mixed method investigation of student experiences and schoolresponses. Journal of Youth and Adolescence, 39, 1175–1188.http://dx.doi.org/10.1007/s10964–010–9540–7 Meyer, G. J., Viglione, D. J., Mihura, J. L., Erard, R. E., & Erdberg, P. (2011). RorschachPerformance Assessment System: Administration, coding, interpretation, and technicalmanual. Toledo, OH: Rorschach Performance Assessment System. Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of Health andSocial Behavior, 36, 38–56. http://dx.doi.org/10.2307/2137286 Michel, N. M., Goldberg, J. O., Heinrichs, R. W., Miles, A. A., Ammari, N., & McDermid Vaz,S. (2013). WAIS-IV profile of cognition in schizophrenia. Assessment, 20(4), 462–473. doi:10.1177/1073191113478153 Mitchell, S. A. (1993). Hope and dread in psychoanalysis. New York, NY: Basic Books. Morey, L. C. (2007). The Personality Assessment Inventory professional manual. Lutz, FL:Psychological Assessment Resources. Mormont, C., Michel, A., & Wauthy, J. (1995). Transsexualism and connection with reality:Rorschach data. Rorschachiana, 20(1), 172–187.http://dx.doi.org/10.1027/1192–5604.20.1.172 Murray, H. A. (1943). Thematic Apperception Test manual. Cambridge, MA: HarvardUniversity Press. Nadal, K. L. (2013). That's so gay: Microaggressions and the lesbian, gay, bisexual, andtransgender community. Washington, DC: American Psychological Association. Nadal, K. L., Skolnik, A., & Wong, Y. (2012). Interpersonal and systemic microaggressionstoward transgender people: Implications for counseling. Journal of LGBT Issues inCounseling, 6, 55–82. http://dx.doi.org/10.1080/15538605.2012.648583 Peterson, C. A. (1992). A psychotic gynemimetic: I just had a pregnant thought. Journal ofPersonality Assessment, 58(3), 464–479. http://dx.doi.org/10.1207/s15327752jpa5803_3 Piedmont, R. L., Satolove, R. L., & Fleming, M. Z. (1989). Discriminating psychotic andaffective disorders using the WAIS-R. Journal of Personality Assessment, 53(4), 739–748.http://dx.doi.org/10.1207/s15327752jpa5304_10

Poteat, T., German, D., & Kerrigan, D. (2013). Managing uncertainty: A grounded theory ofstigma in transgender health care. Social Science & Medicine, 84, 22–29.http://dx.doi.org/10.1016/j.socscimed.2013.02.019 Prince, J. P., & Potoczniak, M. J. (2012). Using psychological assessment tools with lesbian,gay, bisexual, and transgender clients. In S. H.Dworkin & M.Pope (Eds.), Casebook forcounseling lesbian, gay, bisexual, and transgender persons and their families (pp. 319–329).Alexandria, VA: American Counseling Association. Richmond, K. A., Burness, T., & Carroll, K. (2012). Lost in trans-lation: Interpreting systemsof trauma for transgender clients. Traumatology, 18(1), 45–57.http://dx.doi.org/10.1177/1534765610396726 Riddle, D. (1994). The Riddle Scale. In Alone no more: Developing a school support systemfor gay, lesbian, and bisexual youth (pp. 32–33). St. Paul, MN: Minnesota State Department. Saketopoulou, A. (2011). Minding the gap: Intersections between gender, race, and class inwork with gender variant children. Psychoanalytic Dialogues, 21, 192–209.http://dx.doi.org/10.1080/10481885.2011.562845 Sanganjanavanich, V. F. (2014). Counseling transgender clients. In M. J.Ratts & P.B.Pederson (Eds.), Counseling transgender clients. Counseling for multiculturalism andsocial justice: Integration, theory, and application (4th ed., pp. 229–244,). Hoboken, NJ:Wiley. Shelton, J., Winterkorn, G., Gay, H., Sabatino, C., & Brigham, F. (2011). Providing to one'sown community: A panel discussion. Journal of Gay & Lesbian Mental Health, 15, 211–217.http://dx.doi.org/10.1080/19359705.2011.553780 Stotzer, R. L. (2009). Violence against transgender people: A review of United States data.Aggression and Violent Behavior, 14, 170–179. http://dx.doi.org/10.1016/j.avb.2009.01.006 Suchet, M. (2011). Crossing over. Psychoanalytic Dialogues, 21, 172–191.http://dx.doi.org/10.1080/10481885.2011.562842 Tuber, S., & Coates, S. (1989). Indices of psychopathology in the Rorschachs of boys withsevere gender identity disorder: A comparison with normal control subjects. Journal ofPersonality Assessment, 53(1), 100–112. http://dx.doi.org/10.1207/s15327752jpa5301_11 Waldo, C. R. (1999). Working in a majority context: A structural model of heterosexism asminority stress in the workplace. Journal of Counseling Psychology, 46, 218–232.http://dx.doi.org/10.1037/0022–0167.46.2.218 Weathers, F. W., Litz, B. T., Keane, T. M., Palmieri, P. A., Marx, B. P., & Schnurr, P. P.(2013). The PTSD Checklist for DSM-5 (PCL-5). Scale available from the National Center forPTSD at http://www.ptsd.va.gov. Wechsler, D. (2008). Wechsler Adult Intelligence Scale (4th ed.). San Antonio, TX: Pearson.

