Working with suicidal clients: The person‐centred counsellor's experience and understanding of risk assessment

Background: Client risk assessment within the person‐centred paradigm is traditionally seen as squarely opposed to its ethos. Aim: To determine how the person‐centred counsellor experiences and understands the issue of risk assessment within the confines of their work ethos. Method: Semi‐structured interviews with seven person‐centred counsellors using thematic analysis were conducted. Findings: Three main themes emerged following thematic analysis: The impact of the risk assessment process on self; The counsellor's experience of self, and The therapeutic process in relation to risk assessment. Discussion: The findings suggest that person‐centred counsellors conduct risk assessments taking a holistic approach involving not only individual risk predictors and characteristics of the client but also individual factors related to self.     

Counsellors' experiences of working with suicidal clients: An exploratory study

Counselling is increasingly available in a wide variety of contexts, including mental health and psychiatric services. As a consequence, counsellors increasingly work with clients who present with suicidal ideation, expressing either suicidal thought and/or intent in the counselling session. This paper describes an exploratory study that examined the experience of counsellors when working with suicidal clients. The paper considers counsellors' behavioural, cognitive and emotional responses to such suicidal expression, both on a personal and professional level. The research employed semi‐structured interviews. A constant comparative method was used in analysing the transcribed interview text. Results suggest that counsellors experience a range of responses when their clients express suicidal thought, including fear, anxiety, anger and professional impotence. The interviewees also expressed self‐doubts about their professional competence. In addition, they identified the threat of litigation for negligent practice and the lack of confidence in appropriate risk assessment approaches as significant causes for concern. The implications for further research, and practice, are discussed.     

Women counsellors' experiences of personal therapy: A thematic analysis

Background: Following recent moves to relax the requirements for clinical mental health trainees to undergo personal therapy, this qualitative project explored the effects of personal therapy on volunteer counsellors. Method: Interviews were conducted with 19 volunteer counsellors at a women's community centre, and the data were analysed using thematic analysis. Findings: Emerging themes included the importance of personal therapy for trainee development, key elements of personal therapy and the idea that personal therapy is ‘a double‐edged sword’. Discussion: Allowing for evident methodological difficulties in evaluating the impact of personal therapy on trainees, this study suggests that close consideration should be given to the potentially adverse effects of reducing requirements for personal therapy in clinical trainings.     

The experiences of person-centred counsellors working with suicidal clients online through the medium of text

ABSTRACT

In this study, we attempt to provide an understanding of the experiences of four UK-based person-centred counsellors working with suicidal clients online using text-based therapies and the impact of their clients’ suicidal ideation upon their “way of being”. The counsellors were selected purposively; each was working as a person-centred counsellor online, was encountering suicidal ideation in their clients, and was a member of a professional organisation. A narrative approach was taken, using unstructured interviews and a stanza format of representation. We found that participants had developed a way of being online that may be distinct from their in-person practice. Challenges included being more directive, lacking physical presence, lacking confidence in assessing risk and questions about empathic understanding. Working online with risk raises specific challenges for person-centred practitioners in line with what is indicated in the little relevant research currently already available.     

Worst-point suicidal plans: a dimension of suicidality predictive of past suicide attempts and eventual death by suicide

Among 440 psychiatric outpatients with current suicidal ideation, we examined the empirical distinction between the “plans” vs. “desire” dimensions of suicidality, focusing for conceptual and empirical reasons on a worst-point assessment strategy. Factor analyses were consistent with the distinction, but more importantly, among the current ideators included in this study, the worst-point “plans” dimension was the only predictor significantly related to both of two important indices, history of past attempt and eventual suicide. These findings bear on the trajectory of suicidal behavior over time, as well as inform the clinical assessment of suicidal patients.     

Optimising daily diary questionnaires about fatigue,psychological flexibility and well-being: perspectives of people with rheumatic disease

Objectives: The aim of this study was to understand the perspectives of people with rheumatic disease have about completing a pilot daily diary questionnaire on fatigue and well-being, with the objective of incorporating these perspectives into future daily studies.

Methods: Twenty-two participants with experience of rheumatic disease-related fatigue attended a focus group and/or an individual interview. Before the focus group or interview, participants completed a one-off quantitative diary about their fatigue and well-being that day. In the focus groups and interviews, participants were asked about their experience completing the questionnaire. Data were analysed using inductive thematic analysis.

Results: Three themes were identified. ‘Concerns about Misinterpretation and Ambiguity’ addressed the elements of the diary questionnaire that were confusing or unclear to participants. ‘Desire to Provide Useful and Accurate Information’ outlined participants’ uncertainty about how to report complex daily experiences. ‘Gaining Personal Insight through Diaries’ revealed the personal benefits participants gained, particularly the development of insight into their fatigue.

Conclusions: People with rheumatic disease are willing to complete a daily diary questionnaire, but emphasise it is important for diary questionnaires to have clear instructions, questionnaire items and response scales. Addressing these concerns will ensure the reliability and validity of quantitative diary data.     

Beliefs about the cause,manifestation, and cure of schizophrenia: A cross-cultural comparison

This study set out to compare British and Sri Lankan young people's (students) beliefs concerning the causes, manifestations, and cures of schizophrenia. One hundred and seventy-five British and Sri Lankan participants completed the three-part questionnaire in their mother tongue. It was hypothesized that the Sri Lankans would have more negative and uninformed attitudes and beliefs about schizophrenia than the British. It was also hypothesized that the Sri Lankans would favour superstitious, family, and sociological causes to explain the development of schizophrenia, while the British would favour more biological explanations. These two hypotheses were confirmed after factor-analysing the internal structure of the three sections of the questionnaire. Even well-educated young people remain ignorant about one of the most challenging mental illnesses.     

