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Western Michigan University ScholarWorks at WMU Dissertations Graduate College 8-2018 Qualitative Analogue Study on Student Therapist’s Reactions to Client Suicidality Cynthia A. Beevers Western Michigan University, cyn.com Follow this and additional works at: https://scholarworks.edu/dissertations Part of the Counselor Education Commons, and the Psychoanalysis and Psychotherapy Commons Recommended Citation Beevers, Cynthia A., "Qualitative Analogue Study on Student Therapist’s Reactions to Client Suicidality" (2018).edu/dissertations/3314 This Dissertation-Open Access is brought to you for free and open access by the Graduate College at ScholarWorks at WMU. It has been accepted for inclusion in Dissertations by an authorized administrator of ScholarWorks at WMU. For more information, please contact wmu-scholarworks@wmich.

QUALITATIVE ANALOGUE STUDY ON STUDENT THERAPIST’S REACTIONS TO CLIENT SUICIDALITY by Cynthia A. Beevers A dissertation submitted to the Graduate College in partial fulfillment of the requirements for the degree of Doctor of Philosophy Counselor Education and Counseling Psychology Western Michigan University August 2018 Doctoral Committee: Kelly McDonnell, Ph., Chair James Croteau. Kathy Lewis-Ginebaugh, Psy. Copyright by Cynthia A.

Beevers 2018 A QUALITATIVE ANALOGUE STUDY ON STUDENT THERAPIST’S REACTIONS TO CLIENT SUICIDALITY Cynthia A. Western Michigan University, 2018 Suicidal clients are a reality for both professional and student therapists providing counseling (Chemtob et al., 1988; Dexter-Mazza & Freeman, 2003; Goodman, 1995; Howard, 2000; Jacobson, Ting, Sanders, & Harrington, 2004; Kleespies, Penk, & Forsyth, 1993; Kleespies, Smith, & Becker, 1990; Mackelprang, Karle, & Cash, 2014; McAdams & Foster, 2000). Previous research has investigated the experiences of professional therapists working with suicidal clients, but little is known about student therapists’ experiences with suicidal clients. Only two studies were found investigating the experiences of student therapists working with suicidal clients (Kleespies et al., 1993; Kleespies et al.

However, in the two studies explicitly focusing on student therapists’ experiences with suicidal clients, participants were doctoral students from clinical or counseling psychology programs that were in their pre-doctoral internship. No information was found regarding the experiences of student therapists currently attending a master’s degree program. Further, both studies exploring the experiences of doctoral students working with suicidal clients used a retrospective design. Thus, no information was found about the immediate reactions of student or professional therapists when working with a suicidal client.

The current dissertation aims to add to existing literature by using a phenomenological design and analogue methodology to better understand the immediate reactions of master’s level student therapists to a written vignette of a client’s clinical summary that included a history of suicidal behaviors and a second written vignette of a counseling dialogue with the client that included a discussion of the client’s suicidality. Specifically, this study aims to better understand: (a) what reactions do student therapists have in response to a written clinical summary of a potential client that includes a history of suicidal behaviors?, (b) what reactions do student therapists have when anticipating working with a client that has a history of suicidal behaviors?, and (c) what reactions do student therapists have to a written analogue of a counseling dialogue with a suicidal client? An Interpretive Phenomenological Analysis (IPA; Finlay, 2011; Larkin, Watts & Clifton, 2006) approach was used in the current study to analyze data gathered through semi-structured interviews with participants. Participants in this study described a range of complex and sometimes contradictory reactions in response to a written vignette of a client clinical summary that included a history of suicidal behaviors, and a written vignette of a counseling dialogue that included a discussion of the client’s suicidality. Further, findings indicated that these reactions would likely influence participants’ approach to working with a real suicidal client, particularly in regard to hesitancy assessing a client’s suicide risk.

Based on findings from the current study, recommendations are made to better inform graduate training in suicide prevention for master’s level student therapists. ACKNOWLEDGEMENTS Writing this dissertation has had a big impact on me and has been a period of intense learning for me professionally and personally. Completion of this dissertation was definitely a team effort and I would like to take the time to acknowledge and thank those who directly and indirectly contributed to this dissertation. First, I would like to recognize and give much thanks to my dissertation committee for their commitment to my successful completion of this dissertation and my Ph.

I would like to express my great appreciation to Dr. James Croteau who began this long process with me, and who, with great sadness, passed before completion of this dissertation. I will always be grateful to Dr. Croteau for his perseverance and unconditional support.

He has contributed to my professional and personal growth in many ways. Kelly McDonnell, I would like to express my appreciation and gratitude for stepping in as my committee chair following Dr. I am sure it was challenging to step into the middle of a dissertation project and I appreciate her willingness to understand and respect my project and me. Without a doubt, this project would not have come to fruition without her.

Anderson, who was also with me since the beginning of my journey, much appreciation for stepping in as the principle investigator after Dr. Croteau’s passing so that I could collect data and for believing in me as a Bachelor’s level candidate. Kathy Lewis- Ginebaugh, much thanks for being a great mentor as a clinician and advocate for suicide prevention. I have great respect for her passion and dedication to the work.

Lastly, my deepest appreciation to Michaela Bradley, M. for giving up her precious time to help me recruit participants for this study. ii Acknowledgments - Continued Second, I would like to thank my family for their support and encouragement. Completion of this dissertation and, ultimately, my Ph.

was a long challenging process. They were often witness to the struggle. I would like to give a special thanks and gratitude to my parents, Dale Beevers and Teresa Felter, who were there for all the mistakes and successes throughout this journey to gave what they could. Not everyone has parents or family that will catch them when they fall; I am lucky and grateful to them for catching me every time I fell.

