Topic 5: Initial Assessment in Counseling {by 10/6}

Based on the text readings and lecture recording due this week consider the following two discussion points: (1) Share your understanding on why it is important to get an accurate understanding of the client’s problems early in therapy (i.e., intake/early sessions).  (2) Understandably, especially as a beginning therapist, the thought of assessing suicide can be anxiety provoking.  Share a few of your initial concerns when (not if) you are confronted with a suicidal client.  (Keep in mind, you will learn a lot more about responding to suicidal clients in future classes and on your practicum/internship.)

 

(3 – Prepare for Class [do not blog]) You will notice on my website (Class Lectures & Recordings) a short video “Assessment Review Introduction,” “Assessment Review Reflection Questions” template, and five assessments.  Please review these questions and the assessments before class.  You do not have to complete these assessments before class, but you can if you want.  In class, we will complete these assessments and discuss them based on the reflection questions.

 

Your original post should be posted by 10/6.  Post your two replies no later than 10/8.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

75 Comments (+add yours?)

  1. Tiana Faulkner
    Sep 30, 2022 @ 15:14:28

    In order to be able to help the client to your best ability the expectation is that all of the information needed will be shared by the client in the early sessions as well as the intake session. If all of the information does not get shared, you are not able to give them the treatment they need then inhibiting their progress. If there is not an accurate understanding of the client’s problems early on there may be assessments done that do not need to be done, therefore wasting money. Or the skills being taught to the client may not necessarily be exactly what they need, and the progress may be stunted, or none may happen at all. The time of the professional and the client are both being wasted if there is not a clear understanding of the problem or a lack of the whole story.
    I feel as though I am most worried about saying the wrong thing to them that could escalate the problem, not necessarily their likelihood to commit suicide but if there are any other feelings, mental health issues, or drastic situations that I could escalate without knowing obviously that would not be good. I think my issues is more about the unknown. I have not been in a direct one on one situation with a suicidal patient, so I genuinely do not know what to expect.

    Reply

  2. Becca Boucher
    Oct 02, 2022 @ 10:57:36

    It is so important to get an accurate understanding of the client’s problems early on in therapy because you want to start helping and treating your client as soon as possible. In order to do so, you must have a good understanding of what is wrong and what in their lives is contributing to this problem. You want to develop a treatment plan and begin treatment early on because often the issues clients are coming to you about are greatly distressing and require quick action.
    When treating a suicidal client I’m concerned about not doing enough to help them, or underestimating their preparedness to take action. I would take any talk of suicide or hopelessness very seriously, and therefore hopefully do as much as I can for each client, but there is still that fear. I’m also scared about asking the wrong questions or not being able to help. However, on the opposite end, I’m also scared of thinking someone is suicidal or has plans and they actually don’t and setting a false alarm that may harm them in some other ways like in relationships with their parents. For example, if I thought someone was going to try to commit suicide and I got in touch with a hotline or something and the client was hospitalized or something when they shouldn’t be I would feel terrible. And then, the parents may think they are more suicidal than they are and that could create tensions I don’t want to be creating.

    Reply

    • Tiana Faulkner
      Oct 02, 2022 @ 22:30:37

      Hi Becca! I definitely agree with everything you had stated. In regard to your comment about being nervous about overestimating a situation relating to suicide, I did not even think about it in that sense. I am definitely nervous about not doing enough or saying the wrong thing however I did not even think about doing too much in circumstances where I should not. Definitely a new fear unlocked.

      Reply

    • Whitney Andrew
      Oct 05, 2022 @ 20:36:37

      Hi Becca!

      I definitely agree that the urgency of helping the client is so crucial and an accurate understanding is so important for that.
      I also find myself being very scared of doing everything I can and then some for a client and it still not being enough, but hopefully after this program we will be so much more well-equipped to circumvent feeling that way. It is scary to think that we may do too much in prevention and harm the reputation and relationships of the client, which is something that we don’t think of often. So I’m definitely adding that to my already long list now just like Tiana.

      Reply

    • Brenna Stewart
      Oct 05, 2022 @ 21:58:04

      Hey Becca!

      I agree with your point on urgency and tending to distressing symptoms ASAP, which you can truly only do effectively if you have an accurate reading on your client’s presenting problems. Thanks for sharing your perspective!

