Suicide_Prevention_Consultation

Suicide Prevention Consultation Abstract The most appropriate consultation model and levels of intervention will be discussed in the framework of suicide prevention counseling. Also, a most probable effective approach to counseling will be determined and the level and focus of consultation will be discussed in context to the Intake, Evaluation, Assessment, Treatment, Planning and Exit strategies. Elements of the consultation will include relevant aspects of legality, disclosure, questioning, attending behavior/relationship building, client attribute discovery, medical history, tests available and patient-counselor contract prior to exit. Suicide Prevention Consultation Perhaps the most dreadful, yet challenging event which could confront a therapist is the arrival, of a potentially suicidal client. The stress created by this situation can be reduced by proper preparation of the therapist in advance of the visit. Consultation methods will vary with the individual circumstances of each case. The breadth and width of interaction with the client during the evaluation (therapy) will vary because each client is an individual relating to his/her environment as they have interpreted it. This interpretation (their perception), however unrealistic it may seem to the therapist, is the client’s reality. Each client’s history is as unique to them as their fingerprint and is composed of their accumulated perceptions of the events of the world in which they live and interact. This accumulation of events in a client’s life will determine the way they will react to any given stimuli. It is the therapist’s duty to engage in a cooperative relationship with the client to help discover alternate ways of perception and assess the strengths of the client which may not be readily known to them. This might help in diagnosing a problem and assist in providing a solution. Such client-therapist interaction might be described/understood best by the concept of “Johari’s Window” (Luft & Ingram, 1950). A rather simplistic model which very well illustrates the concept of helping a client better understand their relationship with themself and others by listing information Known to Self, Unknown to Self, Unknown to Others, and Unknown to Others and to Self. Other tools available to the therapist include questioning assessments such as the Multidimensional Health Profile (MHP) and the Life Stressors and Social Resources Inventory (LISRES), both of which have been used effectively by the military in making assessments of personnel who might be inclined to attempt suicide. Method Participants Participants are anticipated to be derived from three primary methods. (1) “Walk-ins” or self-reporting - these are individual who have an understanding that they might need some assistance to better understand the current situation which brings them in, (2) Referrals – these individuals have been seen by their primary care physician of another therapist and have been referred to your clinic, and (3) Directed – these clients have been directed to report to you for therapy usually as the result of socially unacceptable behavior. We would expect that those directed to receive therapy might be the most difficult to work with perhaps because they haven’t “accepted” their behavior as inappropriate or don’t recognize the behavior in themselves and are therefore reluctant to participate openly. Contrary to this group, we would expect the walk-ins to be more forthright in their participation in therapy because it was their choice to search out assistance. Assessments Assessment begins with an in-take evaluation to assess lethality. If the client is violently suicidal, actions must be taken to provide for their safety by contacting prober authorities. This evaluation should assess whether the client has had/is having suicidal thoughts, do they have the intent to do themselves harm, do they have a plan by which to carry out their intent and are the means available for this to occur. The in-take can include the presentation of the professional disclosure statement or this statement can be provided by the therapist. The latter might be preferable in that the therapist can explain the requirement directly with the client as they begin. This disclosure agreement is vitally important for a number of reasons, the most important of which includes potential legal issues involved in treating clients (especially suicidal ones). This initial contact with the client could set the course for the remainder of the first session and the entire treatment plan. Using a client-centered approach, the therapist will make their assessment of the client using a variety of open and closed questions. Therapist facilitation skills play an important part of the interview/evaluation, in addition to attending to the client, they must simultaneously interpret verbal and non-verbal cues as they assess their receptiveness to therapy. The body language of the therapist is important during this time as well; they should be visibly relaxed, lean forward and maintain eye contact with the client. During the assessment of client difficulties the therapist continues relationship building by using restatement, reflection, requests for clarification and summary to ensure proper understanding and thereby indicate that they are listening and hear what the client is imparting to them. Efforts during this time should be to reinforce to the client that they are the decision-maker in this process and that the therapist is there to assist in that process. Client motivations are assessed and positive attributes are investigated in an attempt to find/reinforce reasons for living (spiritualism should be considered and multi-culturism must be remembered). The use of open and closed questions is continued as the therapist discovers the motives and history of the client. Exit Strategy Through their interaction the therapist and client create a treatment plan of therapy agreeable to both. This plan should include a signed “contract” in which the client agrees to perform certain actions prior to actually carrying out a suicide attempt. These actions can/should include the client referring to a list of resources which are readily available to assist immediately. The date is set for the next session and good-byes are offered along with positive reinforcement for the client being able to openly assist in their therapy. Conclusion Suicide prevention consultation is “normal” therapy on steroids. The finality of death in very close association with a threat by a client requires therapists to be prepared for the eventuality of the suicidal client arriving at their office and perform at their best. References Luft, J.; Ingram, H (1950). “The Johari window, a graphic model of interpersonal awareness”. DA PAM 600-70. “Guide to the Prevention of Suicide and Self-Destructive Behavior. (1 Nov 1985)”