Elizabeth Simmons

August 1, 2022

CNS 739

During the latter part of Advanced Counseling Skills and Crisis Management, we focused

on suicide. Over the course of two Triads and one Skills session, we were able to practice risk

assessment and safety planning with a fictional client. The following paper is based on the Skills

session.

Suicide Assessment

I was comfortable asking directly if the client was planning to commit suicide. Hurting

yourself or someone else is a big deal to me and should be addressed if there is any suspicion.

Using clear, direct language could save someone’s life.

Moving through the “Simple Steps” assessment questions felt awkward after spending so

much time in basic skills Triads trying not to ask questions. Reframing this portion of suicide

assessment from a counseling stance to information gathering, like an intake assessment would

be helpful for me.

I need to work on the balance of establishing rapport with reflections while evaluating the

risk factors. There was a 30-45 minute time frame for this assignment. I wish that I would have

had more time to develop a clear picture of the client’s background, specifically her dark

thoughts, lack of self esteem, family dynamic and understanding the treatment for her prior

attempt would have also been helpful. I felt rushed to create a safety plan. I think that spending

more time getting to know the client’s worldview and self view would have been benifical in
reflecting to the client how she got to a suicidal point for a second time in a just a few years

would be the key in preventing future problems. I did spend a lot time trying to cocreate coping

mechanisms as protective factors in this current situation.

If I had this situation to happen again, I would have not let the client leave. I think that

she needed a safe, alcohol free environment until she became more stable emotionally. I felt that

she was very resistant to safety planning. I think that sending her back into a household with her

parents and sister, specifically family dinners, would have caused her to continue drinking. I

think that her alcohol use would have preceded her demise. An involuntary hospitalization would

have been the safest option for this client. Given her resistance to the idea in relation to how her

parents and their friends would view her, this could have been a trust buster. Framing a

hospitalization without ruining the therapeutic relationship and instilling mistrust in care

providers with the client is something that I have to work on.

Feedback

My instructor feedback touched on asking questions that were slanted toward leading. I

felt myself doing this. I am trying to think through my motivations on this. I am not sure if it is

because of the seriousness of suicide, the time limit, or the client’s resitance. I need to work on

moving at the client’s pace and really using reflection for the client to see themself. I need

practice in helping the client explore other life options of her own, not me pushing my idea of

other options on her. With this client, I could clearly see that having an undergraduate degree in

pre-med could open doors to entry level positions and a springboard for a master’s degree or

possible doctorate degree in a related field. I could see so many options for her that she had
blinders on to. I understand that I can not lead the client to change their life. For changes to be

long lasting and meaningful, they must make them on their own.

Another piece of feedback was about the lack of scaling questions. I should have used

scaling to determine how much paint the client was in and how likely she was to follow through

with her plan. I felt the client was at high risk and the scaling would have made that more

concrete. Her answers would have been justification for hospitalization or some other safe

environment. The scaling tool could also be used to measure client improvement as she moves

through counseling.

Goals

My first goal is to use scaling questions when doing risk assessments. I think that at least

one possible up to two could be very insightful and helpful to the client. This can be measured by

recalling a session or watching a recorded session to identify when and how the scaling was

used.

My second goal is to slow down. I do not need to be in a rush to get the client to their

finish line. I can do this by using moments of silence to deep breath during the session. This can

be measured by watching recorded sessions and collecting feedback from the client, instructors,

or professors.

I am not sure how common suicide will come up when working with women and

families, but looking into additonal training in suicide management and trauma focused therapies

could be benificial in strengthing my overall skills. Becoming trained in CAMS, Collaborative

Assessment and Management of Suicidality, is an online option. Penn State offers a

training in Cognitive Therapy for Suicide Prevention (CT-SP), that could also be an option.
Progress Note

Client’s chief complaint was thoughts of suicide. She stated “I would rather not be here”,

“It would be a lot easier if I just drank and didn’t wake up”, “I was watching a movie where a

girl shot herself and I was like that is easier than drinking”. She reported suicidal thoughts 2-3

times a week. Client stated that she has lost her appetite to the point of losing “a lot of weight”.

She has developed insomnia and consumes alcohol daily.

Client is a 21 year old, white female. She was on time, well groomed, and dressed

appropriately. She was physically able to participate in the counseling session. She clearly

communicated her reasons for attendance.

Client stated her not eating and inability to sleep started after receiving letters that she did

not get into medical school. She identified her parents and sister as stressors. She stated that

family dinners are a trigger leading her to self medicate with alcohol. While drinking she has

thoughts of suicide. She is resistant to voluntary inpatient treatment. She previously attempted to

end her life while attending college as an undergrad after a break up with her boyfriend. She is

not longer in contact with the care team that supported her through her her first suicide attempt

because she is no longer a student.

Client is classified as a risk level 3 related to her mental health history, generic planning,

substance use, her feelings of being a failure and burden to her family, along with no utilization

of her support system. She is resistant to safety planning. It would be advisable that the client

avoid family dinners until she is able to employ coping skills. She is not ready to open to her

family about her suicidal thoughts despite identifying them as a protective factor.
 Future sessions should involve career counseling. The client could find a new purpose

and self worth with tangible employment options. A new career option could also meet the

client’s idea of moving out of her parents house. Finding work and living on her own could be

things she works on in the here and now but also instill hope. Future sessions should work on

development of coping skills. This would also include a deeper exploration of the client’s dark

thoughts. A long term goal for this client is for her to separate her self image from that of her

family. It could be beneficial to have a family session, pulling in her parents and sister. A few

keys for this client will be self awareness, establishing a healthy family dynamic, and

implementation of a stable support system.