      Reply

    • Jack Halliday
      Oct 06, 2022 @ 15:52:27

      Hey Becca, I definitely agree that an understanding of the problem is crucial to creating an accurate behavior plan. I also agree and didn’t think of that fact that some issues facing our clients will require immediate action. In that case it is especially important that you get a good understanding of the pissues as soon as possible. I am also intimidated by the serious repercussions on both sides of the suicidality spectrum. Not doing enough and doing too much can both have serious consequences. It is also a really good point that doing too much can lead to some serious social consequences as well. You made some really great points!

      Reply

    • rena yaghmour
      Oct 09, 2022 @ 18:35:54

      Hi Becca,

      I agree. If counselors aren’t sure or have enough information about their client how are they going to provide the correct for them? Being able to care correctly for the client is so important especially if they are in need for immediate or help that requires a lot of work. I also have similar fears to yours when It comes to treating suicidal clients. It is so tough because like you said you dont want to ask the wrong questions but at the same time you don’t want to not ask questions. I think even if the questions may be considered “wrong questions” they may give you as the counselor more insight making it easier to help the client in need even if it may not sound like it.

      Reply

  3. Jack Halliday
    Oct 02, 2022 @ 11:33:44

    It is very important to accurately understand a client’s problems early in therapy for many reasons. One of which being that it helps you to have an accurate plan and set good goals for therapy. To make a plan that will be successful and to create goals (with the client), you of course need to first have a good understanding of the client’s issues. Another reason is that it’s beneficial for the client. To accurately help the client with their issues you of course first need to understand the issues. There are many different avenues that therapy can take, and this of course has to do with the therapist’s capabilities, but more importantly it is about the client. Everything, starting with that first session, is about the client and for it to be effective you need to start with a good understanding of their issues.
    Being presented with a client in which suicide must be assessed sounds scary. I feel like it puts a lot of pressure on us as the therapists about the next steps. If you underestimate the severity of the situation someone could literally end up dead. If you overestimate the severity than they could end up being hospitalized against their will which will likely have adverse consequences. It’s also something that, as a society, is a very taboo subject. Since it’s so taboo it’s not something that we are used to talking about or hearing about which makes me feel incredibly unprepared to discuss it in a clinical setting with someone. In addition to that, my students say suicidal make suicidal threats often. When students are dysregulated for some reason it’s just they’re go to thing to say. Every time I hear it, I report it to the clinicians but they’re never serious threats. So, in some ways, I feel like I’m almost desensitized to hearing about it. I handle it as well as I can in the situation, but someday I will be in an entirely different role than I am now, and I feel very unprepared to handle it. Overall I think that the stakes are incredibly high when assessing suicide and that is scary.

    Reply

    • Megan VanDyke
      Oct 05, 2022 @ 11:55:59

      Hi, Jack. I wholeheartedly agree that you should continue reporting suicidal statements your students make. It may seem like you’ve become jaded to it, but a threat is a threat, whether it is passive or active. That is also something you can ask your students if they say they want to kill themselves again. If they are active thoughts, meaning “I want to end my life and this is how I’m going to do it,” that is something you need to assess and report. If they are passive, meaning “everyone would be better off without me,” it’s still worth notifying your supervisors. Still, you can work with the student to develop a safety plan using coping skills and when to communicate their feelings to you. I understand all that is easier said than done, but know that you’re doing the right thing in your position.

      Reply

    • Becca Boucher
      Oct 07, 2022 @ 14:51:03

      Hi Jack, I really like you point about how important it is to have an accurate idea of the client’s problems in order to work together on creating a plan with good goals for their therapy experience. Having a treatment plan and working with the client to establish goals they want and need to make is so important for good treatment. However, your point that everything, starting with the first session, is about the client really stuck out to me. We talked in our other class about always bringing conversations back to the client’s feelings and behaviors because the session is about them. However, the way you put that really made me realize just how much therapy is about the individual and how we should ensure that always is made known by our clients. I also really like how you mentioned that overestimating the severity of someone’s suicidality could result in them being hospitalized against their will. I worked at a behavioral health hospital for a very short time and one of the issues I picked up on was how common it is for people to be hospitalized there against their will because they’ve been sectioned in. This is sometimes necessary, but also very scary!

