Styles of Suicide Intervention: Professionals' Responses and Clients' Preferences

As the rates of suicide in America continue to rise, suicide recently has been declared to be a national public health concern. The crisis intervention model, which has dominated the treatment of suicidal individuals in America since the 1950s, is currently believed to be the most effective model for suicide intervention. This study examined this belief by taking a more complex look at professionals' responses to suicidal clients both by investigating the existence of different ways in which professionals interpret the crisis intervention model. In one interpretation (the "fight" response), the professional takes power and agency away from the client and does what is perceived to be "best" for the client. An alternate interpretation, the "ideal" response, allows for a respectful engagement with the client. Professionals also can act contrary to the model (i.e., the "flight" response). In addition, based on the humanistic notion that clients are the experts of their own experience and that their voices are a very valuable part of evaluating the treatment process, this study investigated which response style clients report to be most helpful and most desired. The results suggest that while the typical response of mental health professionals to suicidal clients is most characteristic of the "fight" response style, clients overwhelmingly report that the contrasting "ideal" response style is most helpful. The findings are discussed along with implications for practice, research, and training.     

The Value of Curiosity and Naiveté for the Cross-Cultural Psychotherapist

Therapists today face a dramatic increase in the cultural diversity of their client populations. Cultural literacy, long the dominant model for preparing to do cross-cultural therapy, advocates study of the prospective client's history and culture. This model, however, poses logistical problems, emphasizes scholarship over the experiential and phenomenological, and risks seeing clients as their culture and not as themselves. In this essay, we argue that teaching culture alone can obscure therapists’ view of human diversity. To balance the cognitive model of preparation, a process-oriented approach is considered, whereby the therapists’ attitudes of cultural naiveté and respectful curiosity are given equal importance to knowledge and skill. We begin from a concern with clients’ vulnerability in the power distribution that inevitably exists in therapy, especially with immigrant and marginalized populations. The use of acculturation narratives, which the therapist explores with naiveté and curiosity, helps clients to find their voices.     

正式反馈的发展与临床应用

摘要:正式反馈通过系统收集当事人的效果反馈来追踪其治疗进展,进而识别缺乏治疗进展的个案,并通过促进治疗策略的调整来阻止治疗失败。正式反馈是近20年来发展出的一种循证治疗手段,其目的为进一步提高当事人的咨询效果。正式反馈的发展大致经历了临床有效性检验和实用性发展两个阶段。正式反馈可用于促进个体、夫妻和团体咨询的效果,也可用于评估临床督导效果、确定督导个案和指导临床督导。未来研究可探讨咨询师对待正式反馈的态度,拓展正式反馈的使用价值,建立正式反馈系统的本土化常模。     

A Model for Adapting Evidence-Based Interventions to Be LGBQ-Affirmative: Putting Minority Stress Principles and Case Conceptualization Into Clinical Research and Practice

The mental health field now possesses clinical trials attesting to the efficacy of affirmative practice with sexual minority individuals. With the goal of efficiently moving the results of these clinical trials into real-world clinical practice, this paper offers a model for adapting existing evidence-based practices originally developed for the general population to be lesbian, gay, bisexual, and queer (LGBQ)-affirmative. The adaptation model presented here guides clinicians to incorporate six LGBQ-affirmative transtheoretical principles of change into practice. These principles facilitate raising awareness of the impact of minority stress on sexual minority clients’ mental health and on client self-evaluation while drawing upon sexual minority resilience and intersectional experiences to build empowering coping skills and validating relationships. The adaptation model also provides a transtheoretical approach to case conceptualization that directs clinicians to consider the role of early and ongoing minority stress on sexual minority clients’ cognitive, affective, motivational, behavioral, and self-evaluative experiences that maintain current distress. This case conceptualization approach highlights common associations among these experiences, suggesting clear routes of interventions for many sexual minority client presentations. Case examples from recent clinical trials of LGBQ-affirmative cognitive-behavioral therapy illustrate how these principles and this case conceptualization can be effectively utilized in practice. While the principles and case conceptualization are meant to be transtheoretical and therefore applicable across therapeutic techniques, to date they have been tested only in clinical trials for cognitive-behavioral treatments. Therefore, this paper concludes with a call for future research to determine the effectiveness of implementing this adaptation model across diverse therapeutic modalities and client presentations.     