Using Therapeutic Assessment in Psychological AssessmentsRequired for Sex Reassignment Surgery American Psychological Association. (2008). Report of the task force on gender identity andgender variance. Washington, DC: American Psychological Association. Comment: Thisslightly dated but excellent report commissioned by the APA gives an excellent summary ofhow psychologists can support transgender individuals. Lev, A. I. (2004). Transgender emergence: Therapeutic guidelines for working with gendervariant people and their families. New York, NY: Haworth Press. Comment: Thiscomprehensive books gives an excellent summary of the research and issues relevant toworking with gender-variant people and spells out a strengths-based approach for mentalhealth professionals treating such clients. World Professional Association for Gender Health (WPATH). (2012). Standards of care forthe health of transsexual, transgender, and gender nonconforming people, version 7.International Journal of Transgenderism, 13(4), 165–232. doi: 10.1080/15532739.2011.700873 Comment: Although this document is criticized as paternalistic by some transgenderrights groups, it lays out the standards of care that many medical professionals adhere to inconducting medical interventions with transgender individuals. Every mental health

professional working with transgender clients needs to be familiar with these guidelines. American Psychiatric Association. (2013). Diagnostic and statistical manual of mentaldisorders (5th ed.). Washington, DC: Author. American Psychological Association. (2008a). Report of the task force on gender identity andgender variance. Washington, DC: American Psychological Association. American Psychological Association. (2008b). Resolution on transgender, gender identity,and gender expression non-discrimination. Washington, DC: American PsychologicalAssociation. Ben-Porath, Y. S., & Tellegen, A. (2008). MMPI–2–RF (Minnesota Multiphasic PersonalityInventory–2 Restructured Form): Manual for administration, scoring, and interpretation.Minneapolis, MN: University of Minnesota Press. Butcher, J. N., Graham, J. R., Ben-Porath, Y. S., Tellegen, A., Dahlstrom, W. G., &Kaemmer, B. (2001). MMPI-2: Manual for administration, scoring, and interpretation (reviseded.). Minneapolis, MN: University of Minnesota Press. Evans, F. B. (2012). Therapeutic Assessment alternative to custody evaluation: Anadolescent whose parents could not stop fighting. In S.Finn, C. T.Fischer, & L.Handler (Eds.),Collaborative/Therapeutic Assessment: A casebook and guide (pp. 357–378). Hoboken, NJ:Wiley. Exner, J. (2003). The Rorschach: A comprehensive system (4th ed.). Hoboken, NJ: Wiley. Finn, S. E. (1996a). A manual for using the MMPI-2 as a therapeutic intervention.Minneapolis, MN: University of Minnesota Press. Finn, S. E. (1996b). Assessment feedback integrating MMPI-2 and Rorschach findings.Journal of Personality Assessment, 67, 543–557. doi: 10.1207/s15327752jpa6703_10 Finn, S. E. (2003). Therapeutic Assessment of a man with ‘ADD.’ Journal of PersonalityAssessment, 80, 115–129. Finn, S. E. (2007). In our clients’ shoes: Theory and techniques of Therapeutic Assessment.Mahwah, NJ: Lawrence Erlbaum. Finn, S. E. (2009). What are the core values of Therapeutic Assessment? Retrieved fromhttps://therapeuticassessment.com/about4.html Finn, S. E., Fischer, C. T., & Handler, L. (2012). Collaborative/Therapeutic Assessment: Acasebook and guide. Hoboken, NJ: Wiley. Finn, S. E., & Martin, H. (2013). Therapeutic Assessment: Using psychological testing asbrief therapy. In K. F.Geisinger (Ed.