Clients regularly come to psychotherapy wanting to discuss sexual concerns. Clinicians (across mental health professions) often lack training and comfort in addressing sexual concerns. Empirically, it is still unclear how clinicians manage their own level of comfort, values, and implicit beliefs about client characteristics associated with sexuality. Differentiation of self may be a useful construct for understanding the influence of (dis)comfort with sexuality, value commitments, and client characteristics (e.g., gender, marital status, exclusivity) on clinicians’ perceptions of client sexual behavior; though no study to date has empirically explored this possibility. To test the role of differentiation of self, participants, both licensed mental health professionals (n = 89) and clinicians-in-training (n = 109) were recruited from across the United States (M age = 36.40; 83.8% female; 80.3% White). Participants were asked to respond to a vignette about a client presenting with sexual behavior concerns and then completed a series of measures on differentiation of self, comfort with sexuality, personal values, and demographic items. As hypothesized, participants’ level of differentiation had nonlinear and linear conditional effects on how participants rated the client’s sexual behavior described in case vignettes. Implications emphasize the role for differentiation of self in clinicians’ management of sexual comfort, personal values, and client characteristics when encountering clients’ sexual concerns.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Ayres, M. M., & Haddock, S. A. (2009). Therapists’ approaches in working with heterosexual couples struggling with male partners’ online sexual behavior. Sexual Addiction and Compulsivity, 16, 55–78. doi:10.1080/10720160802711952.
Bartle-Haring, S., Shannon, S., Bowers, D., & Holowacz, E. (2016). Therapist differentiation and couple clients’ perceptions of therapeutic alliance. Advance online publication. Journal of Marital and Family Therapy. doi:10.1111/jmft.12157.
Corbin, J., & Strauss, A. (2008). Basics of qualitative research: Techniques and procedures for developing grounded theory (3rd edn.). Thousand Oaks, CA: Sage Publications.
Evans, S. C., Roberts, M. C., Keeley, J. W., Blossom, J. B., Amaro, C. M., Garcia, A. M., Reed, G. M. (2015). Vignette methodologies for studying clinicians’ decision-making: Validity, utility, and application in ICD-11 field studies. International Journal of Clinical and Health Psychology, 15, 160–170. doi:10.1016/j.ijchp.2014.12.001.
Fatter, D. M., & Hayes, J. A. (2013). What facilitates countertransference management? The roles of therapist meditation, mindfulness, and self-differentiation. Psychotherapy Research, 5, 502–512. doi:10.1080/10503307.2013.797124.
Ford, M. P., & Hendrick, S. S. (2003). Therapists’ sexual values for self and clients: Implications for practice and training. Professional Psychology, 34, 80–87. doi:10.1037/0735-7028.34.1.80.
Garbarino, J., Gaa, J. P., Swank, P., McPherson, R., & Gratch, L. V. (1995). The relation of individuation and psychosocial development. Journal of Family Psychology, 9, 311–318. doi:10.1037/0893-322.214.171.1241.
Gartner, J., Harmatz, M., Hohmann, A., Larson, D., & Gartner, A. F. (1990). The effect of patient and clinician ideology on clinical judgment: A study of ideological countertransference. Psychotherapy, 27, 98–106. doi:10.1037/0033-3126.96.36.199.
Goldberg, P. D., Peterson, B. D., Rosen, K. H., & Sara, M. L. (2008). Cybersex: The impact of a contemporary problem on the practices of marriage and family therapists. Journal of Marital and Family Therapy, 34, 469–480. doi:10.1111/j.1752-0606.2008.00089.x.
Graham, C. A., & Smith, M. M. (1984). Operationalizing the concept of sexuality comfort: Applications for sexuality educators. Journal of School Health, 54, 439–442. doi:10.1111/j.1746-1561.1984.tb08908.x.
Hainlen, R. L., Jankowski, P. J., Paine, D. R., & Sandage, S. J. (2015). Adult attachment and well-being: Dimensions of differentiation of self as mediators. Contemporary Family Therapy, 38(2), 172–183. doi:10.1007/s10591-015-9359-1.