Supplanting the venom of litigation with alternative dispute resolution: the role of counsellors and guidance professionals

This literature review attempts to interface counselling with alternative legal practice. The authors proceed by contrasting the adversarial nature of litigation with the conciliatory nature of alternative dispute resolution (ADR) with a view to encouraging seekers of dispute resolution to opt for ADR in lieu of litigation. The paper discusses the Ubuntu world view in conflict resolution in relation to ADR practices. While not presenting ADR as a replacement for litigation nor proscribing litigation in itself, this paper prescribes the use of ADR to arrive at settlements that are more satisfactory and longer lasting. The paper finally shows how counsellors and guidance professionals may be involved in ADR processes to effectively give succour to conflicting parties.     

Supporting families of transgender children/youth: Parents speak on their experiences,identity, and views

ABSTRACT

Background: Transgender children/youth demonstrate the best possibility for resilience and positive mental health when they are part of an affirming and supportive family. To optimize families in supporting transgender children/youth, parents/caregivers need to be supported. Transgender children/youth and their families regularly navigate a myriad of challenges through society.

Aims: Within the extant literature on transgender children and youth, relatively little attention is focused on the experiences of parents/caregivers and how their close family relationships are affected. The present qualitative study addresses this gap in knowledge through its exploration of the experiences, identities, and views of parents/caregivers of transgender children/youth.

Method: The study is longitudinal and this article represents the first wave. Fourteen parents of 12 transgender children/youth, aged 6–17, participated in in-depth semistructured interviews. Participants were recruited via social media and at an on-site conference for transgender youth and their families. All children/youth had socially transitioned. Those who were eligible for puberty suppression and/or hormone therapy were receiving those. The interviews were inductively coded for themes by two coders using the constant comparative method.

Results: Participants' reports on their experiences yielded three themes: (1) transgender issues as the family's focus; (2) proactivity, child-focused: preemptive actions to prevent adverse consequences; and (3) self-care. These themes included subthemes on effective coping strategies to mitigate struggles. Three themes related to participants' identity and views emerged: (1) identity reformation, (2) self-evaluation, and (3) views of future. These themes included subthemes that reflected how participants viewed themselves, their child, and the future.

Discussion: A transgender identity in one family member affects all household members. Parents/guardians may experience guilt and self-doubt over decisions. Factors that may improve outcomes with extended family and schools include families' preemptive dissemination of information on transgender identities and explicating expectations of respect and nonintrusion. Ingrained traditions may force life-altering decisions.     

Tomorrow is the start of the rest of their life — so who cares about health? Exploring constructions of weight-loss motivations and health using story completion

ABSTRACT

In Western societies, health is closely associated with body weight and weight loss, achieved through individual health behaviour. I examined such associations in constructions of weight-loss motivations and health in stories generated using the novel method of story completion. The story stem featured either a female or male protagonist deciding to lose weight; 148 women and 22 men (ages 18–24) provided stories in response. A social constructionist thematic analysis identified five themes: health as clothing size and means to an end; weight-loss activity as good for every woman; tomorrow is going to be the start of the rest of their life; tell me when I’m okay — it’s not about wellbeing; and weight loss as signifier of the “true self.” Considering the adverse social and psychological consequences reflected in the stories and the longstanding elusiveness of successful weight-loss methods, I support calls to review the dominant weight-focused approach to public health.     

The prevalence of suicidal ideation and suicide attempt in patients with rheumatic diseases: a systematic review and meta-analysis

A number of studies have reported the suicidal ideation (SI) or suicide attempts (SA) of patients with rheumatic diseases. However, the estimated prevalence of those disorders varies substantially between studies. This systematic review aimed to describe the prevalence of SI and SA in rheumatic diseases. Literature search was done using Web of Science, Embase, the Cochrane database library, PubMed and CNKI database through June 2017. Studies were screened according to inclusion and exclusion criteria and the qualities of included studies were evaluated. The data was analyzed using STATA version 12.0. A random-effect meta-analysis was conducted on all eligible data. A total of 17 identified studies matched the inclusion criteria, involving 5174 participants with systemic lupus erythematosus (SLE), osteoarthritis (OA), rheumatoid arthritis (RA) and fibromyalgia (FM). Meta-analysis showed that rheumatic diseases patients have high prevalence of SI (26%, 95% CI: 19%-32%, I²=96.2%) and SA (12%, 95% CI: 3%-21%, I²=96.6%). We also found the prevalence of SI and SA in females may be higher than in males. All of these indicated that rheumatologists should screen for SI and SA in their patients. Early appropriate intervention is therefore essential to promote the patients’ good mental health.     

Psychotherapy across languages: beliefs,attitudes and practices of monolingual and multilingual therapists with their multilingual patients

Aims: The present study investigates beliefs, attitudes and practices of 101 monolingual and multilingual therapists in their interactions with multilingual patients. Method: A mixed‐method approach was adopted using an online questionnaire with closed questions, and informed questions in interviews with one monolingual and two multilingual therapists. Results: A principal component analysis yielded a four‐factor solution accounting for 41% of the variance. The first dimension, which explained 17% of variance, reflects therapists' attunement towards their bilingual patients (attunement versus collusion). Further analysis showed that the 18 monolingual therapists differed significantly from their 83 bi‐ or multilingual peers on this dimension. The follow‐up interviews confirmed this result. Discussion: Recommendations based on these findings are made for psychotherapy training and supervision.