Completion of this dissertation and Ph. is their success as much as it is mine. Lastly, I would like to thank the supervisors, mentors, and friends I have made throughout this journey. To my supervisors and mentors, thank you for believing in me and seeing my talent and potential, and for always pushing me to believe in myself.

A special thanks to Dr. Carol Foneseca and Dr. Justin Lincoln for their unwavering support and faith in me. They never failed to boost me up when I was questioning myself and getting lost in the struggle.

I will always be grateful for their presence and influence in my life. Not only are they wonderful Psychologists, supervisors, and mentors, they are phenomenal people. I would also like to thank my friend, Carolyn Stockel-Dobbins, who I meet early in my program and who shared her passion for helping and suicide prevention. She has always been a fierce supporter and friend.

Finally, a special thanks to my dear friend Amanda Kruger, who I met at my pre-doctoral internship. She was always a cheerleader and, no matter her own situation, was available to offer her support, encouragement and faith in me. She was the light I needed in my final push to complete this dissertation and my Ph. Beevers iii TABLE OF CONTENTS ACKNOWLEDGEMENTS.

INTRODUCTION AND LITERATURE REVIEW .1 Background for the Current Study .2 Prevalence of Client Suicide Behaviors .2 Counseling Process in Suicide Intervention .9 Research with Professional Therapists .10 Research with Student Therapists .58 Summary and Integration of Research on Professional and Student Therapists’ Experiences with Suicidal Clients .67 Purpose of the Current Study .84 Trustworthiness in Qualitative Research .93 Researcher Background and Experiences .96 iv Table of Contents – Continued CHAPTER Researcher Experiences of the Phenomenon .98 Researcher Perspective of the Phenomenon .101 Research Questions, Interview Questions, and Assumptions .104 Sampling Procedures and Participants .105 Data Collection Procedures.112 Data Analysis Procedures .125 Purpose of the Study .125 Data Collection Procedures.125 Approach to Data Analysis. 127 Themes Identified Under Research Question 1. 127 Themes Identified Under Research Question 2. 134 Themes Identified Under Research Question 3.

163 vi Table of Contents – Continued CHAPTER IV.170 Researcher Reflections and Possible Influence .170 Narrative and Implications of Participant Reactions .17 Participant Reactions to a Written Vignette of a Client’s Clinical Summary that Includes a History of Suicidal Behaviors.177 Participant Reactions to a Written Vignette of a Counseling Dialogue Involving Suicidal Content .183 Possible Influences on Participant Reactions .189 Fit with Existing Literature .193 Implications and Suggestions for Training Student Therapists in Suicide Prevention .199 Need for Training .199 Timing of Training .202 Content of Training .205 Suggestions for Future Research .208 Summary and Concluding Comments. Informed Consent for In-Person Data Collection .231 vi Table of Contents – Continued APPENDICIES D. Updated Informed Consent. Suicide Prevention Resources.

Human Subjects Institutional Review Board Letter of Approval .248 vii CHAPTER I INTRODUCTION AND LITERATURE REVIEW The purpose of the current study is to understand how master’s level student therapists react to a client with a history of suicide and a counseling dialogue with a suicidal client. Specifically, the purpose is to better understand how novice (i., have not provided counseling services) master’s level student therapists react to a written vignette of client case history involving past suicidal behaviors and a second written vignette of a counseling dialogue with the client that involves assessing the client’s suicide risk. The aim of Chapter I is to establish the background and rationale for the current study by reviewing relevant literature. Literature on therapists’ experiences with suicidal clients has focused on professional and student therapists from a variety of mental health fields.

However, this review has been limited to literature on the experiences of therapists from the more traditional counseling professions, including: counseling, counseling psychology, clinical psychology, and clinical social work. While there are other mental health fields that provide direct services to suicidal clients, such as psychiatry and psychiatric nursing, research using these groups was excluded due to significant differences in values, philosophies, treatment focus, client population, and work setting. This chapter is divided into three main sections. The first main section provides the background for the current study, including: (a) prevalence rates of fatal and non-fatal suicide behaviors from clients in counseling, and (b) the counseling process research in suicide 1 intervention.

The second main section is the literature review, which provides a discussion of current research on professional and student therapists’ reactions to suicidal clients. The final section will address the purpose of the current study, and briefly discuss how this dissertation will address the gaps and limitations identified in the reviewed research. Background for the Current Study The following section will establish the background for the current study by reviewing prevalence rates of fatal (i., completed suicide) and non-fatal suicide behaviors (e., suicide ideation or suicide attempts) from clients in counseling, and providing an overview of counseling process research in suicide intervention. Reviewing prevalence rates of fatal and non-fatal suicide behaviors from clients in counseling will establish that suicide is a common issue that is encountered by professional and student therapists.

An overview of research on the counseling process in suicide intervention will show gaps in current knowledge regarding the therapist’s influence on the effective treatment of suicidal clients. Prevalence of Client Suicide Behaviors The following section will review prevalence rates of fatal and non-fatal suicide behaviors both professional and student therapists have encountered from clients in counseling. First, data on the rates that professional therapists encounter client suicide behaviors is briefly summarized. As the specific focus of the current study is on the experience of student therapists, prevalence rates of client suicide behaviors encountered by student therapists is reviewed in more detail.

As mentioned previously, the research reviewed was limited to professional and student therapists in counseling, counseling psychology, clinical psychology, and social work.