Evaluation of a Safe Sleep Training for Home Visitors and Their Clients

Sleep-related deaths are a common preventable cause of death, and such deaths occur disproportionately in families of color. Home visitors provide families with education about infant safe sleep guidelines; however, families face many barriers to engaging in safe sleep practices. This study evaluated the efficacy of a program to train home visitors to talk to clients about infant safe sleep using Motivational Interviewing and cultural sensitivity. We examined the effects of the intervention on home visitors’ (n?=?23) knowledge, MI skill use, and cultural sensitivity using a single group pre-post design. We also examined home visiting clients’ (n?=?78) knowledge, attitudes, and behaviors using a quasi-experimental design. Home visitors were primarily female (97%), had a college degree (86%), and were primarily white (50%) or African American (43%). The home visiting clients were all female and were primarily African American (43%) and Caucasian (36%). Most clients (59%) earned less than 30,000 dollars per year. Home visitors showed significant improvement in MI skill use and cultural sensitivity from pre- to post-test. Regarding client outcomes, our results indicate a significant group by time interaction when predicting changes in client knowledge such that the treatment group showed larger gains than the control group. There were no significant differences between groups when predicting changes in client attitudes or behavior. MI may be an effective technique for home visitors to help increase families’ safe sleep knowledge. Additional research is needed to examine whether such training can translate to changes in families’ safe sleep behavior.

     

Theory and Practice: Assessing the psychological presentation of gifted and talented clients: a multicultural perspective

Researchers suggest that gifted individuals have both strengths and areas of intrapersonal and interpersonal concerns as a result of their talents. The purpose of this paper is to apply a multicultural model of psychological assessment, the Multicultural Assessment Procedure (MAP), to better understand the social and emotional needs of gifted clients. This application is based on the following assumptions: a) giftedness is a sub-culture, b) people with special gifts also identify with and operate in multiple cultural contexts, and c) in order to be effective in working with gifted clients, one must accurately understand the interaction of the client’s multiple cultural identities. Implications for counselling practice are discussed.     

A humanistic developmental model of counselling: A psycho-educational approach

A developmental model of counselling, based on humanistic principals of psychological functioning, is proposed. A psycho-educational approach, in which counsellors are seen as helping clients develop skills rather than solve problems, is discussed. The counselling model involves three stages: exploration, intervention and empowering. The intervention stage includes techniques focused on affect, behaviour or cognition, as suggested by the ABC model of personal change described in the paper.     

A discourse analysis of power in relation to PSYCHLOPS (Psychological outcome profiles) in the context of CBT for psychosis

Aims: Outcome measures (OMs) and routine change measurement have developed dramatically in psychological therapies over the last two decades and some therapists have expressed concerns that this, depending on how it is handled by the parties involved, can markedly affect the therapy. However, little research has investigated this. It therefore seemed timely to explore discourses of OMs drawn upon by both parties in the therapy room. Method: PSYCHLOPS (Psychological Outcome Profiles) is a client‐centred measure which offered an opportunity to explore how therapists and clients receiving CBT for psychosis talked about OMs. A useful contrast was provided by the CORE‐OM (Clinical Outcomes in Routine Evaluation‐Outcome Measure). The discourses drawn upon by clients (n=4) and therapists (n=4) were analysed, informed by a Foucaultian framework. Results: OMs were constructed as empowering or disempowering of clients, as being able to do therapeutic work of engagement and containment, and as part of the apparatus of service power, positioning therapists as relatively powerless to question their use. Discussion: It is suggested that client‐centred measures like PSYCHLOPS, although partly aligned with a recovery framework, may become part of top‐down state and service power, and there is a need for more research into the different ways in which OMs are used in therapy and the impacts on therapists, clients and their relationships.     

Psychological Distress with Direct-to-Consumer Genetic Testing: A Case Report of an Unexpected <Emphasis Type="Italic">BRCA</Emphasis> Positive Test Result

We report a case of a client who discovered she had a BRCA mutation following direct-to-consumer (DTC) genetic testing in the absence of genetic counseling. After testing she presented for genetic counseling with anxiety, distress, and a deficit of knowledge about what the DTC genetic testing revealed. Genetic counseling helped alleviate distress while empowering the client to apply the results of testing to improve medical management. Despite recent studies demonstrating no negative psychological impact of DTC genetic testing on the consumer, this case illustrates that significant psychological distress and confusion can occur as a result of DTC genetic testing for highly penetrant single gene disorders. Pre- and post-test genetic counseling in conjunction with DTC genetic testing may alleviate consumers’ distress and empower clients to proactively utilize their result information.     

