Effective suicide prevention counseling can literally save a life. With timely interventions, treatment and support, suicides and suicide attempts can be prevented. In crisis counseling

10 Apr Effective suicide prevention counseling can literally save a life. With timely interventions, treatment and support, suicides and suicide attempts can be prevented. In crisis counseling

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Effective suicide prevention counseling can literally save a life. With timely interventions, treatment and support, suicides and suicide attempts can be prevented. In crisis counseling, how you encounter the suicidal client may differ from the traditional face-to-face interactions we typically consider for long-term care. Some suicidal clients reach out with a phone call or online messaging. Other times we are given a written case referral and asked to consult for immediate safety planning. Since we encounter suicidal clients in a variety of platforms, this discussion is designated to help you not only perfect your skills in determining how to assess and intervene with a suicidal client, but also to consider the impact of how the client information is presented on our decision making regarding best client care.

In this Discussion, you will be assigned a particular case presentation to review. Students with the last name A–I will watch the video recording as if working with a face-to-face or online client. Based on your assigned format, you will assess for risk factors and begin safety planning for your client.

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___________________________________________

"Facilitative Response Activity" * Program Transcript *

Sue is 43 years old; she has come to a local clinic seeking help. She is feeling sad and not sure why or the cause of her sadness. She is meeting with Michelle, who is conducting a suicide assessment and intervention.

As you observe the interaction between Sue and Michelle, you will be asked to select between two options on what Michelle should say next. You will receive feedback on the selection that you made. Choose wisely, because the better you interact with Sue, the better her suicide assessment and intervention.

Client Paperwork:

• Name: Sue • Age: 43-years-old • Gender: Female • Status: Married • Husband Ken, works as a lawyer in a local law firm. Husband noted that he didn't know why his

wife appeared sad all of the time and recommended that she visit the clinic as a possible solution.

• Client has two children, ages 10 and 12. • Client was a human resource representative for a large company before leaving her position to

start a family.

1 Michelle and Sue Interaction

MICHELLE: So, Ms. Johnson, do you understand the confidentiality that we've just finished discussing?

SUE: Yes.

MICHELLE: Are there any questions you'd like to ask me before we get started?

SUE: No, no questions.

MICHELLE: Would it be all right if I called you Sue?

SUE: Yes, that's fine.

MICHELLE: Thanks. So, Sue, tell me a little bit about what brought you into the clinic today.

___________________________________________

"Facilitative Response Activity" * Program Transcript *

SUE: I'm not really sure where to start. My husband's a successful lawyer. We're financially set. He spends lots of time with me. The kids are doing well. They have lots of activities at school and with their friends. I should be happy, but I'm not. I feel lonely and sad all the time. It's like nothing matters anymore.

1 of 10 How would you respond? Choose A or B *

Choose A: * So even though it seems like there are a lot of things that are going well for you, your life still feels * meaningless and empty. You're having a hard time feeling good about it. *

Choose B: * You know Sue, being a wife and a mom can sometimes feel like a thankless job. Sounds like, even * though you have a lot of things to be grateful for, you're struggling and could use some help figuring out * how to focus on the more positive aspects of your life. *

2 Michelle and Sue Interaction

SUE: I just can't take it anymore. Nothing I do ever works out. I think everybody would be better off without me. And so, I just think I'm going to just end it all.

2 of 10 How would you respond? Choose A or B *

Choose A: * The pain you're feeling is so unbearable. You don't see any other way out. You're feeling helpless. *

Choose B: * You know, things aren't always as bad as they seem. It sounds like you have a lot to live for. And I'm sure * a lot of people would be sad if you were gone. *

3 Michelle and Sue Interaction

SUE: Well, my thoughts have been so terrible, I couldn't tell anyone what I've been thinking.

3 of 10 How would you respond? Choose A or B

___________________________________________

"Facilitative Response Activity" * Program Transcript *

Choose A: * You know, you can talk to me, Sue. I am– I've been trained to be objective about these kinds of things, * and I'm here to listen. *

Choose B: * Your thoughts are so frightening to you that you imagine other people would be shocked to know that * you're thinking such disturbing things. *

4 Michelle and Sue Interaction

SUE: I really feel like I'm going to do something to myself, like I might hurt myself or something, like I want to put an end to all the misery once and for all.

4 of 10 How would you respond? Choose A or B *

Choose A: * Sue, it sounds like you're having some really scary thoughts. And I'd like to hear more about what's * really bothering you. *

Choose B: * It must be terrifying to feel so hopeless and alone. Are you thinking about killing yourself? *

5 Michelle and Sue Interaction

SUE: I've wrestled with it for over a year without involving my family. I don't see the point in telling them now. I don't want to put them through that. So, I just want to just give up.

