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Journal of Homosexuality
ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/wjhm20
A Moderation Analysis of Perfectionism, Cultural
Sensitivity, and Counselors-In-Training Attitudes
toward Non-Dominant Sexual Identities
Hansori Jang, Clark D. Ausloos, Lena M. Salpietro & Jung Hee Ha
To cite this article: Hansori Jang, Clark D. Ausloos, Lena M. Salpietro & Jung Hee Ha
(2021): A Moderation Analysis of Perfectionism, Cultural Sensitivity, and Counselors-In-
Training Attitudes toward Non-Dominant Sexual Identities, Journal of Homosexuality, DOI:
10.1080/00918369.2021.1923279
To link to this article: https://doi.org/10.1080/00918369.2021.1923279
Published online: 14 May 2021.
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A Moderation Analysis of Perfectionism, Cultural
Sensitivity, and Counselors-In-Training Attitudes toward
Non-Dominant Sexual Identities
Hansori Jang, PhD
a
, Clark D. Ausloos, PhD
b
, Lena M. Salpietro, PhD
c
,
and Jung Hee Ha, PhD
d
a
Hankuk University of Foreign Studies, Graduate School of Education, Seoul, South Korea;
b
Department
of Counseling, Palo Alto University, Palo Alto, California, USA;
c
Department of Public Health, University of
North Florida, Jacksonville, Florida, USA;
d
Graduate School of Counseling Psychology, Hanyang
University, Seoul, South Korea
ABSTRACT
The purpose of this study was to explore the moderating eect
of maladaptive perfectionism on the relationship between cul-
tural sensitivity and counselors-in-training attitudes toward
non-dominant sexual identities. A total of 209 counseling grad-
uate students participated in the study. Results showed that
cultural sensitivity predicted attitudes toward individuals who
identify with a non-dominant sexual identity after controlling
for age. Also, a regression analysis demonstrated that maladap-
tive perfectionism is a moderator in the relationship between
cultural sensitivity and attitudes toward individuals who identify
with a non-dominant sexual identity among counselors-in-
trainings. Implications in the counseling and education eld
and suggestions for future research are discussed.
KEYWORDS
Perfectionism; maladaptive
perfectionism; cultural
sensitivity; attitudes of
professional counselors;
moderation effects;
counselors-in-training; non-
dominant sexual identities
Individuals who hold non-dominant sexual (or affective) identities (e.g., lesbian,
gay, bisexual, queer, questioning, pansexual, omnisexual, polysexual and asex-
ual, among others; Association for Lesbian, Gay, Bisexual, and Transgender
Issues in Counseling [ALGBTIC] LGBQQIA Competencies Taskforce, 2013;
Ward, Dahlhamer, Galinsky, & Joestl, 2014) experience wide-spread injustices
including discrimination, prejudice, and stigma (Bostwick, Boyd, Hughes, West,
& McCabe, 2014; Meyer, 2016). As a result of these injustices, people with non-
dominant sexual identities have an increased risk of mental health issues
(Institute of Medicine, 2011), with some studies reporting that individuals
with these identities are two and a half times more likely to experience depres-
sion, anxiety, and substance use (Cochran, Greer Sullivan, & Mays, 2003; Lick,
Durso, & Johnson, 2013). There is an increased need for competent mental
health services for this population, as data shows that individuals who identify
a non-dominant sexual identity are about two to four times more likely than
individuals who identify as heterosexual to have seen a mental health
CONTACT Jung Hee Ha hajung366@hanyang.ac.kr Hanyang University, 222 Wangsimni-ro Seongdong-gu
Seoul, South Korea.
JOURNAL OF HOMOSEXUALITY
https://doi.org/10.1080/00918369.2021.1923279
© 2021 Taylor & Francis Group, LLC
professional in the last 12 months (Platt, Kay Wolf, & Scheitle, 2018; Ward et al.,
2014). Mental health professionals, including professional counselors and coun-
selors-in-training (CITs), are broadly tasked with effectively and ethically pro-
viding treatment to diverse sexual identities (ALGBTIC LGBQQIA
Competencies Taskforce, 2013; American Counseling Association [ACA],
2014; American School Counselor Association [ASCA], 2016; Association of
Lesbian, Gay, Bisexual, and Transgender Issues in Counseling, 2009); however
literature demonstrates that anti-lesbian, gay, and bisexual (LGB) attitudes and
heterosexist biases remain, even in students within helping professions (Bidell,
2012; Troutman & Packer-Williams, 2014).
Perfectionism is a construct that has been widely studied in scholarly
literature (Andrews, Bullock-Yowell, Dahlen, & Nicholson, 2014; Curran &
Hill, 2019; Ganske & Ashby, 2007; Harari, Swider, Steed, & Breidenthal, 2018;
Rice & Ashby, 2007). Curran and Hill (2019) purport perfectionism continues
to increase among young people, especially students. Nascent research demon-
strates counselors-in-training experience consistent levels of self-critical per-
fectionism throughout graduate school (Moate & Gnilka, 2015), and are an
important population to explore, as future helping professionals.
Perfectionism is often categorized as adaptive and maladaptive, whereas adap-
tive perfectionism is often associated with healthy coping mechanisms and posi-
tive life satisfaction (Gnilka & Novakovic, 2017; Gotwals, Dunn, & Wayment,
2003), maladaptive perfectionism is associated with negative self-development
(Lopez, Fons-Scheyd, Morúa, & Chaliman, 2006), increased hopelessness
(Chang & Rand, 2000), and even serious mental illness (Curran & Hill, 2019).
As researchers posit that perfectionism continues to increase due to sociocultural
factors (Curran & Hill, 2019), it is an important construct to examine. Authors of
the proposed study aim to explore the moderating role of perfectionism in the
relationship between cultural sensitivity and attitudes toward individuals who
identify with a non-dominant sexual identity among CITs.
