On Friday we posted the following question on suicidal clients, and today we have the answer and rationale for you!
Jill, an 18-year-old college student who is living at home, has been meeting with a therapist on a weekly basis for several months. She was referred for therapy after receiving medical treatment for alcohol poisoning. Jill reports feeling alone, lacking direction, and does not believe the future has much to offer her. She cut back on drinking after her experience with alcohol poisoning, but continues to smoke marijuana on a regular basis and has experimented with other drugs. In session, she shares that her boyfriend broke up with her over the weekend and now that she is completely alone, she wants to go to sleep and not wake up. How should the therapist manage the legal and ethical issues presented in this case?
a. Determine if she has a plan and means to commit suicide before taking other steps
b. Inform parents of risk because client lives with them and is a danger to self
c. Initiate involuntary hospitalization due to stated suicidal ideation and substance use
d. Validate client’s feelings of helplessness and help her identify healthier coping strategies
This question provides you with some information about risk factors, but the clinical picture is incomplete and until you gather more information it will be hard to determine the most appropriate intervention. The BBS is not only testing that you know when to intervene, but is also testing that you will take reasonable, measured steps based on the level of risk and not overreact. Breaking confidentiality or initiating hospitalization prematurely could rupture the therapeutic relationship and cause greater harm than help to the client. Remember, our legal and ethical responsibilities are to assess and manage our client’s safety and overall well-being. With this in mind, let’s review our answer choices.
The best answer to this question is A. The client has expressed suicidal ideation, but has not indicated a plan or means to carry out a plan. Before we decide what level of intervention is appropriate, we would need to assess the level of risk. Based on the information provided, it’s not clear if breaking confidentiality is necessary, or if it’s even appropriate to involve the parents, so we would hold off on B. We are not required to break confidentiality, but may choose to do so only if we believe it is necessary and would be beneficial. Answer C may be tempting as well because of the risk linked to substance abuse, feelings of hopelessness and suicidal ideation. Again, this would be a jump without assessing plan and means. Answer D is not strong because validating the client’s feelings of helplessness and identifying healthier coping strategies does not directly address the suicidal ideation and potential danger to self and would fall short of fulfilling our legal and ethical obligations.
Which answer did you choose? Does the rationale fit with your understanding of danger to self and how you would work in the clinical setting? Or did you learn something new with this scenario? If you have any further questions feel free to check in with a TDC coach. We are here to support you all along the way. And if you came up with the same answer-great job! You are right on the right track to getting licensed.
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