-in-Chief), APA handbook of testing and assessment inpsychology (Vol. 2, pp. 453–465). Washington, DC: American Psychological Association. Finn, S. E., & Tonsager, M. E. (1992). Therapeutic effects of providing MMPI-2 test feedbackto college students awaiting therapy. Psychological Assessment, 4, 278–287. doi:10.1037/1040–3590.4.3.278 Finn, S. E., & Tonsager, M. E. (1997). Information-gathering and therapeutic models ofassessment: Complementary paradigms. Psychological Assessment, 9, 374–385. doi:10.1037/1040–3590.9.4.374 Fischer, C. T. (1970). The testee as co-evaluator. Journal of Counseling Psychology, 17,70–76. doi: 10.1037/h0028630 Fischer, C. T. (1978). Collaborative psychological assessment. In C. T.Fischer & S.L.Brodsky (Eds.), Client participation in human services (pp. 41–61). New Brunswick, NJ:Transaction Books. Fischer, C. T. (1985/1994). Individualizing psychological assessment. Mahwah, NJ:Routledge. Fischer, C. T. (2004). Individualized assessment moderates the impact of HIPAA privacyrules. Journal of Personality Assessment, 82(1), 35–38. doi: 10.1207/s15327752jpa8201_6 Fischer, C. T., & Finn, S. E. (2014). Developing the life meaning of psychological test data:Collaborative and therapeutic approaches. In R. P.Archer & S. R.Smith (Eds.), Personalityassessment (2nd ed., pp. 401–431). New York, NY: Routledge. Handler, L. (1999). The assessment of playfulness: Hermann Rorschach meets D. W.Winnicott. Journal of Personality Assessment, 72, 208–217. doi:10.1207/S15327752JP720205 Handler, L. (2006). Therapeutic Assessment with children and adolescents. In S.Smith &L.Handler (Eds.), Clinical assessment of children and adolescents: A practitioner's guide (pp.

53–72). Mahwah, NJ: Lawrence Erlbaum. Handler, L. (2012). Collaborative storytelling with children: An unruly six-year-old boy. In S.E.Finn, C. T.Fischer, & L.Handler (Eds.), Collaborative/Therapeutic Assessment: A casebook and guide (pp. 243–266). Hoboken, NJ: Wiley. Jeffreys, S. (2014). Gender hurts: A feminist analysis of the politics of transgenderism. NewYork, NY: Routledge. Lev, A. I. (2004). Transgender emergence: Therapeutic guidelines for working with gendervariant people and their families. New York, NY: Haworth Press. Martin, E. H., & Finn, S. E. (2010). Masculinity and femininity in the MMPI-2 and MMPI-A.Minneapolis, MN: University of Minnesota Press. Olson, S. E., & Möller, A. (2006). Regret after sex-reassignment surgery in a male-to-femaletranssexual: A long term follow-up. Archives of Sexual Behavior, 35(4), 501–506. doi:10.1007/s10508–006–9040–8 Purves, C. (2002). Collaborative assessment with involuntary populations: Foster childrenand their mothers. The Humanistic Psychologist, 30, 164–174. doi: 10.1080/08873267.2002.9977031 Raymond, J. G. (1979). The transsexual empire: The making of the she-male. Boston, MA:Beacon Press. Rorschach, H. (1921). Rorschach plates: Psychodiagnostic plates. Bern, Switzerland: VerlagHans Huber AG. Thurston, N. S., & Cradock O’Leary, J. A. (2009). Thurston-Cradock Test of Shame. LosAngeles, CA: Western Psychological Services. World Professional Association for Gender Health (WPATH). (2012). Standards of care forthe health of transsexual, transgender, and gender nonconforming people, version 7.International Journal of Transgenderism, 13(4), 165–232. doi: 10.1080/15532739.2011.700873