Attitudes of professional counselors
Due to the impact that incessant prejudice and discrimination can have on the
mental health of individuals who identify as non-dominant sexual identities,
professional counselors must have the attitudes, knowledge, skills, and aware-
ness to provide effective and affirmative counseling services (ALGBTIC
LGBQQIA Competencies Taskforce, 2013). While the counseling profession
as a whole has moved toward non-dominant sexual identity affirmative prac-
tice with the adoption of the ALGBTIC Competencies for Working with
LGBQQIA Individuals (ALGBTIC LGBQQIA Competencies Taskforce,
2013), many counselors feel unprepared to work with clients who identify as
LGB (Graham, Carney, & Kluck, 2012) and Lesbian Gay, Bisexual, or
Transgender (LGBT; Walker & Prince, 2010). The term transgender describes
2H. JANG ET AL.
a person whose gender identity and expression are incongruent with their
assigned sex at birth (Ginicola, Smith, & Filmore, 2017). Gender identity
involves one’s experience of gender, while sexual (or affective) identity refers
to one’s physical attraction or one’s romantic or emotional attraction to others
(Ginicola et al., 2017). Graham et al. (2012) aimed to identify differences in
counselor education and counseling psychology graduate students’ (N = 234)
perceptions of their competency to work with LGB clients across the domains
of knowledge, awareness, and skills, as measured by Bidell’s (2005) Sexual
Orientation Counselor Competency Scale (SOCCS). The researchers found
that the participants viewed themselves as more competent on the knowledge
and awareness subscales of the SOCCS, with increased competence associated
with increased level of training (doctoral vs. master’s), number of LGB clients
the participant worked with in practicum, and attendance at LGB-focused
workshops and conferences (Graham et al., 2012).
While counselors-in-training (CITs) have self-reported LGB-affirmative atti-
tudes and knowledge, many feel less competent in their ability to counsel LGB
clients (Graham et al., 2012), with school counseling students reporting signifi-
cantly lower levels of competency compared to their clinical mental health
counseling counterparts (Bidell, 2012; Farmer, Welfare, & Burge, 2013).
Reported low levels of counselor competency and experiences of LGB clients
in counseling may suggest that counselor education programs are not providing
adequate training for CITs to work with clients with non-dominant sexual
identities, a concern that is raised in numerous studies (Bidell, 2012; Farmer
et al., 2013; Graham et al., 2012). However, caution must be taken when general-
izing the results of these studies, as one used national sample (Graham et al.,
2012), one sampled from four universities in different geographical regions
(Bidell, 2012), and the last sampled from a state organization (Farmer et al.,
2013). Shelton and Delgado-Romero (2013) found LGBT clients experience
microaggressions, feel unsafe, uncomfortable, disrespected, and have had coun-
selors impose their own values and judgments while in session (Israel, Gorcheva,
Walther, Sulzner, & Cohen, 2008), suggesting that counselors’ self-reported
attitudes may be inconsistent with their behavior in counseling sessions. This
is especially concerning, as an increase in non-dominant sexual identity affir-
mative training, leading to increased cultural sensitivity, is associated with more
affirmative attitudes, higher level of counseling self-efficacy, increased levels of
perceived competency, and more positive beliefs (Alessi, Dillon, & Mi-Sung
Kim, 2016; Graham et al., 2012; Rutter, Estrada, Ferguson, & Diggs, 2008).
Cultural sensitivity
Predominant counseling theories fail to address the needs of a multicultural
society, often discounting the importance of cultural factors and “blame[ing]
historically marginalized clients for their predicament and ignor[ing] the relevance
JOURNAL OF HOMOSEXUALITY 3
of external factors to clients’ health and well-being” (Ratts & Pedersen, 2015, p. 3).
Therefore, it is important for counselors to be aware of and attend to cultural
factors in counseling. Multicultural competence, cross-cultural competence, cultural
competence, diversity awareness, and cultural sensitivity are terms often used
interchangeably in current scholarly literature (Larson & Bradshaw, 2017). The
United States Department of Health and Human Services’ Office of Minority
Health (United States Department of Health and Human Services Office of
Minority Health [USDHHS], 2001) described culturally sensitive care as care
that is “appropriately responsive to the attitudes, feelings, or circumstances of
groups of people that share a common and distinctive racial, national, religious,
linguistic, or cultural heritage” (p. 131). Research shows cultural sensitivity is
highly correlated with positive treatment outcomes, increased trust in clinicians,
and client satisfaction with provider care (Tucker, Marsiske, Rice, Nielson, &
Herman, 2011).
Professional counseling organizations dictate that multiculturalism must be
infused into professional counseling practices, (ACA, 2014; ASCA, 2016) as well
as in counselor education training programs (Council for Accreditation of
Counseling and Related Educational Programs [CACREP], 2016). While the
professional counseling literature emphasizes that counselors should possess cul-
tural sensitivity (ACA, 2014; ASCA, 2016; CACREP, 2016; Larson & Bradshaw,
2017; Ratts & Pedersen, 2015; Tucker et al., 2011), we found no empirical studies
examining the direct relationship between cultural sensitivity and attitudes toward
non-dominant sexual identities in the counseling literature. Much of the scholarly
inquiry surrounding cultural sensitivity has been studied among other professions,
including medical doctors (Seibert, Stridh-Igo, & Zimmerman, 2002), nurses
(Schim, Doorenbos, & Borse, 2006), and education (Kim, D’Andrea, Sahu, &
Gaughen, 2011). Seibert et al. (2002) view cultural sensitivity as being sensitive to
the differences and diversity of community members’ values and perceptions of
health care. Schim et al. (2006) conceptualize cultural sensitivity as involving “the
recognition of personal attitudes, values, beliefs, and practices” in a clinical setting
(p. 303). Some educational researchers have found there is a correlation between
having knowledge about non-dominant sexual identities and having positive
attitudes toward them (Kim et al., 2011). This notion also supports
a foundational tenet of multicultural and social justice counseling competencies
(MSJCC), the knowledge domain, which says that “privileged and marginalized
counselors possess knowledge of clients’ worldview, assumptions, attitudes, values,
beliefs, biases, social identities, social group statuses, and experiences with power,
privilege, and oppression” (Ratts, Singh, Nassar-mcmillan, Butler, & McCullough,
2016, p. 6). This is essential for fostering positive attitudes toward clients of non-
dominant sexual identities. While the relationship is not clearly outlined in the
literature, we hypothesize that an increase in levels of cultural sensitivity (including
awareness, knowledge, skills with cultural groups) contribute to more affirming
4H. JANG ET AL.
attitudes toward individuals who identify with a non-dominant sexual identity
among CITs (Conner & Walker, 2017).
Perfectionism
Scholars continue to conceptualize perfectionism as persons being adaptive
(healthy or normal), maladaptive (neurotic or unhealthy) and sometimes, non-
perfectionists (Andrews et al., 2014; Harari et al., 2018; Rice & Ashby, 2007);
while some conceptualize perfectionism dimensions as strivings (generally adap-
tive, setting high personal standards) and concerns (generally maladaptive,
constant concern over mistakes; Gnilka & Novakovic, 2017). In the present
study, we note the use of the terms adaptive and maladaptive perfectionism.
