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Summary Due to the focus of micro-practice interventions on clinical outcomes and macro-practice interventions on structural outcomes, limited research exists on the clinical benefits resulting from clients' involvement in macro therapeutic interventions (i.e. structural interventions that target community, organizational, systems, and/or policy-level change and which also have clinical benefits to clients or consumers). In response to this knowledge gap, the authors present four case studies of macro therapeutic interventions in the areas of social enterprise creation, community-based participatory research, transformative organizing, and community-based partnerships. Findings Collectively, these interventions draw from community, economic, and social development theory, empowerment theory, feminist theory, and critical theory. The authors synthesize the key intervention components across case studies that contribute to clinical and collective empowerment outcomes. Applications The authors then offer recommendations to the social work profession for developing, implementing, and evaluating macro therapeutic interventions within clinical practice settings.

Youth of Color, especially those in households with low income, experience multiple stressors and trauma that affect their well-being. Few studies examine the impact of youth engagement in leadership and organizing to address systemic inequity on their mental health and well-being. In a community-based participatory action research design, three organizations which train youth of Color in organizing in Brooklyn, New York, held four focus groups ( n = 43, ages 14-24 years) to examine the impact of organizing on youth mental health and well-being. Key emergent themes of youth organizing include (a) storytelling as therapeutic; (b) group leadership as strengthening personal and collective power, hopefulness, and a sense of protection; and (c) the strain of navigating their hopes and current reality. This study has important implications for actions programs can take who seek to engage youth of Color in organizing in communities and institutions impacted by historical trauma and current day systemic inequity.

Objective: This study evaluates the effectiveness of an intervention using theater and dialogue to raise awareness about homophobia and transphobia and increase intentions to participate in macro-level change efforts around lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQQ) issues. Methods: Using a pretest–posttest design, this study examines changes in advocacy intentions around LGBTQQ issues among middle school and high school students who participated in the intervention ( n = 515). Results: Students reported a significant increase in intentions to advocate. Existing intervention behaviors and increased recognition of homophobia/transphobia as problems were associated with greater increases in intention to advocate. Respondents with higher existing intervention behaviors, as well as White students and cisgender women, reported higher advocacy intentions compared to students of color and cisgender men. Further, we found indication of greater awareness of homophobia/transphobia as a problem in school. Conclusions: Youth-led theater and dialogue-based interventions may be a promising strategy for addressing heterosexism and genderism in schools.

Youth of Color in the United States are often leaders in movements for social justice. Evidence suggests that organizing has a positive macro-therapeutic effect on the mental health of young organizers; however, they can also experience strain and become targets of the very systems they are trying to change. In a community-based participatory action research study, three organizations that train youth of Color in organizing in Brooklyn, New York City held focus groups with youth and adult staff. The focus groups examined the strains experienced by youth organizers and the strategies adult partners use to prepare organizers to maintain hope and well-being. Findings suggest four key emergent strategies: (a) provide an emotional homespace to process the rub between worlds, (b) actively shape the long view on systems change, (c) increase self-care skills and emotional preparation for organizing, and (d) promote healing by building leader(full) communities.