A Distress-Processing Model for Clients in Suicidal Crisis.

Background: While crisis intervention frameworks have indicated the importance of clients in suicidal crisis better understanding their distress to decrease suicidality, it is unclear how clients in suicidal crisis process their distress. Aims: To develop (Study 1) and validate (Study 2) a sequential distress-processing model for clients in suicidal crisis. Methods: Applying task analysis, Study 1 consisted of three phases, which resulted in a theoretically and empirically informed model. In Study 2, we examined the distress-processing model's validity using a longitudinal design. In both studies, data were online crisis chats with adults in suicidal crisis. Results: In Study 1, we developed a sequential five-stage distress-processing model: (Stage 1) unengaged with distress, (Stage 2) distress awareness, (Stage 3) distress clarity, (Stage 4) distress insight, and (Stage 5) applying distress insight. In Study 2, the model's validity was supported via evidence that (H1) progression through the processing stages was sequential and (H2) clients with good outcomes had greater progression in their processing than clients with poor outcomes. Limitation: Clients who were suicidal but did not disclose their suicidality were not included. Conclusion: Our findings provide a framework for conceptualizing and operationalizing how clients move through suicidal crises, which can facilitate intervention and research developments.

Bridging the multicultural orientation framework with sexual and gender minority psychotherapy: A mixed studies systematic review.

Sexual and gender minorities (SGM) experience higher rates of psychological distress and seek psychotherapy at higher rates compared to their heterosexual and cisgender counterparts. However, few therapists are trained on how to provide effective psychotherapy with SGM clients. The multicultural orientation (MCO) framework, which has been linked to improved therapeutic processes and outcomes, may be a valuable tool for working with SGM clients. The primary aim of this systematic review was to link the MCO framework to existing empirical psychotherapy research with SGM clients. A secondary aim was to examine how MCO constructs that we identified within the SGM literature have been associated with therapeutic processes and outcomes with SGM clients. A systematic search of five databases yielded 61 studies that were included in the review. Framework analysis was used to extract data and identify themes and subthemes related to MCO constructs from included studies. Results of the review demonstrate how the MCO framework can be used to conceptualize psychotherapy with SGM clients and-using the MCO framework-highlight potential beneficial and harmful therapist qualities and actions when working with SGM clients. Implications for future research and psychotherapy practice with SGM clients are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

How the helping process unfolds for clients in suicidal crises: Linking helping-style trajectories with outcomes in online crisis chats.

OBJECTIVES: Crisis counselors' active listening and collaborative problem-solving helping styles have been associated with outcomes for clients in suicidal crises. These associations have been based on static conceptualizations of helping (i.e., helping style for the entire session). Our aim was to further understand how the crisis counseling helping process unfolds (i.e., helping trajectory) and helping trajectories' association with clients' outcomes. METHODS: Online crisis chats (N = 269) with suicidal adults were coded for crisis counselors' helping styles (i.e., active listening and collaborative problem-solving) and clients' outcomes (i.e., resolved or unresolved). Each talk-turn was coded for helping style, which were used to examine helping-style trajectories. RESULTS: Growth-curve models indicated that helping styles varied over the course of chats and that helping trajectories were different for resolved and unresolved chats. In resolved chats, helping styles moved from primarily active listening to primarily problem-solving-with a deceleration in the middle of chats. In unresolved chats, helping initially moved from primarily active listening to primarily problem-solving, but this trajectory decelerated in the middle of chats and then turned back toward primarily active listening. CONCLUSION: Our findings demonstrate that how the helping process unfolds is related to clients' outcomes. Implications for practice and research are discussed.