Researchers have examined the relationship between adaptive and maladaptive
perfectionism and other factors such as career decision-making self-efficacy
(Andrews et al., 2014; Ganske & Ashby, 2007), perceptions of career barriers
(Gnilka & Novakovic, 2017), optimism and depression (Black & Reynolds, 2013),
relationship satisfaction (Lopez et al., 2006), self-esteem (Gotwals, Dunn, &
Wayment, 2003), stress (Chang & Rand, 2000), and academic burnout and
motivation (Chang, Lee, Byeon, Seong, & Lee, 2016), among others. Generally,
researchers found that perfectionism is a complex construct, not universally
a “pathological personality characteristic” (Gnilka & Novakovic, 2017, p. 63);
and it is important to identify the specific perfectionistic tendencies of a client,
as adaptive or maladaptive on “cognition, affect, and behavior” (Gotwals et al.,
2003, p. 17).
Maladaptive perfectionism often includes irrational worrying about making
mistakes and constantly criticizing oneself (Andrews et al., 2014; Ganske & Ashby,
2007; Rice & Ashby, 2007) as well as a concern for “living up to the expectations of
others” (Rice & Ashby, 2007, p. 82). Often, this leads to negative coping responses,
psychopathological symptomatology (Black & Reynolds, 2013; Gnilka &
Novakovic, 2017), and an inability to ask others for help (Kawamura & Frost,
2004). Additionally, researchers note a relationship between maladaptive perfec-
tionism and negative self-development, lower attachment with academia (Lopez
et al., 2006); anxiety, moodiness, defensiveness (Gotwals et al., 2003), increased
suicidality, and increased levels of hopelessness (Chang & Rand, 2000). Some
scholars posit there is a relationship between serious mental illness among young
people and an increase in perfectionism (Curran & Hill, 2019)
Adaptive perfectionists often experience lower expectations from parents,
experience less criticism, and are not as concerned with meeting the expecta-
tions of others (Rice & Ashby, 2007). This type of perfectionism has been
associated with healthy coping mechanisms, positive life satisfaction,
increased self-esteem (Gotwals et al., 2003), and an increased utilization of
social support (Gnilka & Novakovic, 2017). In the United States, researchers
speculate that perfectionism has increased over the last twenty-seven years
JOURNAL OF HOMOSEXUALITY 5
because “cultures have become more individualistic, materialistic, and socially
antagonistic” (Curran & Hill, 2019, p. 12).
Perfectionism and cultural sensitivity
Cultural sensitivity was once viewed relating only to racial-ethnic identities
(Kumas-Tan, Beagan, Loppie, MacLeod, & Frank, 2007), but professional
counselors are now called upon to expand the definition of cultural sensi-
tivity to include groups of people who share a common and distinctive
culture, including identities related to sex, gender identity, sexual orienta-
tion, social class, socioeconomic status, spirituality and religious views, and
clients of varying ability and disability statuses (Conner & Walker, 2017;
Tucker et al., 2011; USDHHS, 2001). Presently, there are few studies that
have examined the relationship between perfectionism and cultural sensi-
tivity. One study found maladaptive perfectionism, among other factors,
may lead to decreased cultural sensitivity (Wang, Castro, & Cunningham,
2014). Another study examined the relationship between perfectionism and
attitudes toward people with disabilities and of the sample (N = 188)
researchers broadly found that socially prescribed perfectionism predicted
“negative affect, interpersonal stress, and distancing behavior dimensions of
attitudes towards disabilities” (Cox & Hill, 2018, p. 187). Cox and Hill (2018)
posit that the findings can be explained by the relationship between socially
prescribed perfectionism and difficulties interacting with others, as well as
the relationship between socially prescribed perfectionism and the projec-
tion of socially prescribed beliefs on to others.
Kanamori and Cornelius-White (2017) examined CITs and attitudes toward
non-dominant gender identities/expressions, and found, when compared with
male students, female students hold more affirming and accepting attitudes
toward non-dominant gender identities/expressions. Additionally, researchers
found there was no difference in age of participants, or if participants were
professional counselors or CITs (Kanamori & Cornelius-White, 2017).
Researchers note gender and sexuality are two separate constructs, and future
research should clearly give attention to each specific queer and/or transgender
identity within the LGBTGEQIAP+ Initialism. Rutter et al. (2008) called for the
need for counselor education program to integrate clear affirmative counseling
strategies, and to “incorporate LGB competency in counseling education curri-
cula” (p. 119). Researchers note more research is needed investigating the
relationship between perfectionism and cultural sensitivity factors.
Perfectionism and attitudes toward non-dominant sexual identities
While there is no direct evidence linking perfectionism and attitudes toward
individuals who identify with a non-dominant sexual identity, perfectionists
6H. JANG ET AL.
tend to exhibit dichotomous or categorical thinking patterns (Burns &
Fedewa, 2005; Egan, Piek, Dyck, & Rees, 2007), which have been commonly
considered to be dimension of prejudice (Allport, 1954). The dichotomous or
categorical thinking patterns common in perfectionists are similar to the
“undifferentiated cognitive disposition” often found in indiscriminately pro-
religious individuals (those with both intrinsic and extrinsic religiosity) who
have a tendency to be more prejudiced than their counterparts (Allport &
Ross, 1967). These individuals are characterized by the tendency to create
stereotyped generalizations and that they may not be “entirely secure in
a world that for the most part demands fine and accurate distinctions”
(Allport & Ross, 1967, p. 442). Allport and Ross (1967) theorize that as
a result of this insecurity, a “diffuse anxiety” may ensue and “dispose them
to grapple onto religion and to distrust strange ethnic groups” (p. 442).
Because perfectionism has been shown to affect attitudes toward individuals
who identify with a non-dominant sexual identity in both positive and nega-
tive ways, it is important to develop more comprehensive models that explain
possible mechanisms through which perfectionism may influence attitudes
toward individuals who identify with a non-dominant sexual identity. We
examined two primary research questions: (a) Does cultural sensitivity predict
attitudes toward individuals who identify with a non-dominant sexual iden-
tity? and (b) Does perfectionism serve as a moderator between cultural
sensitivity and attitudes toward individuals who identify with a non-
dominant sexual identity? Based on these research questions, we hypothesized
the following: (a) the association between cultural sensitivity and attitudes
toward individuals who identify with a non-dominant sexual identity would be
weaker for CITs with high maladaptive perfectionism than for those with low
maladaptive perfectionism, and (b) the association between cultural sensitivity
and affirming attitudes toward individuals who identify with a non-dominant
sexual identity would be stronger for CITs with high adaptive perfectionism
than for those with low adaptive perfectionism.
