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treatment time and inadequate scope of treatment content. Regarding (c), for example, participants might receive information about homosexuality but not be exposed to gay men and lesbian women (Hyman, 1980). Or participants might be given extremely limited information about homosexuality, such as only being informed that the American Psychiatric Association had formally depathologized homosexuality (Rosen, 1976). Or participants might receive as their entire treatment an hour-long lecture on homosexuality, followed by a short audiotaped presentation about homosexuality (Goldberg, 1981). Hence, attitudes toward gay men and lesbian women might change simply with repeated testing; attitude change might not produce behavioral change; and treatment failures might be due simply to weak educational treatment programs.

Thus, a multimodal presentation on homosexuality and gay/lesbian counseling, using a comprehensive informationplus-exposure treatment format, was conducted to assess its impact on mental health practitioners' attitudes toward homosexuality and counseling behavior compared with a notreatment comparison group. I predicted the following hypothesis: Treatment participants' attitudes toward homosexuality, and their effectiveness in counseling gay men and lesbian women, would be significantly improved compared with a group not taking the workshop.

Participants

METHOD

Treated participants (n=21) were mental health practitioners and mental health trainees voluntarily enrolled in a 3-day workshop on gay/lesbian counseling, and comparison participants (n=31) were graduate students enrolled in various counselor education courses in the summer of 1987 at Lehigh University. Treatment participants were recruited personally and by mail. Comparison participants voluntarily agreed to participate following a short presentation in their classes.

Treatment and comparison participants were not significantly different (p<.05) in age, with treatment M=34, comparison M=33; in education, with half of both groups holding a bachelor's degree and the remaining half holding at least a master's degree; and in race/ethnicity with 95% of the treatment group and 100% of the comparison group reporting itself to be White. The groups were not different in sex, with 24% of the treatment group male, 76% female, and 32% of the comparison group male, 68% of the comparison group female; or not different in interest in working with gay/lesbian clients, with neutral being the modal response for both groups, based on a 5-point, Likert-type scale that ranged from minimal to substantial. Treatment participants' reported modal response of 1-2 years of counseling experience was significantly greater than that of the comparison participants' reported modal response of less than 1 year (x2, 5=11.19, p<.05), but years of counseling experience did not correlate with any dependent variable. (A limitation of the study is that participants' personal experience with gay men and lesbian women was not reported, a variable that could have differentiated between the two groups and could have correlated with one or more of the dependent variables.)

Procedure

Treatment participants were pretested on all measures before the workshop. Comparison participants were pretested separately, then posttested 2-5 days later.

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Treatment. Treatment participants were exposed to a 3-day, 20-hour multimodal presentation on gay/lesbian counseling sponsored by Lehigh University in the summer of 1987. The first half of the workshop was devoted to background information. Leaders in the field of gay and lesbian counseling, three men and one woman, were invited to speak on their respective areas of expertise. They were not formally trained for the workshop but instead were chosen specifically for their established reputations in the topic areas addressed. These included the prevalence of homosexuality, the problems encountered by gay men and lesbian women in their lives, and in their encounters with counselors, and the history of negative attitudes toward homosexuality to the present. The perception of homosexuality per se as psychopathological was challenged. Participants were instructed in differentiating nonhomosexual disturbances from homosexual crises, past failures of psychoanalytic, behavioral, medical, and eclectic attempts to "cure" or eliminate homosexuality were reviewed as were the methodological and theoretical limitations of claims of successful homosexual to heterosexual reorientations. Because of the distinctive association between Acquired Immune Deficiency Syndrome (AIDS) and homosexuality, information about AIDS and therapeutic considerations of working with clients with AIDS were provided. The growing antihomosexual sentiment in this country was discussed, with emphasis on revitalized religious fundamentalism, a markedly conservative sociopolitical climate, and the recent spread of AIDS.

The second half of the workshop was devoted to the process and content of affirmative gay/lesbian counseling. Participants were instructed in differentiating among homosexual, bisexual, and heterosexual orientations and also instructed in a model for the counselor that would facilitate a client's resolution of a gay or lesbian identity. The model presented was based on Woodman and Lenna's (1982) four stages of denial, identity confusion, bargaining, and depression. Participants were also instructed in a model for facilitating a gay or lesbian client's "coming out" to others, particularly as an adolescent, and to his or her parents; this model relied heavily on Coleman's (1985) five stages of pre-"coming out," "coming out," exploration, first relationships, and identity integration. Finally, general therapeutic recommendations for working with gay or lesbian clients were presented, including the need for therapists to be aware of their own homophobia and to be well informed about the gay and lesbian subcultures (see Rudolph, 1988b, for greater detail of the workshop's content).

The format for the workshop included didactic lecture, videotape-film, case study-role play, and small-group discussion. As noted, four expert speakers, two of whom were selfidentified gay men, presented the didactic lecture material. The videotape-film aspect consisted of two 30-minute, commercially prepared videotapes on the etiology of homosexuality and the process and content of affirmative gay/lesbian counseling; a 20-minute documentary on contemporary homophobia; a 10minute excerpt from the commercial film Making Love, in which the protagonist informs his unsuspecting wife of his gayness; and a 15-minute excerpt from the TV movie An Early Frost, in which a young adult male discloses to his parents that he is both gay and suffering from AIDS.

The case study-role play aspect was composed of several case studies featuring gay and lesbian clients in distress. They were written to reflect both self-disapproval and other-disapproval themes. Participants were divided into groups of approximately 5 members each and randomly assigned a case study and asked

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to assume the roles of the hypothetical counselor, client, and observers. The groups were facilitated by professional counselors experienced in the counseling of gay and lesbian clients. Participants discussed the role plays upon their completion.