5 of 10 How would you respond? Choose A or B *

Choose A: * Sue, you've been carrying the weight of this secret, this pain, for over a year now. And I'm wondering * what happened recently that's caused you to feel so hopeless? *

Choose B: * Protecting your family from the pain that you're experiencing is very important to you. I'm wondering * what you think your family would want. *

___________________________________________

"Facilitative Response Activity" * Program Transcript *

6 Michelle and Sue Interaction

SUE: I don't know how to say it. Every time I think about it and want to talk about it, I try, but I just go numb, and can't talk about it.

6 of 10 How would you respond? Choose A or B *

Choose A: * You're devastated by the weight of what you're dealing with and detaching from that pain. It's been the *

only way that you've been able to get by. *

Choose B: * You can tell me, Sue. I'm here to listen. I know it's hard, but you're doing a great job. *

7 Michelle and Sue Interaction

SUE: I've done good staying positive and taking care of myself and doing everything that I'm supposed to do. But I don't know how much longer I can keep doing this. It's just too hard. And so, I just don't think I can do it anymore.

7 of 10 How would you respond? Choose A or B *

Choose A: * You know, it's exhausting. I can hear that. I can see that. It sounds like you have a really supportive *

family. And I'm sure they would want to help you. You've got to find a way to tell them. *

Choose B: * It's exhausting, carrying it on your own for so long. I'm wondering, what's one thing that you could think * of that might help you get the support that you really need? *

8 Michelle and Sue Interaction

SUE: I cry all the time. I can't keep it together. I feel so weak. I don't want to need anybody and rely on anybody and put anybody through any of this. And I just can't do it anymore.

___________________________________________

"Facilitative Response Activity" * Program Transcript *

8 of 10 How would you respond? Choose A or B *

Choose A: * You put so much pressure on yourself. The pain and the hurt, it's overwhelming. And it must be *

impossible to hold all that pain inside. *

Choose B: * You know, it's hard to talk about your problems and to reach out for help. And there are a lot of stigmas * about what that says about us, and that reaching out for help makes us weak, or that struggling with * mental health issues makes us crazy. And I'm wondering, do you carry shame about needing help from someone? *

9 Michelle and Sue Interaction

SUE: What are you? Are you a doctor or something? How are you going to tell me about the pain and the misery that I've experienced? I'm sure your life has been perfect, and you've never experienced any kind of pain or hurt that I've been feeling. How can you even help me? You don't even know anything about what I'm going through. Have you ever tried to kill yourself before?

9 of 10 How would you respond? Choose A or B *

Choose A: * You know, I have been through difficult times too, and struggles. And I believe that everybody's pain * matters. You're not really giving me a chance to help you. We all struggle. And there are healthy and * unhealthy ways to cope. People find different answers to their pain and look for different solutions. *

Choose B: * You're afraid to trust me, afraid I won't be able to understand. You're taking a risk sharing your pain. * And it makes you feel vulnerable and uncertain, and wondering if it's even going to make a difference. *

10 Michelle and Sue Interaction

SUE: It's been good coming in to talk to you. I feel a lot better, but I still feel like I just put a Band-Aid on an open wound. I'm still raw and I still don't really know what to do. I don't know what's going to happen on the next bad day that I have. What do I do then? Still not sure.

___________________________________________

"Facilitative Response Activity" * Program Transcript *

10 of 10 How would you respond? Choose A or B *

Choose A: * It's hard for you to imagine a future where you'd be free from this pain and despair that's weighed on *

you for so long. You took a huge risk coming in today, Sue, and it was very courageous for you to share * your pain with me. I know that that wasn't easy. *

And, you know, I wish that you could leave today not feeling that pain again. But it's a process that we * can work through together. I hope that you've begun to have some hope that your future might be free * from all this that's weighing you down. *

It does concern me that you were considering suicide. And it's important that you have a plan in place to * keep you safe. I'm wondering if you would consider calling the 1-800 suicide hotline if you were thinking *

of hurting yourself. *

Choose B: * I'm glad you're feeling better, Sue. You took a big step coming in today. But progress takes time. And * you've been struggling with this for a long time. It's going to take time for us to work on that together. *