Coaching Clients to Manage Depression

The author presents a system of behavioral techniques that permits clients to manage their own depression. By coaching clients through the sequence of self-management procedures identified by Kahn (1976) and using the strategies offered by Lewinsohn (1975), counselors have an effective set of techniques to lead clients to successful coping with depression. The sequence of self-observation, self-mediation, and self-reinforcement activities is based on Lewinsohn's (1975) work and is effective with moderately depressed clients. This comprehensive treatment program requires a minimum amount of counselor intervention for a maximum amount of client gain.     

A Case Study Demonstrating Reduction of Aggressive Client Behaviors Using the Neuro-Occupation Model: Addressing Professional Burnout through Nonlinear Thinking

This single case study suggests that mental health practitioners adopt nonlinear modes of thinking within the neuro-occupation model to avoid professional burnout. Accordingly, the elimination of severely aggressive behavior of an institutionalized client was reviewed following an intervention using the model. Provided with new opportunities, the client self-extinguished aggressive interactions, reinstated social behaviors, and expanded occupations. Accepting clients as their own change agents limits our role to facilitators and reframes service delivery in mental health, which argues for comparison studies that measure reduced burnout in occupational therapists using the model.     

Therapist Perceptions of Client Reactions

This study examined therapist ability to identify client-reported reactions. Sixteen therapists each saw two volunteer clients for single counseling sessions. In postsession reviews, clients rated the helpfulness of, and indicated their reactions to, each therapist intervention. Therapists also rated the helpfulness of, and indicated their perceptions of client reactions to, each therapist intervention. In 50% of the instances therapists matched clients, that is, reported the same reaction cluster as the clients did. There were higher match rates on the reaction clusters of therapeutic work (62%), supported (54%), and no reaction (46%) than negative reaction (27%) and challenged (14%). When therapists matched on therapeutic work, helpfulness ratings for the following intervention were higher than when therapists did not match. In contrast, when therapists matched on negative reactions and no reaction, helpfulness ratings for the following intervention were lower than when they had not matched. Thus, therapists' ability to match client reactions was related to their ability to generate helpful interventions. Implications for practice and future research are discussed.     

Being transformed: Delivering a psychotherapeutic group intervention targeting repeat suicide attempts

Clients who make repeat suicide attempts have complex needs, are at high risk of completed suicide and pose a range of challenges for clinicians. Targeted interventions are required. Acceptability, the perceived appropriateness of an intervention, is associated with successful implementation, engagement and effectiveness of interventions. Despite the advantages of group interventions, there is limited research into the acceptability of groups with this population. Using Interpretative Phenomenological Analysis, this paper reports on facilitators’ experiences (n = 9) of the acceptability of a therapeutic group intervention (PISA – a Psychoeducational/psychosocial Intervention for persons who make recurrent Suicide Attempts). Analysis of focus group data revealed how involvement with the intervention profoundly influenced facilitators’ perceptions of and approach to their work with this client group. They embraced the model, developed a deeper appreciation of clients’ resources and became unburdened from sole responsibility for the clients, the therapeutic process and outcomes. PISA provided a model that helped facilitators to work in a focused, compassionate and creative manner as they addressed the central concern of these clients, their suicidal desire, with newly found confidence and eagerness. PISA was experienced as acceptable to facilitators as it was useful to them and deemed appropriate and beneficial to the target population.     

A practice-based study of cultural humility and well-being among psychotherapy clients

One trend in psychotherapy research involves examining client factors to better understand change. Some have framed client factors as virtues. Humility is one virtue that has gained attention with evidence that suggests humility may help facilitate therapeutic change. A specific type of humility, cultural humility, however, has not been closely examined as a client factor. Cultural humility is a relational virtue that addresses an individual's ability to be open towards cultural differences and can be helpful in buffering diverse relational dynamics (e.g., student and teacher, family members and friends with different beliefs). In this study, we examined client change in cultural humility and well-being using group-based trajectory modelling. We also examined differentiation as a predictor of trajectory membership and compared trajectories on levels of symptoms. Results suggested that a subgroup of clients showed significant increases in cultural humility and well-being. Further analyses found that clients with higher levels of initial differentiation were more likely to belong to the growth trajectory. This same trajectory also decreased in symptoms over time.     

