BACKGROUND: Building therapeutic relationships and social presence are challenging in digital services and maybe even more difficult in written services. Despite these difficulties, in-person care may not be feasible or accessible in all situations.
OBJECTIVE: This study aims to categorize crisis counselors\' efforts to build rapport in written conversations by using deidentified conversation transcripts from the text and chat arms of the National Child Abuse Hotline. Using these categories, we identify the common characteristics of successful conversations. We defined success as conversations where help-seekers reported the hotline was a good way to seek help and that they were a lot more hopeful, a lot more informed, a lot more prepared to address the situation, and experiencing less stress, as reported by help-seekers.
METHODS: The sample consisted of transcripts from 314 purposely selected conversations from of the 1153 text and chat conversations during July 2020. Hotline users answered a preconversation survey (ie, demographics) and a postconversation survey (ie, their perceptions of the conversation). We used qualitative content analysis to process the conversations.
RESULTS: Active listening skills, including asking questions, paraphrasing, reflecting feelings, and interpreting situations, were commonly used by counselors. Validation, unconditional positive regard, and evaluation-based language, such as praise and apologies, were also often used. Compared with less successful conversations, successful conversations tended to include fewer statements that attend to the emotional dynamics. There were qualitative differences in how the counselors applied these approaches. Generally, crisis counselors in positive conversations tended to be more specific and tailor their comments to the situation.
CONCLUSIONS: Building therapeutic relationships and social presence are essential to digital interventions involving mental health professionals. Prior research demonstrates that they can be challenging to develop in written conversations. Our work demonstrates characteristics associated with successful conversations that could be adopted in other written help-seeking interventions.

The COVID-19 pandemic has triggered the interest in and demand for online platforms that can replace traditional face-to-face activities. Accordingly, metaverses have been increasingly used across society, especially in the Mental health field. This broad use of metaverses is now recognized as a major trend that will drive various industries across healthcare and society. In response to this societal change, this study provides a theoretical framework for understanding and applying metaverses as therapeutic spaces in mental health fields through a conceptualization and characterization of metaverses for a range of technologies and services. The value of metaverses as a human-centered \"field of experience\" was identified and proposed based on the essential aspect of the user, the human being, rather than from the technology used. According to existing psychotherapeutic theories, four therapeutic concepts for the metaverse were proposed: metaverse as an \"average expectable environment\" in the developmental and therapeutic categories of the self, a transitional stage for adaptation to reality, a creative space for memory and communication for the self, and an expanded or \"surplus\" reality. This work is expected to be a useful basis for expanding new psychotherapeutic strategies and methods as therapeutic spaces for maintaining mental health through the metaverse.

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This study uses Lent et al.\'s (1994) social cognitive career theory (SCCT) as a framework for understanding the career barriers and coping efficacy experienced by international master\'s of counseling psychology students. Grounded in SCCT, we described coping efficacy as international students\' perceived capability to navigate career barriers. Using Braun and Clarke\'s (2006) thematic analysis, we explored the career barriers and coping efficacy of 12 international master\'s of counseling psychology students. The first focus area, International Journey with Multiple Barriers, included five themes: Interpersonal Stress, Language Barriers, Financial Pressures, Advising Concerns, and Visa and Immigration-Related Stress. The second focus area, Agents of Change in the Midst of Barriers, included five themes: Self-Regulating, Stepping into Discomfort, Cognitive Reappraising, Becoming a Change Agent, and Social Support Seeking. Findings demonstrated participants\' coping efficacy and perceptions of themselves as agents of change. This study deepens the field\'s understanding of career development among international master\'s of counseling psychology students.

Recent studies recommend implementing a curriculum that is inclusive of lesbian, gay, bisexual, and transgender (LGBT) identities in health-related higher education programs. Inclusive health services are a means to address stigma-related adverse health outcomes in these populations. In Mexico, research has revealed that sexual and gender minority individuals experience discriminatory conditions that put them at risk for mental health problems. The present study tested the impact of a LGBT training protocol in Mexico; 17 psychology majors living in Mexico City received 12-plus hours of training on LGBT multicultural competencies. A quantitative retrospective assessment of participants\' attitudes toward LGBT individuals, knowledge of LGBT issues, and willingness to work with LGBT clients, alongside qualitative data collected from a focus group, provided evidence on the impact of this training strategy. Implications for LGBT multicultural competency training in undergraduate and graduate programs in psychology are discussed herein.

