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Wk 6 Discussion – Assessing Risk During Intake

When meeting with a client for the first time, a counselor typically asks some standard questions to gather information about the presenting issues and complete the biopsychosocial assessment. When engaging in crisis response, sometimes an intake moves so quickly or is so chaotic that the counselor may not gather as much information as they would have liked. Respond to the following questions after watching “Suicide Risk Intake Assessment.”

Respond to the following in a minimum of 175 words: 

· What are some additional questions that the counselor could ask this client? 

· What cultural factors might influence the professional counseling relationship between counselor and client in this scenario? 

· After the client’s phone call intervention, what should be the next steps? How should the counselor follow up with this client? 

Respond to the following classmates in a minimum of 175 words: 

SW classmate response

The counselor could ask the client many questions. One issue I noticed was the client’s fear of talking to strangers, counselors, and men. This counselor is all three. I think he should ask if she is feeling ok with him doing the intake at all. He could inform her that going forward, she can have a female counselor if that would be helpful. He could tell the client that if he takes the intake today, she can schedule with a female counselor as soon as possible and he will pass along the intake information. He should ask her how she feels about this. Then, the male counselor should wait for the client’s response. Other questions the counselor could ask are about her social history, education history, and any past trauma.

The counselor needs to be aware of cultural factors that could influence the professional counseling relationship. He is a black male in his early 30’s (?) and the client is a white female in her late 20’s (?). Perhaps their similar age or difference in race could be an issue. The counselor will need to be cognizant of this and look for indications they are not connecting. In addition, the client has made it known she is apprehensive talking to a man, and that she is “not so sure if (he will) be able to understand where I’m coming from.” Therefore, the male counselor will need to get a female colleague to take his place or build rapport quickly and ask the client if she is comfortable with him. Offering to get another counselor will show cultural humility and validate the client’s feelings (Buse et al., 2013). This offer itself may build rapport, indicating to the client that he is sensitive to her feelings and recognizes they are important.

After the phone call intervention, the counselor should present a safety plan. Together, the counselor and client should explore strengths and reasons to stay alive and put them on the safety plan (Kanel, 2018). The counselor should follow up with the client by providing his work cell and presenting a list of resources she can use to call for support or help should she find herself escalating. The client should be scheduled for frequent counseling appointments, twice a week to start. During these appointments, the client and counselor can re-visit the safety plan, see what resources such as police or campus administration are involved, and support and validate the client with counseling interventions such as reframing and building coping skills.

 Buse, N. A., Burker, E. J., & Bernacchio, C. (2013). Cultural variation in resilience as a response to traumatic experience. 

Journal of Rehabilitation, 79

(2), 15-23.

 Multicultural competency, individualism vs collectivitsm, spirituality, cultural perceptions of resiliency.

Kanel, K. (2018). An Overview of Crisis Intervention. In (Ed.), A guide to crisis intervention (6th ed.). Cengage Learning. 

https://bibliu.com/app/#/view/books/9780357088531/epub/OEBPS/11_9781337566414_ch1.html

LK Classmate response

One of the aspects of the entire interview which I observed is that the overall line of questioning was very clinical, and had very few attending behaviors and bonding attempts. While the counselor did ask some very good questions to get definitive answers, very few of those answers explored how the client may be able to walk back from her suicidal ideation, but instead defined it. When the client was first asked what brought her into counseling, she specified that an event had happened last week which was making her feel overwhelmed. However, instead of asking about the event (which would have been an indication of interest and care in why she was there), the counselor asked the client to define what overwhelmed meant to her, which can be hard with no context. Asking about the event may have given an easier segue into her definition of overwhelmed, and given the counselor context about why the client feels uneasy about speaking to strangers and men in particular. In addition, when the client mentioned being uncomfortable talking to strangers, especially men, there was another opportunity to ask if there was any way the counselor could make her more comfortable, or if her level of comfortability was important enough to switch counselors. While the counselor did ask if she would be comfortable talking to someone else, again, it felt almost clinical and with no understanding of her fear of men or strangers, and no investigation, the counselor just kind of reported his own diversity in clientele and then moved forward. There was a definitive lack of bonding in the beginning of the interview which just made the entire process awkward, and almost robotic. “The primary purpose of using the basic attending skills is to gain a clear understanding of the internal experience of the crisis as the client sees it. The focus should be on the client’s feelings and thoughts about his or her situation” (Kanel, 2018, p. 68). I feel as though there was no understanding of the client’s thoughts or feelings until nearly halfway through the intake session. Overall, structurally, I simply feel like this session was stilted and very rushed, which can lead to disharmony in the therapeutic relationship.

Culturally, this is a black male counseling a white, sexually assaulted female. One of the things she states is that she does not think that he will be able to understand where she is coming from. Before declaring diversity, if he would have asked for clarification on that statement, he might have a more culturally informed response. Again, this would be easier had they talked about the incident which led her to counseling before this point, but asking for clarification allows her to talk about her feelings on men and strangers, and gives her the opportunity to talk about how she feels, which gives him the insight into how she is acting, and insight into her view on culture. Cultural humility creates cultural competence, and learning about a client’s culture requires them to be honest and open about what they have experienced (Kanel, 2018).

While the phone call is a good prevention measure, the next steps the client should take is to schedule another appointment so that he and the client can get better acquainted and perhaps explore the positive aspects of her live and the traumatic event. The validation statements which help with dignity and embarrassment (Kanel, 2018) should be focused on, and the client should know that her counselor is on her side. Lastly, ensuring that the client has a safety plan and emergency contacts in case she feels like truly following through with her suicidal ideation is critical.

References

Kanel, K. (2018). A guide to crisis intervention, (6th ed.). Cengage

CCMH558 – Suicide Risk Intake Assessment Transcript

Counselor is an African American male in his mid to late thirties.