Method
Participants
Participants consisted 209 CITs at a large university in Seoul, South Korea.
A majority of the participants identified as female (n = 177, 84.5%) while the
rest of the participants identified as male (n = 32, 15.3%). Participants were
recruited from graduate counseling classes targeted to students from counsel-
ing majors (i.e., school counseling and adult counseling). Participants identi-
fied as master’s-level (n = 165, 79%) and doctoral-level (n = 44, 21%) students.
Participants’ ages ranged from 24 to 48 (M = 34.50, SD = 9.22). The number of
years of counseling experience endorsed by the participants included: never/
JOURNAL OF HOMOSEXUALITY 7
none (n = 70, 33.5%), less than six months (n = 40, 19.1%), six months to two
years (n = 41, 19.6%), two years to four years (n = 17, 8.2%), and more than
four years (n = 41, 19.6%).
Procedures
Upon the approval of the Institutional Review Board, recruitment e-mails
were sent to the university program director. The university program director
asked instructors to forward the recruitment e-mails to their CITs.
Recruitment e-mails included a link where participants could respond the
survey. A consent form was presented in the survey, followed by demographic
questions asking about respondents’ gender, age, graduate-level, and number
of years of counseling experiences.
Measures
Cultural sensitivity
To measure cultural sensitivity, we used the Intercultural Sensitivity Scale (ISS;
Chen & Satrosta, 2000). In our study, we used the Korean version of the ISS,
which has been validated by Kim (2008). The ISS has 24 items and uses a 5-point
Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). The instru-
ment has five subscales (Interaction Engagement with 7 items, Respect for
Cultural Differences with 6 items, Interaction Confidence with 5 items,
Interaction Enjoyment with 3 items, and Interaction Attentiveness with 3
items). Sample items include: “I enjoy interacting with people from different
cultures” and “I tend to wait before forming an impression of culturally-distinct
counterparts.” Items are summed with higher scores indicating a greater level of
cultural sensitivity. The ISS had an internal consistency reliability of .84 (Kim,
2008). In the current study, the Cronbach’s α for the total was .81.
Attitudes toward non-dominant sexual identities
To measure attitudes toward individuals who identify with a non-dominant
sexual identity we used the Attitudes subscale of the Sexual Orientation
Counselor Competency Scale (Bidell, 2005), a 29-item measure of individuals’
self-perceptions of attitudes, knowledge, and skills when counseling non-
dominant sexual identities with three separate scales: The Attitudes subscale
has 10 items (i.e., “It’s obvious that a same sex relationship between two men
or two women is not as strong or as committed as one between a man and
a woman”), the Skill subscale has 11 items (i.e., “I have experience counseling
gay male clients”), and the Knowledge subscale has 8 items (i.e., “I am aware of
institutional barriers that may inhibit LGB people from using mental health
services”). The Attitudes subscale on the SOCCS measures awareness of
respondents’ attitudes about non-dominant sexual identities needed by
8H. JANG ET AL.
counselors to be competent in implementing individual and group counseling
(Bidell, 2005). In our study, we used the Korean version of the Attitudes
subscale of the SOCCS, which has been translated and back translated by
Woo and Yoo (2017).
Items were scored on a 7-point Likert-type scale ranging from 1 (strongly
disagree) to 7 (strongly agree). Higher scores indicated higher levels of atti-
tudes competency toward non-dominant sexual identities. The Attitudes sub-
scale of the SOCCS had an internal consistency reliability of .88 (Woo & Yoo,
2017). In the current study, the Cronbach’s α for the attitude subscale was .81.
Perfectionism
Frost’s Multidimensional Perfectionism Scale (FMPS; Frost, Marten, Lahart, &
Rosenblate, 1990) was used to measure to explore six facets to differentiate
perfectionist experiences and traits. In our study, we used the Korean version
of the FMPS, which has been validated by Chung and Yon (2000). This scale
comprises of six subscales: Personal Standards (PS) with 7 items, Organization
(OR) with 6 items, Concern Over Mistakes (CM) with 9 items, Doubts About
Actions (DA) with 4 items, Parental Expectations (PE) with 5 items, and
Parental Criticism (PC) with 4 items. In our study, we used PS, as a measure
of adaptive perfectionism, and CM, as a measure of maladaptive perfectionism
(Kornblum & Ainley, 2005; Mofield & Peters, 2015). PS relates to setting
extremely high standards or expectations for oneself (i.e., “It is important for
me to be thoroughly competent in everything I do”), and CM relates to equating
mistakes with failures and reacting negatively to these mistakes (i.e., “People will
probably think less of me if I make a mistake”; Mofield & Peters, 2015).
Items were scored on a 5-point Likert-type scale ranging from 1 (strongly
disagree) to 5 (strongly agree), and higher scores indicated higher levels of
adaptive perfectionism (PS) and maladaptive perfectionism (CM). The FMPS
revealed evidence of internal consistency reliability with the Cronbach’s α of
.73 and .83, respectively, representing PS and CM (Chung & Yon, 2000). In
this study, Cronbach’s α was .75 for PS and .88 for CM.
Results
Preliminary analyses
An analysis of variance (ANOVA) was conducted for the dependent variable of
attitudes toward individuals who identify with a non-dominant sexual identity
to examine whether it varied as a function of the categorical demographic
variable (i.e., gender). There was no significant finding. Correlational analyses
were conducted for the continuous variables (i.e., age, number of years of
counseling experience). Age was correlated with attitudes toward individuals
who identify with a non-dominant sexual identity (r = −.16; p < .05) and was
JOURNAL OF HOMOSEXUALITY 9
used as a control variable. The skewness and the kurtosis of the observed
variables were also examined to verify the multivariate normal distribution of
the data (see Table 1). The results showed that skewness of each variable ranged
from −.45 to .97 and the kurtosis varied from −.75 to .68. The distribution of
each observed variable satisfied the normal distribution assumption, as they did
not exceed the absolute values of 2 (Tabachnick & Fidell, 2000).
Table 1 illustrates that age was negatively correlated with maladaptive
perfectionism (i.e., concern over mistakes; r = −.19 p < .01). Cultural sensitivity
was positively correlated with attitudes toward individuals who identify with
a non-dominant sexual identity (r = .31 p < .01). Lastly, maladaptive perfec-
tionism was negatively correlated with cultural sensitivity (r = −.23 p < .01)
and adaptive perfectionism (r = −.52 p < .01).