Medically unexplained symptoms and syndromes (MUS) affect the health of 20%-30% of patients seen in primary care. Optimally, treatment for these patients requires an interdisciplinary team consisting of both primary care and mental health providers. By developing an expertise in MUS, counseling psychologists can improve the care of patients with MUS who are already in their practice, expand the number of patients they help, and enhance the integration of counseling psychology into the broader medical community. Additionally, counseling psychologists\' expertise in culture, attunement to therapeutic processes, and our focus on prioritizing patients\' perspectives and quality of life can fill the gap in research on MUS and bringing increased attention to counseling psychologists\' unique contributions to health service delivery.

The goal of therapy is typically to improve clients\' self-management of their problems, not only during the course of therapy but also after therapy ends. Although it seems obvious that therapists are interested in improving client\'s self-management, the psychotherapy literature has little to say on the topic. This article introduces Leventhal\'s Common-Sense Model of Self-Regulation, a theoretical model of the self-management of health, and applies the model to the therapeutic process. The Common-Sense Model proposes that people develop illness representations of health threats and these illness representations guide self-management. The model has primarily been used to understand how people self-manage physical health problems, we propose it may also be useful to understand self-management of mental health problems. The Common-Sense Model\'s strengths-based perspective is a natural fit for the work of counseling psychologists. In particular, the model has important practical implications for addressing how clients understand mental health problems over the course of treatment and self-manage these problems during and after treatment.

Police brutality and widespread systemic racism represent historical and current sources of trauma in Black communities. Both the Black Lives Matter movement and counseling psychology propose to confront these realities at multiple levels. Black Lives Matter seeks to increase awareness about systemic racism and promote resilience among Black people. Counseling psychology states values of multiculturalism, social justice, and advocacy. Executive leadership in counseling psychology may seek to promote racial justice, yet struggle with how to participate in Black Lives Matter movements and address racial discrimination within larger systems spontaneously and consistently. However, counseling psychology trainees and professionals are actively involved in the Black Lives Matter movement, leading the way forward. Through the framework of spontaneity in social movements, this manuscript highlights what counseling psychologists are currently contributing to Black Lives Matter and makes recommendations that build on the opportunity counseling psychologists have for further involvement in the movement.

Using a sex positive framework, the authors conducted a 61-year (1954-2015) content analysis of sexuality research in the flagship counseling psychology journals, the Journal of Counseling Psychology and The Counseling Psychologist. Given counseling psychology\'s core strengths- and multiculturalism-related values, this study aimed to uncover which human sexuality topics were published most, whether publications aligned with a sex positive, neutral, or negative discourse, what methodologies were used, and differences in how populations were investigated across race. Researchers used an integrative approach to content analysis and human coding (Neuendorf, 2011). Results highlighted that out of 188 articles meeting criteria, a slight majority (38.05%) focused on sexual orientation, identity, and minorities topics. Only 4.78% utilized a sex-positive perspective. Quantitative and conceptual pieces were most published, and publications disproportionately focused on primarily White populations. When people of color were included, the discourse was sex negative. Implications for research and practice are discussed.

To explore how psychology trainee death concerns and ageist behavior relate to their willingness and desire to work with older adults.
Trainees (N = 104; 80.8% women) completed the Death Thought-Accessibility Measure, Relating to Older People Evaluation (ROPE), Death Anxiety Scale-Extended (DASE), and Beck Anxiety Inventory (BAI) and rated their willingness and desire to work with older adults and their willingness to obtain training on how to work with older adults.
Pearson correlations showed that salience of death-related thoughts, death anxiety (but not general anxiety), and negative behaviors toward older adults were significantly negatively associated with trainees\' willingness and desire to work with older adults. Regressions revealed that negative behaviors toward older adults was the strongest factor associated with willingness and desire to work with older adults, whereas positive behaviors toward older adults was the strongest factor associated with being willing to obtain training in working with older adults. Death anxiety and salience of death-related thoughts positively correlated with each other and were each positively associated with negative behaviors toward older adults.
Helping graduate trainees become more comfortable with mortality and changing negative behaviors toward older adults may increase their interest in gerontology and geriatrics.