      Reply

  4. Tiana Faulkner
    Oct 02, 2022 @ 22:36:18

    Hi Jack! I absolutely agree with everything you stated, I feel like we all have similar understandings of what is important in regard to having all of the information within sessions. However, with your comment about being desensitized I did not even think about that being the case and it is so true. The idea of suicide in one instance is definitely taboo however I feel as though it is an overused word. “I am going to kill myself” or “I want to kill myself” seems to be used more when someone is feeling dramatic rather than in situations when it may really be the case. It can become a very difficult distinction between serious and not serious and you do not want to end up reporting something that is not serious that could then put the person in a situation that may worsen their other problems. There is so much to think about.

    Reply

  5. Megan VanDyke
    Oct 04, 2022 @ 11:49:25

    It is essential to get an accurate understanding of the client’s problems early on. During the intake session, the counselor should inquire about why the individual sought out or was referred to therapy and any goals they may have in mind. That way, the counselor and client can work together on a treatment plan explicitly curated for their wants and needs. It is also vital for counselors to gain a multidimensional outlook on the client’s background, including previous psychiatric and therapeutic interventions, educational history, family history, medical conditions, and developmental history. This allows the counselor to learn everything unspoken to understand biopsychosocial factors better and create the most well-rounded plan. However, such a feat is easier said than done, as there may be situations in which certain aspects may not be on the record, or the counselor cannot obtain them due to consent purposes. As a result, the first few sessions must incorporate trust-building to gain as much knowledge as possible.

    I’ve already experienced situations where individuals I’ve worked with have expressed thoughts of wanting to end their lives. These situations have been highly anxiety-provoking because I feared I might push them over the edge if I said something wrong. My agency offers training to employees called QPR, or Question, Persuasion, Referral, which helps bring the individual back to a state where they can ask for and receive help. However, there will come the day when I am the person they are referred to, and that fear of saying the wrong thing will return. If the client is experiencing passive ideations, it may be beneficial to enact a safety plan with them. On the other hand, if those ideations become active, I may need to file a Section 12 for emergency hospitalization. I think sectioning a client is what scares me the most. Although I would be doing it for their safety and wellbeing, it may damage the relationship, and the client may not trust me as much.

    Reply

    • Wendy Fernandes
      Oct 07, 2022 @ 18:27:54

      Hi Megan!
      Thanks for mentioning the type of training your agency offers. After reading your post I looked up suicide prevention trainings and I have to say I was surprised at the various kinds of suicide prevention trainings there are. This is one of those areas where I would think it would be important to get the proper kinds of training. I haven’t investigated it too deeply, but I hope I would be able to remember the key points of this when the time comes. As for sectioning someone, it’s true that it may damage the relationship, but it’s just as possible they would be grateful afterwards that someone cared enough to do it.

      Reply

  6. Gitte Lenaerts
    Oct 04, 2022 @ 12:17:29

    It’s important to get an accurate understanding of a client’s problem early in therapy so we can figure out the best treatment process. We want to get as much early information as possible to obtain a better understanding of the client. In the initial intake session, we want to gather information on demographics, background, concerns, and goals for therapy. This way we are building a foundation for the therapeutic relationship as well as the treatment process. Within that, we want to be able to find assessments that would be best for the client. For example, if the client specifies that the reason, they began therapy is because of feelings of depression and isolation. The therapist may present assessments on depression and anxiety, along with accessing suicidal ideation to see where the client is at. Identifying early concerns as well as background factors can help the therapist see an overview of the client and to start working on treatment.
    In my undergrad, I interned at a suicide hotline and spoke with many people who were at different levels of suicidal ideations. I received great training for individuals who are feeling suicidal. Additionally working in a group home, I have lost a client to suicide. It is never easy and is frightening. But as mentioned in the audio lecture it gets easier to talk about with clients. When beginning my internship at the suicide hotline of course I was nervous and scared that someone would actually end their life on the phone with me. Fortunately, that never happened but I did deal with people who were a few steps away from ending their life. I found that in my training and experience, assessing risk is the most important part, and never underestimate it. Being honest and having an open conversation around thoughts of suicide is so important. There is a huge stigma around suicide and thoughts of suicide, so having those open conversations with clients is vital. When becoming a therapist and having a client who is feeling suicidal, my concern is what if they are not honest. I know it is a negative way to approach the situation, but it has happened. I also worry that I should do more and ask more questions. At the suicide hotline, for those that were at high risk, I would spend at least half an hour talking with them. The organization that I interned for recommended being on the phone no longer than 30 minutes. Which was difficult to do as I worried what would happen after the call. This worry will continue when treating a client who is suicidal.