Test for moderation
A regression analysis was performed in order to examine the relationship
between cultural sensitivity and attitudes toward individuals who identify with
a non-dominant sexual identity according to perfectionism (i.e., adaptive and
maladaptive perfectionism). Age was entered in the first stage, cultural sensi-
tivity and adaptive perfectionism in the second stage, and the interaction
variables of adaptive/maladaptive perfectionism and cultural sensitivity in
the third stage.
Two regression analyses were conducted to test for moderation using SPSS 25.
We first examined maladaptive perfectionism as a moderator. In step 1, age was
entered a control variable. In step 2, cultural sensitivity and maladaptive perfec-
tionism were entered, only cultural sensitivity reached statistical significance.
However, the two-way interaction between cultural sensitivity and maladaptive
perfectionism (see Step 3 of Table 2) yielded a significant interaction effect
(β = −.17, p < .05). Thus, the presence of maladaptive perfectionism within the
sample moderated the effect of cultural sensitivity on attitudes toward individuals
who identify with a non-dominant sexual identity and explained 14% of the
Table 1. Means, standard deviations, and correlations among study variables (N = 209).
Variables 1 2 3 4 5
1. Age – −.04 −.16* −.08 −.19**
2. Cultural sensitivity – .31** −.10 −.23**
3. Attitudes toward non-dominant sexual identities – −.12 −.03
4. Adaptive perfectionism – −.52**
5. Maladaptive perfectionism –
M34.50 3.80 5.30 3.19 2.62
SD 9.22 .40 1.24 .56 .62
Skewness .97 .07 −.45 .11 .12
Kurtosis .68 .39 −.71 −.06 −.75
M = Mean; SD = Standard Deviation; Adaptive Perfectionism = Personal Standards; Maladaptive Perfectionism = Concern
Over Mistakes.
*p < .05, **p < .01.
10 H. JANG ET AL.
variance. As a statistically significant interaction was found, we examined addi-
tional regressions to test: (a) the simple slopes at high, medium and low levels of
the moderator (i.e., maladaptive perfectionism); and (b) whether the sloes showed
significantly differences from zero.
From these regressions, it was discovered that the relationship between
cultural sensitivity and attitudes toward individuals who identify with a non-
dominant sexual identity was lower for participants with higher maladaptive
perfectionism when compared with participants having lower maladaptive
perfectionism (Figure 1). Specifically, when participants with high standardized
scores on maladaptive perfectionism were examined alone, cultural sensitivity
contributed more to attitudes toward individuals who identify with a non-
dominant sexual identity than it did when participants with low standardized
scores on maladaptive perfectionism were examined alone (b = .25, t
(209) = 2.50, p < .05; b = .35, t(209) = 4.21, p < .01; b = .46, t(209) = 4.67, p < .01).
Adaptive perfectionism, another moderator, yielded different results than
maladaptive perfectionism. Cultural sensitivity and adaptive perfectionism
were not statistically significant, and the interaction term was also not statisti-
cally significant (β = −.147, p > .05). Thus, it appeared that adaptive perfection-
ism did not moderate the relationship between cultural sensitivity and attitudes
toward individuals who identify with a non-dominant sexual identity.
Discussion
Several significant results were revealed in this study. First, cultural sensitivity
predicted attitudes toward individuals who identify with a non-dominant sexual
identity after controlling for age. The impact of cultural sensitivity on specific
views toward individuals who identify with a non-dominant sexual identity
among CITs is still not well-understood, as much of the literature surrounding
cultural sensitivity has been conducted by other professionals such as medical
doctors (Seibert et al., 2002), nurses (Schim et al., 2006), and educators (Kim
Table 2. Hierarchical moderated regression of maladaptive perfectionism and cultural sensitivity
on attitudes toward non-dominant sexual identities.
Predictor
Unstandardized
Coefficients
β t R
2
R
2
F F
2
bSE
Step 1 .037 .037 2.57 2.57
Age −.03 .01 −.20 −2.73**
Step 2 .117 .081 5.35*** 9.20***
Cultural Sensitivity .36 .09 .29 4.20***
Maladaptive Perfectionism .02 .09 .01 .17
Step 3 .136 .019 5.26*** 4.39*
Cultural Sensitivity × Maladaptive
Perfectionism
−.17 .08 −.14 −2.10*
Dependent variable: Attitudes toward Non-dominant Sexual Identities.
*p < .05, **p < .01, ***p < .001.
JOURNAL OF HOMOSEXUALITY 11
et al., 2011). Thus, our results expand the literature by proving that cultural
sensitivity may play a pivotal role in contributing to affirming attitudes toward
individuals who identify with a non-dominant sexual identity among CITs.
Second, this study identified maladaptive perfectionism as a moderator in
the relationship between cultural sensitivity and attitudes toward individuals
who identify with a non-dominant sexual identity among CITs. As hypothe-
sized, high maladaptive perfectionism weakened the association between cul-
tural sensitivity and attitudes toward individuals who identify with a non-
dominant sexual identity among CITs. This result supports Allport (1954) and
Allport and Ross (1967) theories by identifying that the thought patterns
6
6.2
6.4
6.6
6.8
7
7.2
7.4
7.6
7.8
8
2.5 2.8 3.1 3.4 3.7 4 4.3 4.6 4.9 5.2
Attitudes toward
Non-dominant
Sexual Identities
Cultural Sensitivity
Maladaptive
Perfectionism
High
Med
Low
hgiHwoL
Figure 1. Predicted attitudes toward non-dominant sexual identities by level of cultural sensitivity
for high, medium and low levels of maladaptive perfectionism.
12 H. JANG ET AL.
found in those with high maladaptive perfectionism may contribute to more
stereotyped generalizations and therefore acting as a buffer against attitudes
toward individuals who identify with a non-dominant sexual identity among
CITs. Our finding is also consistent with previous findings that maladaptive
perfectionism, among other factors, may lead to decreased cultural sensitivity
(Wang et al., 2014).
Third, contrary to our hypothesis, adaptive perfectionism was not
a moderator in the relationship between cultural sensitivity and attitudes toward
individuals who identify with a non-dominant sexual identity among CITs.
Although no moderating effect was found, both cultural sensitivity and adaptive
perfectionism contributed to the variance in attitudes toward individuals who
identify with a non-dominant sexual identity among CITs. However, though
cultural sensitivity was statistically significant at each step, the overall variance
accounted for increased significantly when adaptive perfectionism entered the
equation. This finding indicates that adaptive perfectionism may play a larger
role in determining attitudes toward individuals who identify with a non-
dominant sexual identity among CITs.