Hanson, W. E., Creswell, J. W., Clark, V. P., Petska, K. S., & Creswell, J. D. (2005). Mixed methods research designs in counseling psychology. Journal of Counseling Psychology, 52, 224–235. doi:10.1037/0022-0188.8.131.52.
Harris, S. M., & Hays, K. W. (2008). Family therapist comfort with and willingness to discuss client sexuality. Journal of Martial and Family Therapy, 34, 239–250. doi:10.1111/j.1752-0606.2008.00066.x.
Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York: Guilford.
Hayes, A. F. (2014). Process for SPSS v2.13. [Computer Software]. http://www.processmacro.org/download.html.
Hayes, A. F. (2015). Hacking process for estimation and probing of linear moderation of quadratic effects and quadratic moderation of linear effects [White paper]. http://afhayes.com/public/quadratichack.pdf.
Hayes, J. A., Gelso, C. J., & Hummel, A. M. (2011). Managing countertransference. Psychotherapy, 48, 88–97. doi:10.1037/a0022182.
Hayes, J. A., Nelson, D. L. B., & Fauth, J. (2015). Countertransference in successful and unsuccessful cases of psychotherapy. Psychotherapy, 52, 127–133. doi:10.1037/a0038827.
Hays, D. G., Prosek, E. A., & McLeod, A. L. (2010). A mixed methodological analysis of the role of culture in the clinical decision-making process. Journal of Counseling and Development, 88, 114–121. doi:10.1002/j.1556-6678.2010.tb00158.x.
Hecker, L. L., Trepper, T. S., Wetchler, J. L., & Fontaine, K. L. (1995). The influence of therapist values, religiosity and gender in the initial assessment of sexual addiction by family therapists. The American Journal of Family Therapy, 23, 261–272. doi:10.1080/01926189508251356.
Heiden-Rootes, K., Jankowski, P. J., & Sandage, S. J. (2010). Bowen family systems theory and spirituality: Exploring the relationship between triangulation and religious questing. Contemporary Family Therapy, 32, 89–101. doi:10.1007/s10591-009-9101-y.
Hogg, M. A., Adelman, J. R., & Blagg, R. D. (2010). Religion in the face of uncertainty: An uncertainty-identity theory account of religiousness. Personality and Social Psychology Review, 14, 72–83. doi:10.1177/1088868309349692.
Jankowski, P. J., & Hooper, L. M. (2012). Differentiation of self: A validation study of the Bowen theory construct. Couple and Family Psychology: Research and Practice, 1, 226–243. doi:10.1037/a0027469.
Jankowski, P. J., Ivey, D. C., & Vaughn, M. J. (2012). Re-visioning a model of clinical judgment for systemic practitioners. Journal of Systemic Therapies, 31, 17–35. doi:10.1521/jsyt.2012.31.3.17.
Jankowski, P. J., Sandage, S. J., & Hill, P. C. (2013). Differentiation-based models of forgivingness, mental health and social justice commitment: Mediator effects for differentiation of self and humility. The Journal of Positive Psychology, 8, 412–424. doi:10.1080/17439760.2013.820337.
Johnson, P., Buboltz, W. C., & Seemann, E. (2003). Ego identity status: A step in the differentiation process. Journal of Counseling and Development, 81, 191–195. doi:10.1002/j.1556-6678.2003.tb00241.x.
Kerr, M. E., & Bowen, M. (1988). Family evaluation. New York, NY: WW Norton & Company.
Khaddouma, A., Gordon, K. C., & Bolden, J. (2015). Zen and the art of dating: Mindfulness, differentiation of self, and satisfaction in dating relationships. Couple and Family Psychology, 4, 1–13. doi:10.1037/cfp0000035.
Krycak, R. C., Murdock, N. L., & Marszalek, J. M. (2012). Differentiation of self, stress, and emotional support as predictors of psychological distress. Contemporary Family Therapy, 34, 495–515. doi:10.1007/s10591-012-9207-5.