    Reply

    • Abby Sproles
      Oct 05, 2022 @ 12:23:15

      Hi Gitte! Wow, I can’t imagine working for a suicide hot-line, especially so early in your career. I definitely agree with your point that we as therapists should bring up the discussion of suicide if we suspect it. Therapy is supposed to dive into uncomfortable conversations to influence growth in the client. The chapter described that bringing up suicide within a session does not increase the likelihood of them committing to it. I think that point can assure us to not be afraid to discuss the topic.

      Reply

    • Jack Halliday
      Oct 06, 2022 @ 15:57:54

      Hey Gitte, I liked your inclusion of therapeutic relationship when discussing understanding client’s problems early. That is not something that has occurred to me but it’s a great point. You also provided some really good and informative insight from your time working at the hotline. I can’t imagine how stressful that responsibility must’ve been. Your post really put things into perspective and (slightly) diminished some of the fear I have surrounding assessing suicidal clients. I’m sure they had a good reason for it, but I wonder why they had a 30-minute cap on the phone calls? I also imagine that sometimes it must’ve been really hard to stick to that limit.

      Reply

  7. Abby Sproles
    Oct 04, 2022 @ 13:59:29

    It is important to understand a client’s problems early in therapy because the therapist needs to know how to conceptualize the course of treatment. The therapist can also gain an understanding of the client’s social background that contributes to their presenting issues. An accurate understanding can be beneficial to the therapeutic alliance as the client feels heard, and the two can work toward shared goals throughout the course of treatment. In addition, an accurate understanding will increase the effectiveness of the diagnosis, prognosis, and treatment plan.
    Working with clients that express suicidal ideation can be anxiety-provoking because of the severity of their issues, and you might be the only person who knows about these issues. It is important for therapists to bring up the topic of suicidal thoughts when they suspect that the client may be experiencing them. It is better to initiate a discussion of suicide rather than neglecting the issue. A teen expressed to me that they were having suicidal thoughts the very first session at my first clinical job experience. I was very nervous because I did not have any experience with suicidal clients. I was worried that I would not say the right thing. Thankfully, my supervisor stepped in to assist in ensuring the client had a safety plan in place. We discussed with the client that we needed to break confidentiality in order to ensure that they would be safe after leaving.

    Reply

    • Gitte Lenaerts
      Oct 06, 2022 @ 17:53:48

      Hi Abby, it’s so important to get an understanding of the client’s problem early in therapy so we as therapists can plan the course of treatment. I agree that accurate knowledge will increase the effectiveness of the diagnosis, prognosis, and treatment plan. Not only is this beneficial for the therapist but also for the client. Though the client might not understand how important the first few sessions are. Additionally, I can understand how anxiety-provoking it is to have worked with a client who is suicidal. Especially it being your first session! I think it will always be worrisome and anxiety-inducing to work withing clients who are suicidal because as you said, what if you don’t say the right thing? At the end of the day though, you were still there helping. I try to remind myself that when working or talking with individuals who are suicidal.