Well if you're feeling like hurting yourself, you can always call and make an appointment. And in the meantime, I hope you'll stay positive and continue to do the best you can trying to cope until we get a *

chance to meet again. *

FEMALE SPEAKER: So, Robert, did you understand the confidentiality I just presented? ROBERT: Yeah. It's fine. FEMALE SPEAKER: Do you have any questions before we get started? ROBERT: No, no. I mean, that was pretty clear. FEMALE SPEAKER: OK. So why don't you tell me a little bit about your background growing up? ROBERT: Background. Well, growing up was– I mean, it was– what do people do? We grow up, right? It wasn't– it was tough. My dad, he was really tough on me. I was the oldest. Little sister. So she didn't see much of what happened. And eventually what happened was, we left. They were never married, so my mom didn't feel a commitment to stay. They had me. That didn't keep them together, so we left. Went to stay with some cousins in Virginia. FEMALE SPEAKER: So your dad was abusive? ROBERT: Very, I would say. I mean, I would get– there was this one Christmas where I opened up a packet. And all I think was to open up the package, right? And he was like, did you give me the finger? I'm like– I'm like a kid, right? And I'm like, this isn't even– I knew as a child that it didn't make any sense, right? He's like, how would I give a– I didn't even know what a finger was. I mean. It was just scary to live in the house. So you would just get beat for nothing. And my mom would stop it. She would come in time to try to stop him from spanking me. So she did what she– she did the best she could. Everybody did the best they could with what they had at the time. So– FEMALE SPEAKER: Yeah. So it says on your intake form that you were in the military. Can you tell me a little bit more about your experience in service? ROBERT: Yeah. Well, we didn't have any money and I knew that they would pay for schooling. So I was always taking things apart and putting them back together. So I went into combat engineering. We would build things and blow things up. That was always fun. Now, I like to know how people think, so my backup was like psy-ops, which is– people hear psy-ops. They think, oh, crazy strange stuff. But it's not crazy strange. It's just how people think. The methodologies and modalities of how people make decisions. So combat engineers was first, psy-ops was second. I grew up near Norfolk. And I don't know if you ever been to the area, but it's nothing but jets all the time, right? So I never wanted to fly, but I think that's what pushed me towards the military. So I chose the Army and enlisted when I was 18. Went on from there. FEMALE SPEAKER: And when you enlisted, where did you head from there? What were your experiences? ROBERT: I had two tours. The first one was Afghanistan, the second was Iraq. And the second one is where I ended my career and left. FEMALE SPEAKER: I can see as you're talking about that that it's painful. I'm wondering if you'd be willing to talk to me a little bit about that. ROBERT: What would you like to know? FEMALE SPEAKER: I guess I'm most interested in what you experienced there. It's part of who you are sitting in front of me today. And I'd like to understand what that experience was like for you. ROBERT: [clears throat] OK. We can. So headed back to base. Not far away, like five clicks. There was debris on the road in front of us. It wasn't enough that it looked like it was intentionally placed, but I knew that it didn't belong there. We could not sit there because, of course, they could come on our six, have us trapped. So what we did was we reversed about 50 feet, made a k-point turn. And when we made the k-point turn, that was when we hit the IED. And the way the vehicle slipped back onto its left side. I was pinned down. My mother says– [laughs briefly] she always talks about how she would pray for me and stuff, but– so not everybody that day was protected, though. FEMALE SPEAKER: Yeah. And you carry that pain with you. ROBERT: Yeah. I would say so. Ramirez– and he was having a baby girl. I don't know why I– I was allowed to live, you know? That's– I mean, it's not fair. FEMALE SPEAKER: Yeah. ROBERT: But I don't make the rules, so– FEMALE SPEAKER: Yeah. But you ask yourself that. Why? Why him? Why them? Why not me? ROBERT: I do. I mean, I do. I– what makes me deserving? It sounds cliche when people say survivor's guilt. I mean, it's– I'm not guilty, it just doesn't make– what if I was sitting on the right-hand side, you know? It's little decisions like that that makes you think about what you do and don't do. FEMALE SPEAKER: Yeah. And does it matter at all? Sounds like it's left you with a lot of confusion and questions, and now what? ROBERT: [laughs briefly] Exactly. I mean, like, now what? FEMALE SPEAKER: You were protected and it sounds like you're struggling even to understand why or what you're supposed to do with this life that you got saved. ROBERT: Yes, ma'am. FEMALE SPEAKER: So, I'm sorry. I'm sorry to hear about that experience for you. And I can't imagine what it's been like to cope with that. And can you tell me a little bit about what it's been like since you came home? After you had discharged? ROBERT: [exhales] Not the same. [exhales] FEMALE SPEAKER: Yeah. How could that be? ROBERT: I have no freaking idea how that could