Liszcz, A. M., & Yarhouse, M. A. (2005). Same-sex attraction: A survey regarding client-directed treatment goals. Psychotherapy, 42, 111. doi:10.1037/0033-3184.108.40.206.
McGlynn, F. D., Smitherman, T. A., & Mulfinger, A. M. M. (2006). Anxiety and fear. In M. Hersen (Ed.), Clinician’s handbook of adult behavioral assessment (pp. 189–205). Burlington, MA: Elsevier Academic Press.
Meteyard, J. D., Andersen, K. L., & Marx, E. (2012). Exploring the relationship between differentiation of self and religious questing in students from two faith-based colleges. Pastoral Psychology, 61, 333–342. doi:10.1007/s11089-011-0401-4.
Miller, S. A., & Byers, E. S. (2008). An exploratory examination of the sexual intervention self-efficacy of clinical psychology graduate students. Training and Education in Professional Psychology, 2, 137–144. doi:10.1037/1931-39220.127.116.11.
Miller, S. A., & Byers, E. S. (2009). Psychologists’ continuing education and training in sexuality. Journal of Sex and Marital Therapy, 35, 206–219. doi:10.1080/00926230802716336.
Miller, S. A., & Byers, E. S. (2010). Psychologists’ sexual education and training in graduate school. Canadian Journal of Behavioural Science, 42, 93–100. doi:10.1037/a0018571.
Miller, S. A., & Byers, E. S. (2012). Practicing psychologists’ sexual intervention self-efficacy and willingness to treat sexual issues. Archives of Sexual Behavior, 41, 1041–1050. doi:10.1007/s10508-011-9877-3.
Mohr, J. J., Weiner, J. L., Chopp, R. M., & Wong, S. J. (2009). Effects of client bisexuality on clinical judgment: When is bias most likely to occur? Journal of Counseling Psychology, 56, 164–175. doi:10.1037/a0012816.
O’Hara, D., Meteyard, J., & Andersen, K. (2012). The relationship between anxiety and managing interpersonal difference: Implications for couples counseling. Psychotherapy and Counselling Journal of Australia, 1. http://pacja.org.au/?p=945.
Paine, D. R., Jankowski, P. J., & Sandage, S. J. (2016). Humility as a predictor of intercultural competence: Mediator effects for differentiation-of-self. The Family Journal, 24, 15–22. doi:10.1177/1066480715615667.
Perry, W. G. Jr. (1970). Forms of intellectual and ethical development in the college years. Oxford: Holt, Rinehart & Winston.
Priest, J. B., & Wickel, K. (2011). Religious therapists and clients in same-sex relationships: Lessons from the Court Case of Bruff v. North Mississippi Health Service, Inc. American Journal of Family Therapy, 39, 139–148. doi:10.1080/01926187.2010.530196.
Reddick, G.T., Heiden-Rootes, K.M., & Brimhall, A.S. (2016). Therapists’ assessments in treating “Sex Addiction” and their relationship to clients’ gender, relationship status, and exclusivity status. Journal of Marital and Family Therapy. doi:10.1111/jmft.12210.
Reissing, E. D., & Giulio, G. D. (2010). Practicing clinical psychologists’ provision of sexual health care services. Professional Psychology, 41(1), 57. doi:10.1037/a0017023.
Ro, H., & Wampler, R. S. (2009). What’s wrong with these people? Clinicians’ views of clinical couples. Journal of Marital and Family Therapy, 35, 3–17. doi:10.1111/j.1752-0606.2008.00092.x.
Ross, A. S., & Murdock, N. L. (2014). Differentiation of self and well-being: The moderating effect of self-construal. Contemporary Family Therapy, 36, 485–496. doi:10.1007/s10591-9311-9.
Rowden, T. J., Harris, S. M., & Wickel, K. (2014). Understanding humility and its role in relational therapy. Contemporary Family Therapy, 36, 380–391. doi:10.1007/s10591-013-9297-8.
Schnarch, D., & Regas, S. (2012). The crucible differentiation scale: Assessing differentiation in human relationships. Journal of Marital and Family Therapy, 38, 639–652. doi:10.1111/j.1752-0606.2011.00259.x.