      Reply

  8. Melissa Elder
    Oct 05, 2022 @ 19:27:11

    When getting a new client it is very important to get an accurate understanding of the individuals problems early on because you would be unable to provide them with accurate treatment. In order to treat your client correctly and give them the tools they need, you must start with a good foundation of understanding them and their particular problem or problems. If there is not a clear understanding, that ends up leaving room for a messy treatment process for the client, which would lead to a waste of time for both individuals. Therapy cannot work properly without all the needed background information.
    When it comes to having a client who presents to be suicidal, that makes me feel all sorts of things. I first would be nervous about how to go about the topic and make sure I am providing all I can for them. I also fear, if they were to commit while seeing me as a helper, how that would affect me. I don’t mean that to sound selfish but seriously that’s a hard hit. Did I not do enough? What did I do wrong? Another thing, is I fear taking something way more seriously then I should have. The topic of suicide is very serious and need immediate attention but is also a word widely used by many individuals who are not actually suicidal, for instance an individual in my shop in high school ALWAYS said she was going to kill herself and eventually my teachers became very worried and sent her to see the school counselor and I remember her laughing non stop at them because they thought she was serious but they then explained a more deeper understanding of where they were coming from and she understood. I am hoping that as a helper I could do the same without upsetting the client but letting them understand not to talk that way and why they shouldn’t.

    Reply

    • Whitney Andrew
      Oct 05, 2022 @ 20:31:45

      Hi Melissa!

      I totally agree that though it sounds selfish, how it would affect me if a client committed while seeing me. Those same questions popped into my head as well and its nice to know I’m not the only one who thought that.
      The topic of suicide has become more difficult to navigate now because of this non-serious approach by so many. I had the same instance happen in my high school as well, but luckily the girl took the topic seriously when confronted and found better ways to express her intense negative feelings. I’m sure that you will be able to help anyone in that way instead of being laughed at!

      Reply

    • Brenna Stewart
      Oct 05, 2022 @ 21:55:01

      Hey Melissa,

      The part of your post about feeling “all sorts of things” in regards to encountering a suicidal client really resonated with me. I have literally all the same questions/thoughts and feelings come up when thinking about it, as well as asking myself if I’m selfish for feeling that way. I really do think it’s super normal to feel that though, especially in the case of a client actually committing… that’s HEAVY, for anyone, and to know how crucial our role can be in a person’s healing, it’s hard not to feel responsible in a sense? I think it’s not only important but necessary to explore those feelings/how it would affect us especially as therapists, and I don’t believe you or any of us deserves to feel shame around that. I think this type of situation highlights the importance of therapists utilizing their support systems (I think any good therapist.. has a therapist, ha!). Thanks for being so vulnerable with this post, you’re definitely not alone in what you’re feeling.

      Reply

    • Ariannah Zagabe
      Oct 07, 2022 @ 20:35:45

      Hi Melissa,

      I don’t think it’s selfish at all to feel that way. I also mentioned in my post that I am concerned about how I would handle if a client of mine were to commit suicide. It’s scary to think that it could be a possibility and would leave one questioning if they did enough to help their client.

      Reply

  9. Ashley Millett
    Oct 05, 2022 @ 19:45:45

    It is highly important to get an accurate understanding of the client’s problem early in therapy. You would want to be as accurate as possible in order for them to get the proper treatment they need. The sooner the problem is issued in therapy, the sooner the treatment can happen. It can also increase some awareness in the client. If you can pick out some of the problems early on, the client might be able to dive deeper into those problems. You may be able to make the client think deeper about their problems. Some problems are easy to detect when it comes to a client. You would be able to tell from mood, body posture, facial expressions, etc. It is also important to follow your hunch when you are a therapist. If you suspect a client to have a certain disorder from some context clues, then you would want to focus on that disorder. If not, then it would just repeat again with a different disorder or problem solver.

    It is very anxiety provoking to confront a suicidal client. You never know what you are gonna say that could possibly trigger them. Though I did not have any clincial experience, I had someone who was close with me who was suicidal. It was nerve racking talking to her because I always had the chance to trigger her on accident. It was always a thought in the back of my mind. Another thing is the thought of talking to them about their problems one day, and something happening the next. That alone scares me. As a therapist, you want to make sure your client is safe. However, you can not physically watch them 24/7. You would have to put it in their own hands to make sure they are. The unknown about the client is scary. Something can always click in their head. I do know that with the proper training, I think I might be able to confront them easier. I think that training is something that is severely important for a situation like this.

    Reply

    • Magdalen Paul
      Oct 05, 2022 @ 22:16:29

      Hi Ashley! I totally agree that working with and confronting a suicidal client would likely provoke a decent amount of anxiety. It can feel like a lot of responsibility and pressure to say the “right” things and avoid the “wrong” words/phrases/actions/etc. Essentially, I think it’s easy to overthink even our smallest tendencies when we are engaging with a suicidal client because we don’t want to feel like we contributed negatively to their situation. Yet, I appreciate your point that we cannot be with a suicidal client at all hours of the day–it is simply impossible. Therefore, I also think that training will be crucial so that we can walk away feeling like we tried our best to support clients in crisis. I look forward to feeling more competent in this area.