In sum, this study demonstrated that maladaptive perfectionism is
a vulnerability factor for attitudes toward individuals who identify with a non-
dominant sexual identity among CITs and identified maladaptive perfectionism
as a moderator in the relationship between cultural sensitivity and attitudes
toward individuals who identify with a non-dominant sexual identity among
CITs. The results shed light on the importance of addressing maladaptive
perfectionism with CITs.
Limitations and future research
Although this is one of the first studies to examine the role of perfectionism
in the relationship between cultural sensitivity and attitudes toward indivi-
duals who identify with a non-dominant sexual identity among CITs, it has
several limitations. First, the results do not directly endorse the directional
relationships hypothesized in the model of this study because of the cross-
sectional design of the study. Thus, longitudinal research is needed to explain
how cultural sensitivity, perfectionism and attitudes toward individuals who
identify with a non-dominant sexual identity interact over time. Another
limitation of this study was the diverse makeup of CITs regarding their
degree level. Future research should consider the subgroup differences
between master’s level and doctoral-level CITs on the moderation results
of this study. Additionally, future researchers should explore more specifi-
cally how maladaptive and adaptive perfectionism appear in counselor edu-
cation. Lastly, participants of the study were consisted of CITs in South
Korea; thus, it can be difficult to generalize the results in other cultures
and geographic locations. The study should be replicated with CITs in other
JOURNAL OF HOMOSEXUALITY 13
cultures to identify how cultural sensitivity and perfectionism can influence
their attitudes toward individuals who identify with a non-dominant sexual
identity.
Implications for counseling and counselor education
Our study has important implications for CITs, counselor education faculty,
and counselor education programs. First, our results demonstrate the
important role that cultural sensitivity plays in strengthening affirming
and supportive attitudes toward those who hold non-dominant sexual iden-
tities. Thus, it is essential that counselor education programs are teaching
cultural sensitivity and cultural humility, not only social and cultural diver-
sity courses, but throughout the CACREP core content areas (CACREP,
2016). In addition to teaching foundations of cultural sensitivity, counselor
education programs should continually assess and reevaluate CITs using
standardized, valid and reliable instruments; as a part of professional
growth, in order to increase competence when working with individuals
who identify with a non-dominant sexual identity. While we acknowledge
limitations with the cross-sectional design of the study and lack of direc-
tional relationships, we support the idea that cultural sensitivity is dynamic
and developmental in nature, and counselor education programs should use
measures of assessment prior to acceptance into the program, infused
throughout graduate coursework, and throughout practicum and internship
field experiences (CACREP, 2016; Larson & Bradshaw, 2017). We recom-
mend counselor education programs utilize reliable and valid psychometric
measures of multicultural competence, in addition to informal measures
that assess a students’ awareness of themselves and others relating to power,
privilege, and oppression (Kumas-Tan et al., 2007; Larson & Bradshaw,
2017). Additionally, counselor education programs should promote CITs
working with culturally diverse clients and students within their field experi-
ences and should promote rigorous professional development opportunities
that focus on individuals who identify with a non-dominant sexual identity
(Graham et al., 2012).
Additionally, our study highlights the role of maladaptive perfectionism and
its’ relationship with cultural sensitivity and CIT attitude toward individuals
with non-dominant sexual identities. This is important in that literature already
demonstrates graduate students and learners in higher education often possess
traits associated with maladaptive perfectionism, including high concern over
mistakes, concern over others’ perceptions, and fear of failure (Curran & Hill,
2019; Garratt-Reed, Howell, Hayes, & Boyes, 2018). Counselor education pro-
grams should educate CITs on perfectionism within academia (Curran & Hill,
2019; Garratt-Reed et al., 2018), the relationship between perfectionism and
mental health issues (Limburg, Watson, Hagger, & Egan, 2017), and structure
14 H. JANG ET AL.
intentional activities that foster awareness, promote resilience and teach con-
crete strategies to mitigate negative coping responses which lead to psycho-
pathology (Black & Reynolds, 2013; Gnilka & Novakovic, 2017). As CITs are
increasingly tasked with working with diverse affectional, gender, and sexual
identities, it is imperative researchers understand the relationships between
concepts that promote strong, affirmative counseling competence. As CITs are
better prepared to work with and mitigate negative attitudes toward non-
dominant sexual identities in counselor education programs, clients and systems
will be better served and their unique mental health needs met.
Funding
Hansori Jang’s work was supported by Hankuk University of Foreign Studies Research Fund.
ORCID
Jung Hee Ha, PhD http://orcid.org/0000-0003-1139-0166
References
Alessi, E. J., Dillon, F. R., & Mi-Sung Kim, H. (2016). Therapist correlates of attitudes toward
sexual minority individuals, affirmative counseling self-efficacy, and beliefs about affirmative
practice. Psychotherapy Research, 26(4), 446–458. doi:10.1080/10503307.2015.1026422
Allport, G. W. (1954). The nature of prejudice. Oxford, England: Addison-Wesley.
Allport, G. W., & Ross, J. M. (1967). Personal religious orientation and prejudice. Journal of
Personality and Social Psychology, 5(4), 432–443. doi:10.1037/h0021212
American Counseling Association [ACA]. (2014). ACA code of ethics. Alexandria, VA: Author.
American School Counselor Association [ASCA]. (2016). ASCA ethical standards for school
counselors. Alexandria, VA: Author.
Andrews, L. M., Bullock-Yowell, E., Dahlen, E. R., & Nicholson, B. C. (2014). Can perfection-
ism affect career development? Exploring career thoughts and self-efficacy. Journal of
Counseling and Development, 92(3), 270–279. doi:10.1002/j.1556-6676.2014.00155.x
Association for Lesbian, Gay, Bisexual, and Transgender Issues in Counseling [ALGBTIC]
LGBQQIA Competencies Taskforce. (2013). Association for lesbian, gay, bisexual, and
transgender issues in counseling competencies for counseling with lesbian, gay, bisexual,
queer, questioning, intersex, and ally individuals. Journal of LGBT Issues in Counseling, 7(1),
2–43. doi:10.1080/15538605.2013.755444
Association of Lesbian, Gay, Bisexual, and Transgender Issues in Counseling [ALGBTIC].
(2009). Competencies for counseling with transgender clients. Alexandria, VA: Author.
Bidell, M. P. (2005). The sexual orientation counselor competency scale: Assessing attitudes,
skills, and knowledge of counselors working with lesbian, gay, and bisexual clients.
