The Practice of Suicide Assessment and Management by Marriage and Family Therapists

Abstract

Over 90% of mental health providers encounter suicidal clients. However, the majority of marriage and family therapists (MFTs) are not exposed to suicide-specific trainings within their clinical coursework. Due to the lack of consistent training protocols for suicide assessment and management among MFTs, this qualitative study identified common MFT responses to suicidal clients, including assessment of risk severity and intervention modalities. Responses were then compared to best practices for suicidal clients. Participants inconsistently adhered to best practices identified in the larger field of mental health, revealing the need for increased MFT training on suicide to ensure appropriate and effective care.     

Predictors and Trajectories of Response to the Homework,Organization, and Planning Skills (HOPS) Intervention for Adolescents With ADHD

The goal of the present study was to evaluate the relative importance of adolescent and parent skills acquired during participation in the Homework, Organization, and Planning Skills (HOPS) intervention in predicting intervention response. A sample of 111 middle school students with attention-deficit/hyperactivity disorder (66% male; M_age = 11.99, SD = 1.05) received the HOPS intervention, which includes 16 brief sessions with the adolescent and two parent meetings. Each session, school mental health providers completed checklists measuring students’ acquisition of homework recording, materials organization, and time management skills. Parents provided information on whether they monitored and used contingencies to reinforce skills use at home. Outcome measures included parent and teacher ratings of homework problems and organizational/time management skills postintervention. Grade point average and assignment completion were also evaluated as objective outcomes. Regressions found accurate homework recording and time management to be unique predictors of parent-reported homework and organizational skills outcomes. Growth mixture models examining organizational skills trajectories throughout the intervention significantly predicted parent- and teacher-reported outcomes, GPA, and assignment completion; homework recording trajectories predicted parent-reported outcomes and GPA. Sixty-eight percent of participants displayed high acquisition of organization and homework recording skills. Parent-reported use of monitoring and contingencies to support adolescent skills implementation was not associated with outcomes. Results highlight the importance of examining individual differences in school-based intervention studies targeting organization, time management, and planning. Importantly, for a school-based adolescent-focused intervention, improvement in outcomes does not appear to be dependent upon parent skills implementation.     

Play in Supervision

Abstract

Clinical supervision is a fundamental component of counselor education training. Counselor Educators play an active and dynamic role in helping beginning practicum students conceptualize their work with clients. The use of expressive arts in counseling has been shown to be effective in creating a deeper level and meaning to counselor and client interactions. This article describes the use of a particular expressive art technique, a sandtray, based on Sandplay Therapy, with students enrolled in beginning practicum. Additionally, results from a pilot study comparing ratings of traditional supervision and ratings of sandtray supervision with students enrolled in a beginning practicum experience are provided. Results of the pilot study indicated some preliminary support for the viability of the application comparing ratings of traditional supervision sessions with ratings of supervision using sandtray.     

Counselor Competence With Lesbian,Gay, and Bisexual Clients: Differences Among Practice Settings

Counselors from school and community practice, counseling students, and counselor educators (N= 468) participated in this study of competence to serve lesbian, gay, and bisexual (LGB) clients. Participants reported high LGB‐affirmative attitudes but lower knowledge and skills. School counselors reported significantly lower LGB competence than did counselors in other settings. Implications include the importance of graduate and postgraduate training to improve LGB knowledge and skills and the hope that LGB‐affirmative attitudes suggest receptivity toward such growth. Consejeros que trabajan en prácticas escolares y de comunidad, estudiantes de consejería y educadores de consejería (N= 468) participaron en este estudio sobre la competencia para servir a clientes lesbianas, gays y bisexuales (LGB). Los participantes comunicaron un nivel elevado de actitudes afirmativas hacia LGB, pero menores conocimientos y habilidades. Los consejeros escolares indicaron niveles de competencia en LGB significativamente menores que los consejeros en otros escenarios. Las implicaciones incluyen la importancia de la formación de estudiantes de grado y posgrado para mejorar sus conocimientos y habilidades sobre LGB y la esperanza de que las actitudes afirmativas hacia LGB sugieren receptividad hacia dicha formación.     

Creativity in Teaching Case Conceptualization Skills: Role-play to Show the Interconnectedness of Domains

Case conceptualization is an important skill for counselors to master in order to meet treatment needs of clients. Some students struggle while learning this skill, as it requires advanced cognitive complexity, reflection skills, and affective awareness. Further, it is difficult for developing counselors to understand the interconnectedness of clients’ presenting problems, history, and strengths to form a holistic case conceptualization. The authors of this article describe a role-play for teaching the complexity of case conceptualization, in which students role-play various perspectives of psychosocial information and process the experience to create a holistic conceptualization. Activity steps are outlined with examples, and process questions to facilitate classroom discussion are included. Suggestions for implementation are also provided.     