A Mixed Methodological Analysis of the Role of Culture in the Clinical Decision‐Making Process

Even though literature indicates that particular cultural groups receive more severe diagnoses at disproportionate rates, there has been minimal research that addresses how culture interfaces specifically with clinical decision making. This mixed methodological study of 41 counselors indicated that cultural characteristics of both counselors and clients—including the degree of match between these characteristics—affect attention to cultural issues in clinical decision making. In addition, there was a significant relationship between participant cultural bias and perceived level of client functioning.     

Pilot test of a measure to assess clients’ perceptions of their home visitors

Home visiting services for caregivers of infants and young children have been found to be an effective method for promoting child development. Unfortunately, such services suffer from high rates of attrition, suggesting the need to identify factors related to client retention in services. Research has indicated that the client-provider relationship is an important predictor of client retention in home visiting services; however, measures to assess this relationship are limited. This study reports on a pilot test of the Client Perceptions of Home Visitors Questionnaire, developed to assess home visiting clients’ perceptions of their relationship with their home visitor. The measure was completed by 39 diverse home visiting clients during pregnancy in a midwestern town in the United States. The scale was found to have good internal consistency. Validity analyses found that the scale was positively associated with client satisfaction with services and perceived provider cultural sensitivity. The scale was also positively associated with retention in services at an 8-month follow-up. Additional research should examine the measure's psychometrics with larger samples.     

Therapeutic Utility of Discussing Therapist/Client Intersectionality in Treatment: When and How?

The impact of the therapeutic alliance on positive clinical outcomes has been established in the literature; however, literature is lacking on how the intersection of therapist and client identities influences this process. We propose that the relational intersectionality resulting from similarities or differences in therapist and client identities has the potential to impact the bonds, tasks, and goals of treatment (key components of the therapeutic alliance; Bordin, 1979) depending on how it is addressed or avoided in therapy. In this paper, we present a model containing pragmatic steps therapists can follow to navigate these conversations with clients in a way that is therapeutically beneficial and culturally sensitive and attuned. Additionally, we provide suggestions for using the proposed model to train new student therapists (or expose experienced therapists) to ideas of intersectionality and social justice by reflecting on the intersection of their own identities, acknowledging dynamics of power and oppression, and understanding how this could shape their relationship with clients.     

Using the Sand Tray to Facilitate Client Creativity: A Strengths Focused Approach to Adolescent Depression

Interventions incorporating the sand tray are presented as a tool for facilitating creative solutions in adolescent clients presenting with depression. The authors describe how interventions using the sand tray promote client strengths and provide a tool for adolescent clients to better understand their depressive symptoms, identify triggers, and practice coping skills. Attention will be given to how these interventions can be used across counseling perspectives including cognitive-behavioral, narrative, and psychodramatic approaches. The intervention is described and the authors present a case study of its use with an adolescent client experiencing significant levels of depression.     

Infusing culture in career counseling

This article introduces the culture‐infused career counselling (CICC) model. Six principles are foundational to a tripartite model emphasizing cultural self‐awareness, awareness of client cultural identities, and development of a culturally sensitive working alliance. The core competencies ensure the cultural validity and relevance of career counseling practices for all clients and shift the focus of career practice to support social justice action.     

The practice research network: Research into practice,practice into research

The purpose of the broader project on which this report is based was to utilize a Practice Research Network, an alternative to traditional clinical studies to 1) identify demographically one practice group, namely professional counselors in the United States, 2) describe their practice patterns, and 3) identify their client population and the efficacy of their clinical work through client outcomes based on actual client reports. This article describes the development of one such nation‐wide Practice Research Network (PRN) and provides some preliminary findings for each phase of the project. Use of the PRN model can help overcome the traditional “research to practice” gap and provide research results into community practice thus integrating outcomes measures into the daily practice of mental health professionals. During the early phases of this project, a software program was developed upon which the participating practitioners could identify the data elements within the parameters of the focus on their agreed‐upon research interests, enter data following client visits over time, and by comparing their own composite profiles and effectiveness with those of other participating practitioners who had clients presenting with similar diagnoses, could alter their own service delivery patterns, therapeutic interventions, or approaches while working with the clients and thereby improve the efficacy of their service. By participating, the practitioners benefited by access to downloadable and printable reports on profiles of 1) their specific clients, 2) their service delivery patterns, and 3) the outcomes or efficacy by their clients’ direct feedback. They were also able to compare these results with the composite data from other practitioners.