      Reply

  10. Whitney Andrew
    Oct 05, 2022 @ 20:22:05

    It is important to get an accurate understanding of the client’s problems early in therapy during the intake and early sessions to better help them and solidify a treatment plan. If any piece of information is missing then you cannot accurately treat them and may over look crucial details of why the client is even coming in to see you. The client’s history is also important to gather to paint the full picture of the client and to also be able to build rapport and gain trust. Without gaining an accurate understanding then the client will not feel supported by the therapist as much as if accurate information is collected to begin with.
    In looking at treating suicidal clients I am worried about almost everything. I am nervous to misread scales and to even overreact to potential signs that will worry the client and push them away from therapy. I also am wary of not being able to recover if one of my clients is successful with a suicide attempt after coming to see me, even if it was just for one intake session. It is always nerve-racking to talk about suicide even though talking about it does not increase the likelihood of action, it is hard to remind yourself of that when it is not a widely talked about topic.

    Reply

    • mikayladebois
      Oct 06, 2022 @ 08:24:13

      Hi Whitney, I agree with everything you said! I think that in the session I will be nervous to make the first mention of suicide, but once the words are out it will be easier to keep going. I would also remind myself that in the long run, I will have wanted to do what was best for the client, not my own comfort level.

      Reply

    • Taylor Poland
      Oct 06, 2022 @ 18:26:34

      Hi Whitney!
      I agree, the idea of someone completing suicide after meeting with me makes me feel really uneasy. You mention that you are worried about overreacting to the results and pushing the client away. I did not even think about that side of the coin. I am scared of misinterpreting the results and underscoring them. Both are scary and I hope to learn more about how to address these situations.

      Reply

  11. Brenna Stewart
    Oct 05, 2022 @ 21:40:08

    Getting an accurate understanding of the client’s problems is essential for many reasons, especially early on. One point that really stuck out to me was how it is common for therapists (especially beginning) to underestimate the severity of presenting problems, which in turn can lead to a negative outcome, with one example being overall ineffective therapy for the client. I also believe the more accurate read a therapist can obtain, the more potential there is for the most authentic therapeutic relationship. In turn, this can only benefit the therapeutic process.

    Circling back to the potential of underestimating severity of symptoms, I am overall concerned about encountering this type of situation more as a beginning therapist than anything, because it’s inevitable that I may overlook something, and it’s going to take time to establish the skills to effectively respond and/or react and properly utilize resources in these situations to best assist the client, with keeping safety at the forefront, of course. I also worry about the status of the therapeutic relationship at the time where this would show up, but I think if there is proper training in place, an effective therapist will be able to respond effectively regardless.. however what I’m getting at with that point is that I think naturally as humans it may feel more difficult with a client who we don’t have an established relationship with (yet), which puts even more emphasis on the importance of proper training, skills and confidence to manage these crisis-type situations. Despite these concerns, I am hopeful they will dissipate with proper training, establishment of skills, confidence and overall experience within the field/these encounters.

    Reply

    • Becca Boucher
      Oct 07, 2022 @ 14:56:20

      Hi Brenna! I really like you point about how it’s important to understand client problems early on because a big mistake therapists make is underestimating the severity of client problems. This is a great point that I didn’t think of, but it is so true! If you underestimate a client’s issues from early on in treatment more than likely therapy will not be effective for that client. I also agree with you that I worry about underestimating a client’s suicidality. Luckily, I think that you are also correct when you say that we will have proper training and support to deal with these difficult and scary situations.

      Reply

  12. Esther Konadu
    Oct 05, 2022 @ 22:11:20

    Without a proper understanding of the client’s problems early on in therapy, it can lead to misunderstandings down the road. Imagine if you were sitting in therapy, and your therapist did not ask you what was troubling you/ the reason you came to therapy. You would feel hurt and that it was not worth coming because your therapist is “out of touch”. Taking the time to understand your client; making sure that their problems are not dismissed allows for a safe & welcoming growth environment. It also helps us (that is, therapists) to know what is going on and formulate a plan to help our clients. If you do not know what the issue is, you cannot pretend and get away with it because clients will see that you are not being genuine.