Counselor Education & Supervision, 44(4), 267–279. doi:10.1002/j.1556-6978.2005.tb01755.x
Bidell, M. P. (2012). Examining school counseling students‘ multicultural and sexual orienta-
tion competencies through a cross-specialization comparison. Journal of Counseling &
Development, 90(2), 200–207. doi:10.1111/j.1556-6676.2012.00025.x
JOURNAL OF HOMOSEXUALITY 15
Black, J., & Reynolds, W. M. (2013). Examining the relationship of perfectionism, depression,
and optimism: Testing for mediation and moderation. Personality and Individual
Dierences, 54(3), 426–431. doi:10.1016/j.paid.2012.10.012
Bostwick, W. B., Boyd, C. J., Hughes, T. L., West, B., & McCabe, S. E. (2014). Discrimination
and mental health among lesbian, gay, and bisexual adults in the United States. The
American Journal of Orthopsychiatry, 84(1), 35–45. doi:10.1037/h0098851
Burns, L. R., & Fedewa, B. A. (2005). Cognitive styles: Links with perfectionistic thinking.
Personality and Individual Dierences, 38(1), 103–113. doi:10.1016/j.paid.2004.03.012
Chang, E., Lee, A., Byeon, E., Seong, H., & Lee, S. M. (2016). The mediating effect of
motivational types in the relationship between perfectionism and academic burnout.
Personality and Individual Dierences, 89, 202–210. doi:10.1016/j.paid.2015.10.010
Chang, E. C., & Rand, K. L. (2000). Perfectionism as a predictor of subsequent adjustment:
Evidence for diathesis-stress mechanism among college students. Journal of Counseling
Psychology, 47(1), 129–137. doi:10.1037/0022-0167.47.1.129
Chen, G. M., & Satrosta, W. J. (2000). The development and validation of the intercultural
sensitivity scale. Human Communication, 3, 1–15.
Chung, S. J., & Yon, M. H. (2000). A study of the development of cognitive-behavioral group
counseling program for reducing the perfectionism. Korean Journal of Counseling and
Psychotherapy, 12(2), 147–167. doi:10.1080/07448481.2011.630703
Cochran, S. D., Greer Sullivan, J., & Mays, V. M. (2003). Prevalence of mental disorders,
psychological distress, and mental services use among lesbian, gay, and bisexual adults in the
United States. The Journal of Consulting and Clinical Psychology, 71(1), 53–61. doi:10.1037/
0022-006X.71.1.53
Conner, G., & Walker, W. (2017). The culturally competent counselor: Issues specific to four
minority groups. Open Journal of Social Sciences, 5(3), 113–121. doi:10.4236/jss.2017.53010
Council for Accreditation of Counseling and Related Educational Programs [CACREP].
(2016). 2016 CACREP standards. Retrieved from http://www.cacrep.org/wp-content
/uploads/2017/08/2016-Standards-with-citations.pdf
Cox, N. C., & Hill, A. P. (2018). Trait perfectionism and attitudes towards people with disabilities.
Personality and Individual Dierences, 122, 184–189. doi:10.1016/j.paid.2017.10.028
Curran, T., & Hill, A. P. (2019). Perfectionism is increasing over time: A meta-analysis of birth
cohort differences from 1989 to 2016. Psychological Bulletin, 145(4), 410–429. doi:10.1037/
bul0000138
Egan, S. J., Piek, J. P., Dyck, M. J., & Rees, C. S. (2007). The role of dichotomous thinking and
rigidity in perfectionism. Behaviour Research and Therapy, 45(8), 1813–1822. doi:10.1016/j.
brat.2007.02.002
Farmer, L. B., Welfare, L. E., & Burge, P. L. (2013). Counselor competence with lesbian, gay,
and bisexual clients: Differences among practice settings. Journal of Multicultural Counseling
and Development, 41(4), 194–209. doi:10.1002/j.2161-1912.2013.00036.x
Frost, R. O., Marten, P., Lahart, C., & Rosenblate, R. (1990). The dimensions of perfectionism.
Cognitive Therapy and Research, 14(5), 449–468. doi:10.1007/BF01172967
Ganske, K. H., & Ashby, J. S. (2007). Perfectionism and career decision-making self-efficacy.
Journal of Employment Counseling, 44(1), 17–28. doi:10.1002/j.2161-1920.2007.tb00021.x
Garratt-Reed, D., Howell, J., Hayes, L., & Boyes, M. (2018). Is perfectionism associated with
academic burnout through repetitive negative thinking? PeerJ, 6, e5004. doi:10.7717/peerj.5004
Ginicola, M. M., Smith, C., & Filmore, J. M. (Eds.). (2017). Armative counseling with LGBTQI
+ people. Alexandria, VA: American Counseling Association.
Gnilka, P. B., & Novakovic, A. (2017). Gender differences in STEM students‘ perfectionism,
career search self-efficacy, and perception of career barriers. Journal of Counseling &
Development, 95(1), 56–66. doi:10.1002/jcad.12117
16 H. JANG ET AL.
Gotwals, J. K., Dunn, J. G. H., & Wayment, H. A. (2003). An examination of perfectionism and
self-esteem in intercollegiate athletes. Journal of Sport Behavior, 26(1), 17–38.
Graham, S. R., Carney, J. S., & Kluck, A. S. (2012). Perceived competency in working with LGB
clients: Where are we now? Counselor Education & Supervision, 51(1), 2–16. doi:10.1002/
j.1556-6978.2012.00001.x
Harari, D., Swider, B. W., Steed, L. B., & Breidenthal, A. P. (2018). Is perfect good? A
meta-analysis of perfectionism in the workplace. Journal of Applied Psychology, 103(10),
1121–1124. doi:10.1037/apl0000324
Institute of Medicine. (2011). The health of lesbian, gay, bisexual, and transgender people:
Building a foundation for better understanding. Retrieved from https://www.ncbi.nlm.nih.
gov/books/NBK64806/
Israel, T., Gorcheva, R., Walther, W. A., Sulzner, J. M., & Cohen, J. (2008). Therapists’ helpful
and unhelpful situations with LGBT clients: An exploratory study. Professional Psychology,
Research and Practice, 39(3), 361–368. doi:10.1037/0033-3204.44.2.205
Kanamori, Y., & Cornelius-White, J. H. D. (2017). Counselors’ and counseling students’
attitudes toward transgender persons. Journal of LGBT Issues in Counseling, 11(1), 36–51.
doi:10.1080/15538605.2017.1273163
Kawamura, K. Y., & Frost, R. O. (2004). Self-concealment as a mediator in the relationship
between perfectionism and psychological distress. Cognitive Therapy and Research, 28(2),
183–191. doi:10.1023/B:COTR.0000021539.48926.c1
Kim, B. S. K., D’Andrea, M. J., Sahu, P. K., & Gaughen, K. J. S. (2011). A multicultural study of
university students’ knowledge of attitudes toward homosexuality. The Journal of Humanistic
Education and Development, 36(3), 171–182. doi:10.1002/j.2164-4683.1998.tb00387.x
Kim, O. (2008). Comparison of intercultural sensitivity between preservice teachers in South
Korea and China. Korea Comparative Education Society, 18(1), 193–217.