Schnarch, D. M. (1991). Constructing the sexual crucible: An integration of sexual and marital therapy. New York: W. W. Norton.
Schwartz, S. J., Zamboanga, B. L., Luyckx, K., Meca, A., & Ritchie, R. A. (2013). Identity in emerging adulthood: Reviewing the field and looking forward. Emerging Adulthood, 1, 96–113. doi:10.1177/2167696813479781.
Shamoon, Z. A., Lappan, S., & Blow, A. J. (2017). Managing anxiety: A therapist common factor. Contemporary Family Therapy, 39, 43–53. doi:10.1007/s10591-016-9399-1.
Skowron, E. A., & Dendy, A. K. (2004). Differentiation of self and attachment in adulthood: Relational correlates of effortful control. Contemporary Family Therapy, 26, 337–357. doi:10.1023/B:COFT.0000037919.63750.9d.
Skowron, E. A., & Friedlander, M. L. (1998). The differentiation of self inventory: Development and initial validation. Journal of Counseling Psychology, 45, 235–246. doi:10.1037/0022-018.104.22.168.
Skowron, E. A., Holmes, S. E., & Sabatelli, R. M. (2003). Deconstructing differentiation: Self regulation, interdependent relating, and well-being in adulthood. Contemporary Family Therapy, 25, 111–129. doi:10.1023/A:1022514306491.
Skowron, E. A., & Schmitt, T. A. (2003). Assessing interpersonal fusion: Reliability and validity of a new DSI fusion with others subscale. Journal of Marital and Family Therapy, 29, 209–222. doi:10.1111/j.1752-0606.2003.tb01201.x.
Skowron, E. A., Stanley, K. L., & Shapiro, M. D. (2009). A longitudinal perspective on differentiation of self, interpersonal and psychological well-being in young adulthood. Contemporary Family Therapy, 31, 3–18. doi:10.1007/s10591-008-9075-1.
Timm, T. M., & Keiley, M. K. (2011). The effects of differentiation of self, adult attachment, and sexual communication on sexual and marital satisfaction: A path analysis. Journal of Sex and Marital Therapy, 37, 206–223. doi:10.1080/0092623X.2011.564513.
Tomko, J. K., & Munley, P. H. (2013). Predicting counseling psychologists’ attitudes and clinical judgments with respect to older adults. Aging and Mental Health, 17, 233–241. doi:10.1080/13607863.2012.715141.
Turns, B. A., Morris, S. J., & Lentz, N. A. (2013). The self of the Christian therapist doing sex therapy: A model for training Christian sex therapists. Sexual and Relationship Therapy, 28, 186–200. doi:10.1080/14681994.2013.765557.
Wei, M., Vogel, D. L., Ku, T. Y., & Zakalik, R. A. (2005). Adult attachment, affect regulation, negative mood, and interpersonal problems: The mediating roles of emotional reactivity and emotional cutoff. Journal of Counseling Psychology, 52, 14–24. doi:10.1037/0022-022.214.171.124.
Wisch, A. F., & Mahalik, J. R. (1999). Male therapists’ clinical bias: Influence of client gender roles and therapist gender role conflict. Journal of Counseling Psychology, 46, 51–60. doi:10.1037/0022-0126.96.36.199.
Conflict of interest
All authors have no conflicts of interest related to this study.
This study was a human subject research project approved by the Saint Louis University IRB (see IRB protocol #22809).
We received informed consent by all participants as part of the web-based survey. A copy of the informed consent can be found in the IRB protocol and I can provide you with a copy to review.
About this article
Cite this article
Heiden-Rootes, K.M., Brimhall, A.S., Jankowski, P.J. et al. Differentiation of Self and Clinicians’ Perceptions of Client Sexual Behavior as “Problematic”. Contemp Fam Ther 39, 207–219 (2017). https://doi.org/10.1007/s10591-017-9412-3
- Differentiation of self
- Sexual comfort
- Value commitments
- Problem conceptualization
- Clinicians’ perceptions