Exploring Adoption with Clients: The Need for Adoption Education Within the Genetic Counseling Profession

Genetic counselors and other health professionals may encounter adoption during any counseling session. They must be skilled in using appropriate language and understand how to approach and discuss this topic with clients. A thorough knowledge of adoption as an option for clients facing a prenatal or postnatal diagnosis is necessary when presenting individuals with non-biased information needed for informed decision-making. However, three preliminary studies have demonstrated an absence of graduate education and lack of a professional knowledge base regarding this option (Mates 2008; Oksala 2007; Perry 2003). We discuss the impact of medical professionals’ preconceptions on client decision-making, increasing early identification of fetal anomalies, deficiency of adoption knowledge and resources, and the resulting need for genetic counselors and other health professionals to develop their skills in discussing adoption with clients.     

A Novel Approach

Abstract

The relationship between empathy and forgiveness is explored through the painful experience of divorce and relationship loss. Authors propose a literary exercise, the Novel Approach, to help clients discover the power of empathy and find resolution to past pains. Included is a case study used to describe the Novel Approach and to highlight its facilitative power for creating a deeper empathic understanding.     

Impact of educational intervention on willingness-to-pay for suicide prevention: a quasi-experimental study among university students in Japan

Many individuals show negative attitudes toward the use of taxes for suicide prevention. Activities that enhance knowledge and awareness of suicide and suicide prevention may increase willingness to pay (WTP) for suicide prevention. WTP is the amount that a consumer will pay for a product or service. The present study examined the influence of educational activities on enhancing knowledge and awareness of suicide and its prevention on WTP. We conducted a quasi-experimental study to examine the influence of lectures on suicide by comparing the amount of change in WTP between two groups over the same period: an intervention group (n = 92) comprising students who participated in the lectures and a control group (n = 128) comprising general university students recruited through an Internet-based survey. A t-test showed that the amount of change was significantly larger in the intervention group (t (152.31) = 2.25, p = .026). Ordinal logistic regression analysis showed that increased WTP was significantly correlated with an annual household income of JPY 4–6 million or higher. It may be appropriate to conclude that participation in lectures about suicide is effective in increasing WTP for suicide prevention.     

Telephone counseling and crisis intervention: A review

The empirical research pertaining to the effectiveness of telephone counseling and referral systems personnel was critically reviewed. The assessment was organized according to several evaluation strategies that researchers have utilized to evaluate effectiveness. These strategies included, for example, client self-reports, client "shows" versus "no-shows" following referral, data pertaining to suicide rates, counselor ratings of personal effectiveness, and phone workers' ability to offer empathy to clients. It was concluded that discussions of effectiveness should be constrained by a careful consideration of the specific index of efficacy chosen by investigators as well as methodological issues associated with current research in this area. There is reason to believe that the availability of telephone crisis services may be related to reduced suicide rates among young white females. Also, there is a significant need to empirically associate counseling technique and indices of effectiveness with substantive measures of client outcome in future research. Additional topics reviewed include the probable differential effectiveness of lay workers with various presenting problems of clients, and the role that training and maturity seem to play in successful interventions. Guidelines for the use of evaluation techniques which coincide with service goals are also offered.     

A Functional Approach to the Assessment and Treatment of Non-Suicidal Self-Injury in Veterans: A Dialectical Behavior Therapy–Informed Perspective

Given that non-suicidal self-injury (NSSI) is related to increased odds of suicidal ideation and suicide attempts, treating NSSI in veterans is a key treatment priority to help reduce suicide risk and increase quality of life. Treating NSSI can be difficult for clinicians and training in addressing NSSI can enhance therapist empathy and decrease negative attitudes. The current paper describes prevalence of and risk factors for NSSI in veterans and presents a Dialectical Behavior Therapy (DBT)-informed approach for arriving at a functional understanding of NSSI in order to inform assessment and treatment. This DBT-informed approach is demonstrated with two case examples of veteran clients. While in many circumstances treatment of NSSI may be most effective in the context of full model DBT (i.e., individual therapy, group skills training, phone coaching, and therapist consultation team), many aspects of the functional approach discussed herein are not specific to DBT and could therefore be integrated into behavioral analyses and case formulations conducted within non-DBT therapeutic approaches.     

A Pilot Study of Transformational Leadership and College Counseling Outcomes

This pilot study explores the relationship between perceived transformational leadership skills of college counselors and outcomes in counseling. College students receiving counseling (n = 46) were given a revised version of the Multifactor Leadership Questionnaire (MLQ), the Working Alliance Inventory, Short Form (WAI-S), and the Counseling Center Assessment of Psychological Symptoms (CCAPS-34). Results yielded significant relationships between improvement in areas of client functioning and subscales measuring aspects of transformational leadership in counselors as perceived by clients. In addition to significant correlations between alliance and subscales of the MLQ, there were strong negative relationships between social anxiety and management by exception (active); academic distress and idealized influence (behavior); and alcohol use and management by exception (passive).     