Assessment of Pretend Play: Gender Similarities and Differences Russ, S. W. (2004). Play in child development and psychotherapy: Toward empiricallysupported practice. Mahwah, NJ: Lawrence Erlbaum. Comment: This book overviews thefoundations of play therapy and presents evidence on how this technique has empiricalsupport and validation. Sandra Russ applies the field's understanding of the role of play inchild development to the mental health field, which aims to design intervention andprevention programs that can be empirically evaluated. Overall, the book overviews clinicaland developmental research and theory and provides an updated review of approaches tousing play in both therapeutic work and assessment. Russ, S. W. (2014). Pretend play in childhood: Foundation of adult creativity. Washington,DC: APA Books. Comment: This book reviews the theory and research on pretend play andcreativity. Sandra Russ provides evidence that pretend play in childhood creates a foundationfor the continued development of adult creativity. She describes cognitive and affectiveprocesses involved in play and creativity, as measured by the Affect in Play Scale. Theoriesas to how play development may stem from evolutionary processes are also reviewed. Theimportance of pretend play in emotional development is discussed, along with how theseprocesses can be targeted in intervention. Carlson, S. M., & Taylor, M. (2005). Imaginary companions and impersonated characters:Sex differences in children's fantasy play. Merrill-Palmer Quarterly, 51(1), 93–118. Chessa, D., Riso, D. D., Delvecchio, E., Salcuni, S., & Lis, A. (2011). The Affect in PlayScale: Confirmatory factor analysis in elementary school children. Psychological Reports,109(3), 759–774. doi: 10.2466/09.10.21.PR0.109.6.759–774 Fehr, K. K., & Russ, S. W. (2013). Aggression in pretend play and aggressive behavior in theclassroom. Early Education & Development, 24(3), 332–345. Fein, G. (1987). Pretend play: Creativity and consciousness. In P.Gorlitz & J.Wohlwill (Eds.),Curiosity, imagination and play (pp. 281–304). Hillsdale, NJ: Lawrence Erlbaum.

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Silence Harms American Psychological Association. (2012). Guidelines for psychological practice withlesbian, gay, and bisexual clients. American Psychologist, 67(1), 10–42. Comment: Theseguidelines are essential for guiding ethnical clinical work, including assessment, with sexualminority clients. Attitudes toward sexual orientation (e.g., nonheterosexual sexual orientationsare not mental illnesses; psychologists should strive to distinguish sexual orientation fromgender identity), workplace issues, education and training, and research considerations arejust a few of the areas covered. Each guideline is supported by descriptions of its rationaleand application, as well as a review of the literature supporting the particular guideline. Theseguidelines should inform the practice of every psychologist, and it would be particularlybeneficial for these guidelines to be initially reviewed early in training. Martell, C. R., Safren, S. A., & Prince, S. E. (2004). Cognitive-behavioral therapies withlesbian, gay, and bisexual clients. New York, NY: Guilford Press. Comment: This bookprovides a helpful overview of clinical work with sexual minority clients. The authors areresearchers and clinicians who are experts in the field of culturally competent mental healthcare of sexual minority clients. Assessment, case conceptualization, and treatment planningare reviewed within a cognitive-behavioral framework. Treating depression and anxiety and