Treatment participants were posttested on all measures immediately after the workshop. Twenty treatment participants (95%), and 26 comparison participants (84%) completed the two homosexuality attitude questionnaires at an 8-week follow-up by mail-a period of time chosen as an average follow-up period from a review of the attitude change literature. Missing observations were estimated by substituting the mean of the cell from which the score was missing. (Because the N was >10, up to 25% of the scores could be estimated without seriously affecting the analysis of variance; Linton & Gallo, 1975.)

MEASURES

Attitudes toward homosexuality. Slightly modified versions of the Index of Attitudes Toward Homosexuals (IAH; Hudson & Ricketts, 1980) and the Homosexuality Attitude Scale (HAS; Milham, San Miguel, & Kellog, 1976) were used to assess attitudes toward homosexuality. The original IAH is a 25-item scale measuring homophobia, or the fear, disgust, anger, discomfort, and aversion individuals feel in dealing with gay men and lesbian women (e.g., "If I saw two men holding hands in public, I would feel disgusted"). The original IAH and HAS use a true-false format. This was changed to a 5-point, Likert-type format to collect data on a continuum rather than on a dichotomous basis. The range of scores for the modified IAH is 25 to 125, with the higher score indicating a greater tolerance of gay men and lesbian women. Coefficient alpha and test-retest reliabilities have been reported from .90 to .97 (Hudson & Ricketts, 1980; Rudolph, 1986), with the authors concluding good content and construct validity (Hudson & Ricketts, 1980). The original HAS is a 26-item factor-analyzed scale measuring the legality, morality, and social desirability of homosexuality (e.g., "Homosexuality is not a perversion"). The modified HAS eliminated 7 items for redundantly measuring homophobia. Six independent factors make up the scale, including Personal Anxiety, Moral Reprobation, and Repressive-Dangerous (see Milham, San Miguel, & Kellog, 1976, for a complete discussion of the factor analysis of the instrument). The range of scores for the modified HAS is 19 to 95, with the higher score indicating a greater tolerance of homosexuality. All items loaded .45 or greater on their respective factors to be included in the scale, and test-retest reliability has been reported from .77 to .96 (McCann-Winter, 1983; Rudolph, 1986).

Gay/lesbian counseling effectiveness (CEM). As a quasibehavioral measure of counseling effectiveness, participants were presented with six short audiotaped vignettes simulating gay and lesbian clients expressing distress to a counselor. Participants were instructed to write within 60 seconds their most therapeutic response to each vignette. The vignettes were divided equally into self-disapproval and other-disapproval scenarios and were written to be representative of problems likely to be experienced by gay and lesbian clients. Participants' written responses were rated by two counselor-judges chosen for their familiarity in working with gay and lesbian clients. The participants' responses were rated according to three criteria: (a) presence of antihomosexual bias; (b) expressed willingness to collaborate in a positive way with the gay or lesbian client; and (c) general counseling effectiveness, not directly related to homosexuality per se (absence of ignoring, dominating, or

Effects of a Training Workshop on Mental Health Practitioners inaccurately reflecting the client's response). The counselorjudges rated each response blindly, without knowledge from which experimental group or testing phase the response originated. Once rated, the response to each vignette was given a total score based on the following weights: presence of antihomosexual bias (0), absence (3); presence of willingness to positively collaborate (3), absence (0); and presence of ignoring, dominating, or inaccurately reflecting the client's response (0), absence (2). Six vignettes times 8 points equal a maximum possible score of 48, with the higher score indicating greater gay/lesbian counseling effectiveness. Although attitudes toward homosexuality rather than overall counseling ability were the study's focus, as reflected in the greater weightings of the two criteria directly related to homosexuality, the extent to which participants ignored, dominated, or inaccurately reflected responses of gay and lesbian clients arguably revealed participants' attitudes toward homosexuality as well, if less obviously. That is, if participants harbored antihomosexual sentiment, one way it might have been expressed was by ignoring, dominating, and inaccurately reflecting the gay and lesbian clients' communications.

One rater scored all of the 600 pretest and posttest responses, and a second independent rater scored 30% of the responses selected at random. Reliability was calculated for the three criteria combined using the following formula: number of agreements divided by number of agreements plus number of disagreements times 100. A test of the difference between two proportions revealed that the obtained 84% interrater agreement rate was significantly (p<.05) greater than the chance agreement rate of 70% (the .14 difference exceeding the .056 critical value).

Due to the prohibitive impracticality of responding by mail to the standardized audiotape presentation constituting the CEM, four convenient times were arranged at a central location at Lehigh University to test in person as many of the treatment and comparison participants as possible. As the sample that appeared for testing was small and unrepresentative (treatment subjects, n= 1; comparison subjects, n = 10), no statistical analysis was performed on the CEM follow-up data.

RESULTS

Intergroup differences prior to treatment. Table 1 shows treatment and comparison participants were not significantly different at pretest on any of the dependent variables.

Differences between treatment and comparison subjects. Table 1 presents means of the groups on the various measures. As predicted, the treatment participants became more tolerant of homosexuality and more gay/lesbian counseling effective than the comparison group. The IAH and HAS data were analyzed using a series of 2 x 2 (group by assessment phase) ANOVA. The CEM data were analyzed similarly, but seven CEM protocols (five treatment, two comparison,) were unusable, and the CEM follow-up data were omitted altogether, as previously noted. As Table 2 shows, there were significant pretest-posttest ANOVA interaction effects for attitudes toward gay men and lesbian women (IAH), attitudes toward homosexuality (HAS), and gay/lesbian counseling effectiveness (CEM). Gains were maintained at the 8-week follow-up with significant pretest/follow-up interaction effects for both attitudes toward gay men and lesbian women and attitudes toward homosexuality.

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