Getting Everybody Involved

Abstract

This paper describes a creative approach for training counselor and counselor educators that provides collaborative interactions among students and faculty in several university training programs. Structured around a problem-solving activity and self-reflection questionnaires, undergraduate teachers-in-training were given an opportunity to receive one-to-one consultative counseling from the master's level counselors-in-training, who in turn received structured problem-solving supervision from the doctoral level students. Finally, the doctoral level students received faculty support to facilitate the development of their supervisory skills. The goal of this training approach is to provide students at all three levels with experiences similar to those they will encounter as professionals following graduation from the university, but within the context of scaffolding from faculty and more advanced students.     

Rational suicide and the crisis of terminal illness

Abstract

One of the controversial issues facing counselors in the 1990s is whether or not suicide may be considered a rational choice for clients with terminal illness. This article begins by reviewing the definition of rational suicide and the literature and statistics pertaining to suicide and terminal illness. Then various issues related to rational suicide as a treatment option are addressed, including moral and ethical issues.     

Loving‐Kindness Meditation and Empathy: A Wellness Group Intervention for Counseling Students

The effect of a 6‐week loving‐kindness meditation (LKM) on the multidimensional empathy of 103 master's‐level counseling students was evaluated, in addition to the correlation between reported levels of time spent meditating and empathy. Statistical analyses indicated that participants who received the LKM intervention experienced gains in dimensions of empathy. A significant relationship between quantity of meditation and perspective taking was noted. Implications and suggestions for future research are explored.     

Personal and professional factors and suicide intervention skills

This research investigated the relationship of professional and personal factors to the ability of counselors to respond appropriately to suicidal verbalizations using the Suicide Intervention Response Inventory (SIRI). Level of training, experience with suicidal clients, and death acceptance were positively related to suicide intervention competencies. A personal history of suicidality and a belief that suicide is a personal right were negatively related to such skills. Regression analysis revealed that personal history of suicidality and attitude toward suicide as a personal right accounted for a modest, but significant, percentage of the variance in SIRI scores, beyond that accounted for by professional factors. Post hoc analysis indicated that the negative relationship between personal history of suicidal behaviors and suicide counseling skills was significant in the professionally trained participants. These results highlight the importance of attitudes toward suicide and personal history of suicidality, as well as training and experience, in effectively counseling potentially suicidal clients.     

Assessing risk: confrontation or avoidance—what is taught on counsellor training courses

Recent mental health policy development has focused on the assessment and management of risk in vulnerable clients. Counsellors have a significant role to play in delivering mental health care in a range of settings, with clients sometimes presenting with suicidal ideation, self-injury and a risk of violence. The aim of this research was to explore the profile of risk assessment teaching within BACP accredited courses. A total of 49 BACP accredited courses were contacted and 24 responded. This response rate is discussed with particular reference to those courses that did not respond to the questionnaire. Risk assessment was viewed as an important consideration for counsellor training whilst suicide and self-harm seemed to have a higher profile than violence to others. Supervision was cited by the majority of respondents to have an important role in developing trainees' skills in assessing risk. The implications of the findings of this study for how counsellors are prepared by their training experiences to work with clients at risk are discussed and some recommendations made for future training developments.     

The Family Peace Project

Summary

Intimate partner violence-assault by a spouse, ex-spouse, intimate friend or ex-friend-is the most common cause of injury for women and a serious public health problem. As a result, the American Medical Association has recognized physicians' ethical obligation to diagnose and treat partner violence, and called for new models of training. In this article, we review literature on the health care system's response to domestic violence. We then describe the Family Peace Project, a community oriented model for training health care professionals to identify, treat and prevent partner violence in primary health care settings. This training program provides knowledge, clinical skills and a sense of professional empowerment. Unique features of this program include: involvement of community mentors (survivors of family violence) as program faculty; training in specific clinical skills and protocols for screening, assessment and intervention; a hands-on assessment of community resources; coinmunity service; and, creation of an award winning web site to promote dissemination of the training program.     

Empathy,Vulnerability and Anxiety

ABSTRACT

A concept of empathy as openness to the emotional perspective of another is developed in opposition to a concept of sympathy as agreement with the emotional perspective of another. Empathy involves knowledge of how things are emotionally for the other person, which is not the same thing as knowledge of the other person’s emotions. Being open to another perspective requires the capacity to hold two perspectives in mind simultaneously – one that is one’s own perspective and at the same time the adopted perspective. This is why empathy can be so challenging for someone suffering from some kinds of anxiety.