conducting couples therapy are particularly highlighted. How the case conceptualization andtreatment plan are influenced by the client's sexual orientation (or not) is described andillustrated with detailed examples that clinicians will find interesting and applicable. Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexualpopulations: Conceptual issues and research evidence. Psychological Bulletin, 129,674–697. doi: http://dx.doi.org/10.1037/0033–2909.129.5.674 Comment: This seminal articledescribes the Minority Stress Model, which is a useful framework for understanding howprejudice and stigma can impact the mental health of sexual minorities. Meyer details howexternal, objective stressful events (e.g., discrimination), expectation of such events and theassociated (sometimes adaptive) hypervigilance, and internalized negative societal attitudescan result in mental health disparities among sexual minorities, as well as other marginalizedgroups. The role of coping and social support in attenuating the negative impact of proximaland distal stressors is also highlighted. These concepts are essential for assessment, caseconceptualization, and treatment planning. While the articles focuses primarily on theory, theclinical applications will be readily apparent to both experienced clinicians and trainees. American Psychological Association. (2011). Guidelines for psychological practice withlesbian, gay and bisexual clients: Attitudes toward homosexuality and bisexuality. RetrievedOctober 20, 2011, from http://www.apa.org/pi/lgbt/resources/guidelines.aspx?item=3 American Psychological Association. (2012). Guidelines for psychological practice withlesbian, gay, and bisexual clients. American Psychologist, 67(1), 10–42. doi:http://dx.doi.org/10.1037/a0024659 American Psychological Association. (2015). Guidelines for clinical supervision in healthservice psychology. The American Psychologist, 70(1), 33–46.http://dx.doi.org/10.1037/a0038112 American Psychological Association Task Force on Gender Identity and Gender Variance.(2009). Report of the task force on gender identity and gender variance. Washington, DC:Author. Ayvazian, A. (2004). Interrupting the cycle of oppression: The role of allies as agents ofchange. In P. S.Rothenberg (Ed.), Race, class and gender in the United States: An integratedstudy (6th ed., pp. 598–604). New York, NY: Worth. Balsam, K. F., Beauchaine, T. P., Mickey, R. M., & Rothblum, E. D. (2005). Mental health oflesbian, gay, bisexual, and heterosexual siblings: Effects of gender, sexual orientation, andfamily. Journal of Abnormal Psychology, 114, 471–476.http://dx.doi.org/10.1037/0021–843X.114.3.471 Bertsch, K. N., Bremer-Landau, J. D., Inman, A. G., DeBoer Kreider, E. R., Price, T. A., &DeCarlo, A. L. (2014). Evaluation of the critical events in supervision model using genderrelated events. Training and Education in Professional Psychology, 8(3), 174–181. doi:10.1037/tep0000039 Bockting, W. O., Miner, M. H., Swinburne Romine, R. E., Hamilton, A., & Coleman, E. (2013).Stigma, mental health, and resilience in an online sample of the US transgender population.American Journal of Public Health, 103, 943–951.http://dx.doi.org/10.2105/AJPH.2013.301241 Boysen, G. A., & Vogel, D. L. (2008). The relationship between level of training, implicit bias,and multicultural competency among counselor trainees. Training and Education inProfessional Psychology, 2(2), 103–110. doi: 10.1037/1931–3918.2.2.103 Cochran, S. D. (2001). Emerging issues in research on lesbians’ and gay men's mentalhealth: Does sexual orientation really matter? American Psychologist, 56, 929–947.http://dx.doi.org/10.1037/0003–066X.56.11.931 Cochran, S. D., & Mays, V. M. (2009). Burden of psychiatric morbidity among lesbian, gay,and bisexual individuals in the California Quality of Life Survey. Journal of AbnormalPsychology, 118, 647–658. http://dx.doi.org/10.1037/a0016501 Cochran, S. D., Sullivan, J. G., & Mays, V. M. (2003). Prevalence of mental disorders,psychological distress, and mental health services use among lesbian, gay, and bisexualadults in the United States. Journal of Consulting and Clinical Psychology, 71, 53–61.http://dx.doi.org/10.1037/0022–006X.71.1.53 Cochran, S. V., & Rabinowitz, F. E. (2003). Gender-sensitive recommendations forassessment and treatment of depression in men. Professional Psychology: Research &

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Sex, Gender, and Psychological Assessment: Integrating Principleand Feminist Ethics Brown, L. S. (2010). Feminist therapy. Washington, DC: American Psychological Association.Comment: Part of the APA's Theories of Psychotherapy Series, this concise volume providesan excellent introduction to—or refresher on—feminist therapy. Brown traces thedevelopmental trajectory of feminist therapy, from its roots in the women's liberationmovements of the 1970s to its integration with multicultural counseling in current clinicalpractice. It includes sections on history, theory, practice, and future directions. Rave, E. J., & Larsen, C. C. (Eds.). (1995). Ethical decision making in therapy: Feministperspectives. New York, NY: Guilford Press. Comment: Though somewhat outdated, thisvolume traces the development and evolution of the Feminist Therapy Code of Ethics. Itoffers numerous vignettes with ethical commentaries from a variety of clinicians, focused onissues such as diagnosis, overlapping relationships, and therapist self-care.

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Sex, Gender, and Sexuality in Psychological Assessment: Where DoWe Go From Here? Cochran, S. V. (2005). Evidence-based assessment with men. Journal of Clinical Psychology, 61(6), 649–660. doi:10.1002/jclp.20100 Comment: Written for working with men who havetraditional, Western masculine values, Cochran's article discusses the most common

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