Client is a White female in her mid to late thirties.

Counselor – So tell me what’s bringing you into counseling today?

Client – I’ve just been feeling really, really overwhelmed lately.

Client – Something happened on campus last week and I haven’t felt like myself ever since.

Counselor – Okay. So tell me what you mean by overwhelmed.

Client – Well, just I’ve been having a hard time focusing and I’ve been having a really hard time sleeping. My emotions are all over the place, sometimes I’ll cry for no reason. I’m really jumpy. You know, like, I catch myself looking over my shoulder a lot and every little sound kinda sets me off.

Counselor – I noticed that you’re shifting in your chair a lot and you’re kind of wringing your hands and I’m wondering, how you’re feeling right now?

Client – Not great. I’ve just, I mean, I kinda feel, I don’t know, frightened or sad, or kind of like I’m watching everything from really far away, kinda like things aren’t really real around me anymore, you know? 

Counselor – Okay. Do you feel comfortable with me as a counselor and things like that? I’m not really comfortable with, I’m not really comfortable talking to strangers, let alone counselors.

Client –  And then especially after last week, I’m not typically comfortable talking to men.

Counselor – Okay. With me being a male, do you feel comfortable talking to me or would you rather me get someone else? 

Client –  I’m just not so sure how you’ll be able to understand where I’m coming from.

Counselor – Okay. Well, I have some training in working with diverse clients and so hopefully I can be able to relate to you. And one of the things with counseling is that there is confidentiality with a few exceptions. One of those exceptions is if you are thinking about harming yourself or are actively suicidal. And so hopefully that makes you feel a little bit more comfortable in our relationship together. So I’m gonna do a quick assessment and so I’m gonna ask you a couple of questions and I just want you to be as truthful as possible and things like that. So tell me, do you have any previous psychological diagnoses or anything like that? 

Client – No. I saw a counselor for a while when I was back in high school, but I haven’t been diagnosed with anything.

Counselor – Okay. And what about any family history of psychiatric diagnoses or anything like that? 

Client – There’s some depression in the family, especially, yeah, I mean, with my brother.

Counselor – Okay. Tell me about that.

Client – Well, I mean, he was always a weird little kid but he was diagnosed in a pretty straightforward way. I mean, we were able to get him into counseling and therapy early, but his was different than mine. You know, I was just a teenager going through some stuff though and his was different.

Counselor – Okay. Is there been any suicidal behavior in the family? Has anyone completed suicide or had any suicide attempts? Attempts?

Client –   Yes, but no suicides.

Counselor – Okay. And so tell me, do you have any thoughts about harming yourself or anything like that? 

Client – Sometimes, especially since last week.

Counselor – Tell me what happened last week.

Client –  I was finishing class, and it was my late night class. I’ve been taking classes at night after work and I didn’t…

Client –  I don’t really know the details of what happened. Campus security doesn’t usually have the cameras on in that dark part of the quad, but I was attacked from behind and I was assaulted and I still don’t know who it was.

Counselor – You sound really scared and really kind of afraid right now. It seems like that is affecting you in multiple areas of your life right now.

Client –  Yeah. Yeah, it’s getting in the way of everything.

Counselor – Okay. And so I’m wondering, you mentioned that you kind of have some thoughts about harming yourself. Have you thought about attempting suicide? 

Client –  Thinking about it and thinking about doing it or different things, you know, like, it seems like it would be a good idea. It seems like it would be really, really easy. When I can’t sleep I have sleeping pills, they’re right there. I know how easy it would be. And sometimes it just seems like the best option would just be go to sleep and not wake up again.

Counselor – So you have a plan and that would be to.

Client –  I mean, if I were to go through with such a thing.

Counselor – Okay. So like on a scale of one to 10, one being, not at all and 10 being definitely gonna do it. Where would you say that your intent is right now? 

Client –  I would say that, depending on whether or not I am distracted and whether or not I have had a nightmare maybe a seven.

Counselor – Okay. So I’m really worried about your safety right now. So one of the things that I’m worried about is You said that your kind of intend is kinda high now. So I’m wondering what are some reasons to live? Tell me about some reasons that you have to wake up tomorrow.

Client –  I don’t want to hurt anyone whom might care for me. I mean, you never know how that’s gonna hurt people. I remember how I felt when that kid in my class killed himself when he was in high school. And I just, I don’t want to do that to people, you know. My mom loves me, my roommate would be really scared. I’m certain that my friends from work would be worried about me. But I don’t really, I don’t really know why me being in the world would make it more important for me to be there.

Counselor – So I hear that you’re worried about the impact that completing suicide would have on like your family, your friends, your coworkers, and things like that. But you still may be a little bit hesitant or you still kind of have those suicidal thoughts surrounding you.

Client –  It just seems like it would be the easiest fix.

Counselor – Okay. I’m wondering if you have any other, maybe, factors to live, maybe some children or anything like that, a beloved pet, just something to wake up to in the morning?

Client –  I do have a cat who would be very upset if anything happened to me. And I know, I know that my mom, even though that we’re not close, like we used to be, I know that my mom, she wouldn’t be the same.

Okay. So I’m wondering if we can call someone to maybe secure those pills, maybe your mom or someone who can just be able to secure those pills, so that way we don’t, you don’t attempt suicide or complete suicide cause I’m really worried about just safety right now.

Client –  Do you think it’s necessary that I go without the pills? 

Counselor – Yeah, I’m really worried about your health and your safety. And so I think that the best thing that we do is to secure those pills, because one of the things about counseling is we want to make sure that you’re safe and we want to make sure that things are secure. And so I think that the best option right now is to really call someone while we’re here in session to secure those pills.

Client –  I can call my mom.

Counselor – Okay. So let’s go ahead and do that now.