Kornblum, M., & Ainley, M. (2005). Perfectionism and the gifted: A study of an Australian
school sample. International Education Journal, 6(2), 232–239.
Kumas-Tan, Z., Beagan, B., Loppie, C., MacLeod, A., & Frank, B. (2007). Measures of cultural
competence: Examining hidden assumptions. Academic Medicine, 82(6), 548–557.
doi:10.1097/ACM.0b013e3180555a2d
Larson, K. E., & Bradshaw, C. P. (2017). Cultural competence and social desirability among
practitioners: A systematic review of the literature. Children and Youth Services Review, 76,
100–111. doi:10.1016/j.childyouth.2017.02.034
Lick, D. J., Durso, L. E., & Johnson, K. L. (2013). Minority stress and physical health among sexual
minorities. Perspectives on Psychological Science, 8(5), 521–548. doi:10.1177/1745691613497965
Limburg, K., Watson, H. J., Hagger, M. S., & Egan, S. J. (2017). The relationship between
perfectionism and psychopathology: A meta-analysis. Journal of Clinical Psychology, 73(10),
1301–1326. doi:10.1002/jclp.22435
Lopez, F. G., Fons-Scheyd, A., Morúa, W., & Chaliman, R. (2006). Dyadic perfectionism as
a predictor of relationship continuity and distress among college students. Journal of
Counseling Psychology, 53(4), 543–549. doi:10.1037/0022-0167.53.4.543
Meyer, I. H. (2016). The elusive promise of LGBT equality. The American Journal of Public
Health, 106(8), 1356–1358. doi:10.2105/AJPH.2016.303221
Moate, R. M., & Gnilka, P. B. (2015, October). A longitudinal study of perfectionism and
wellness in counselor education students. Poster presentation at the 2015 Association for
Counselor Education and Supervision Conference, Philadelphia, PA.
Mofield, E., & Peters, M. P. (2015). Multidimensional perfectionism within gifted suburban
adolescents: An exploration of typology and comparison of samples. Roeper Review, 37(2),
97–109. doi:10.1080/02783193.2015.1008663
JOURNAL OF HOMOSEXUALITY 17
Platt, L. F., Kay Wolf, J., & Scheitle, C. P. (2018). Patterns of mental health care utilization
among sexual orientation minority groups. Journal of Homosexuality, 65(2), 135–153.
doi:10.1080/00918369.2017.1311552
Ratts, M. J., & Pedersen, P. B. (2015). Counseling for multiculturalism and social justice:
Integration, theory and application. Transcultural Psychiatry,52(6), 18–20. doi:10.1177/
1363461515612353
Ratts, M. J., Singh, A. A., Nassar-Mcmillan, S., Butler, S. K., & McCullough, J. R. (2016).
Multicultural and social justice counseling competencies: Guidelines for the counseling
profession. Journal of Multicultural Counseling and Development, 44(1), 28–48. doi:10.1002/
jmcd.12035
Rice, K. G., & Ashby, J. S. (2007). An efficient method for classifying perfectionists. Journal of
Counseling Psychology, 54(1), 72–85. doi:10.1037/0022-0167.54.1.72
Rutter, P. A., Estrada, D., Ferguson, L. K., & Diggs, G. A. (2008). Sexual orientation and
counselor competency: The impact of training on enhancing awareness, knowledge and
skills. Journal of LGBT Issues in Counseling, 2(2), 109–125. doi:10.1080/15538600802125472
Schim, S. M., Doorenbos, A. Z., & Borse, N. N. (2006). Cultural competence among hospice
nurses. Journal of Hospice and Palliative Nursing, 8(5), 302–307. doi:10.1097/00129191-
200609000-00016
Seibert, P. S., Stridh-Igo, P., & Zimmerman, C. G. (2002). A checklist to facilitate cultural
awareness and sensitivity. Journal of Medical Ethics, 28(3), 143–146. doi:10.1136/jme.28.3.143
Shelton, K., & Delgado-Romero, E. A. (2013). Sexual orientation microaggression: The experi-
ence of lesbian, gay, bisexual, and queer clients in psychotherapy. Psychology of Sexual
Orientation and Gender Diversity, 1(5), 59–70. doi:10.1037/2329-0382.1.S.59
Tabachnick, B. G., & Fidell, L. S. (2000). Using multivariate statistics (4th ed.). Needham
Heights, MA: Allyn & Bacon.
Troutman, O., & Packer-Williams, C. (2014). Moving beyond CACREP standards: Training
counselors to work competently with LGBT clients. The Journal for Counselor Preparation
and Supervision, 6(1), 1–17. doi:10.7729/61.1088
Tucker, C. M., Marsiske, M., Rice, K. G., Nielson, J. J., & Herman, K. (2011). Patient-centered
culturally sensitive health care: Model testing and refinement. Health Psychology, 30(3),
342–350. doi:10.1037/a0022967
United States Department of Health and Human Services Office of Minority Health
[USDHHS]. (2001). National standards for culturally and linguistically appropriate services
in health care. Rockville, MD: IQ Solutions, Inc.
Walker, J. A., & Prince, T. (2010). Training considerations and suggested counseling interven-
tion for LGBT individuals. Journal of LGBT Issues in Counseling, 4(1), 2–17. doi:10.1080/
15538600903552756
Wang, K., Castro, A. J., & Cunningham, Y. L. (2014). Are perfectionism, individualism, and
racial color-blindness associated with less cultural sensitivity? Exploring diversity awareness
in White prospective teachers. Journal of Diversity in Higher Education, 7(3), 211–225.
doi:10.1037/a0037337
Ward, B. W., Dahlhamer, J. M., Galinsky, A. M., & Joestl, S. S. (2014). Sexual orientation and
health among U.S. adults: National health interview survey, 2013. National Health Statistics
Reports, 77, 1–10. Hyattsville, MD: Department of Health & Human Services.
Woo, S., & Yoo, S. K. (2017). Counselor’s reaction and clinical judgment according to counselor’s
negative attitude and competence in lesbian and gay counseling. The Korean Journal of
Counseling and Psychotherapy, 29(2), 311–334. doi:10.23844/kjcp.2017.05.29.2.311
18 H. JANG ET AL.