be. My joy is there. John is fine. You know? I mean, I missed his birth, but he's good. Tess is great. She works at the hospital. She's what keeps us going because where we're at is rural, so there's not a lot to do. It's farms, it's this– it's– she'll always have a job. I mean, nurses can go anywhere. Backwoods, they'll be fine. Me, like I said, with the combat engineering, I'm good with my hands, right? With the psy-ops, that's like marketing. Big city, New York stuff, so– we're not in the big city, we're not in New York, work is hard to come by. I just had a online sites Craigslist list to try to find stuff to do. And we fight a lot because she– I mean, she didn't sign up to be the breadwinner. That's my job. I'm the man. I'm supposed to do that, so– FEMALE SPEAKER: Yeah. And it sounds like you're having a hard time finding your place. ROBERT: It's tough. I mean, I get to see John all the time because I'm the babysitter, but I'm not supposed to be the babysitter, you know? I was supposed to be out there and doing, so– FEMALE SPEAKER: Yeah. It's creating a lot of tension at home? ROBERT: We go at it. [laughs] We do go at it. It gets intense. The other day, it was about, like, nothing, you know? She said something, I said something, he's crying, and then it just blew up into a whole bunch of nothing. And it was like all this red flash, right? And then I blanked out for a second. Not blanked out like on the floor. Just like I wasn't me and like I just saw– I just saw my hand like moving towards her and I was like, I– I can't do that. It's– you know? FEMALE SPEAKER: Like it was happening outside of you. And that's not the person– ROBERT: No. FEMALE SPEAKER: you want to be, that you know yourself to be. ROBERT: No, no. That's totally– that's totally out of character for me. That's not– FEMALE SPEAKER: What else is different since you've gotten back? ROBERT: No friends. Nothing happening. No hanging out. I mean, it's TV. I would never even start video games because I know my addictions. [laughs] You know? Just trying to find stuff to do. Trying to find work. FEMALE SPEAKER: Pretty isolated. ROBERT: That's a very good word. Isolated. And she comes home and she doesn't want to talk because she's had a tough day. I don't want to talk. So she'll eat, I'll eat downstairs. She'll go to bed and then she would be like (IMITATING FEMALE VOICE) can you go to bed? And then I'm like, I'm coming to bed, but– I'll go to bed but I'll get back out of bed because I can't sleep, right? So then, what will happen next is– let's open a beer. It's beer, beer, beer, beer. And just– you know, six, eight. Even numbers is good, right? So a 12 pack, you know? Just– FEMALE SPEAKER: Whatever it takes to be able to get to sleep. Shut it off. ROBERT: Shut it off. Yeah. That's a good way to put it. FEMALE SPEAKER: That's causing problems at home. ROBERT: Oh, definitely. Because, I mean, how can you pay for beer when you don't have work, right? [laughs] So it's like a cycle, you know? Trying to break the cycle. FEMALE SPEAKER: Yeah. So, tell me, Robert, I'm getting this picture of some of the trauma that you've gone through and what you've experienced since you were discharged. What specifically caused you to seek help today? ROBERT: I almost hit my wife. FEMALE SPEAKER: It scared you. ROBERT: It scared the hell out of me. That's not me. Like, I know that's not me. So that's not me. FEMALE SPEAKER: What else is not you? Are there other things that you're concerned about? Sounds like there's a lot of things you've said a couple of times that are out of character for you. ROBERT: But– I mean, why– my thing is, why– I'm sorry. I'm just thinking about the confidentiality thing. What I share between you and I, right? FEMALE SPEAKER: Everything that you share in here is confidential unless you're talking about hurting yourself or someone else, then we would have to have another conversation. Is there's something that you're afraid to share, that you're afraid you can't talk about with me? ROBERT: It's not that I'm afraid to talk about it, it's just– sometimes I feel like why even keep going on, you know? Like, why– I guess it goes back to that whole protection thing. Like, why was I protected? Why was I spared? Maybe it would just be better for everybody, you know– Tess will always have work. John will always be OK. We have a family that will take care of them, you know? Like, if I'm the problem, well, you do the math, right? You solve the problem. So if I wasn't around, it would be– maybe it would be better for everybody. You know? FEMALE SPEAKER: If you took yourself out of the equation. ROBERT: Yes, ma'am. I mean, I have a gun. I would– I'm not saying I'm going to walk around and do anything crazy, I'm not just– I'm not saying that, but I'm just saying, why? FEMALE SPEAKER: Because you're having a hard time understanding why you're here and why it's all worth it. Or thinking that it's not. ROBERT: Is it even worth it? FEMALE SPEAKER: Yeah. ROBERT: That's question, right? FEMALE SPEAKER: Sounds like you really are struggling with that. Trying to answer that question. ROBERT: Yes, ma'am.

10 Apr Effective suicide prevention counseling can literally save a life. With timely interventions, treatment and support, suicides and suicide attempts can be prevented. In crisis counseling

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