    When thinking about assessing a suicidal client, I am not overly too concerned since I have some experience volunteering and interning at a suicide hotline. Granted, my biggest concern would be hoping my skills translate into in-person or telehealth sessions since I have only done over the phone assessments. Yes, it can be anxiety-inducing assessing someone who is suicidal, but remaining calm and relying on your training helps. And do not struggle alone, ask your supervisor for tips on how they handle suicidal client situations. There have been times when I was unsure of what to do at the moment, and asking for their advice helped me to support the person in crisis. Like most things in life, once you experience it a few times, it gets easier and you know what to do.

    Reply

    • Magdalen Paul
      Oct 05, 2022 @ 22:44:11

      Hi Esther! I can relate a lot to your feelings around translating over-the-phone sessions/scenarios to those in-person or via telehealth. Having also volunteered for a hotline, I recognize that sometimes when you do not see the person in crisis who you are speaking with, you can feel less pressure. Therefore, I wonder also how these skills will translate, but I appreciate your words here around the support of supervisors and peers/colleagues. We are not expected to know exactly what to do or how to handle difficult situations perfectly the first time, or really any time. With training and continued practice, we can simply work to build competence and confidence, and trust that we are supporting each client to our best ability.

      Reply

    • Megan VanDyke
      Oct 07, 2022 @ 07:26:49

      Hey, Esther! I like how you tried to put yourself in the client’s shoes when discussing the importance of establishing an understanding of their problems during the beginning sessions. I believe that is a great skill to have throughout the therapeutic relationship as the counselor so that we always keep the client’s best interests in mind. Also, thank you for sharing some of your experience volunteering at a suicide hotline. Knowing that it’s normal and encouraged to bring in a supervisor for a second opinion or assistance is a bit relieving. For a while, I was afraid that by doing so, the client might think that I was unsure about what I was doing, and I’ll lose some rapport with them, but as I previously mentioned, I’m doing it with the client’s best interests in mind.

      Reply

  13. Chandal Powell
    Oct 05, 2022 @ 22:42:46

    It is important to get an accurate understanding of the client’s problems early in therapy for many reasons. One such reason and possibly the most important is understanding what prompted the client to seek out therapy and the issues they hope to address. In doing so, you can set achievable goals to aid clients in having successful treatment. Not only will this help the client in the moment, but they will be more willing to engage in therapy in the future if they have a positive experience. In understanding the clients problems this will also lead to move meaningful conversations because the client will feel heard. Consequently, this will assist in establishing a beneficial therapeutic alliance.

    While I’ve had some experiences with suicidal clients, I was able to use my skills as a QPR trainer to assist clients to a much safer place before having them speak with their clinicians. This unfortunately did not reduce my anxiety. My concern is that with QPR I was never the individual clients were referred to when they were experiencing suicidal ideation. Consequently, the unknown is what I’m fearful of. Additionally, these clients were in controlled environments where I could take measures to create a safer space for them. This would decrease the likelihood of them following through with suicidal statements. As a therapist I can have influence on a client in their own environment, but no control. This highlights one of my biggest fears, because I might not be convincing enough or able to support a client who is suicidal in making the choice to live.

    Reply

    • Emily Forde
      Oct 06, 2022 @ 09:45:56

      Hi Chandal, I agree that understanding the client’s problem can make them feel heard and strengthen the therapeutic relationship. I like that you bring up that as therapists we have no control over the environment the client is in, and I really agree with that and think it is tremendously scary. This reminds me of letting the client’s discover their own problems in the exploration stage. I think that letting the client themselves make their decisions and determine their environment is more helpful to them in the long run, because they move at their own pace and do not feel like someone is making their decisions for them. I think this allows for a therapist to be more of a supporter, rather than a ruler over them and their life. Hopefully, because the therapist is more of a supportive role in their life and is not telling them what to do, the client will be more likely to understand the therapist’s perspective.

      Reply

  14. rena yaghmour
    Oct 05, 2022 @ 23:04:16

    It’s important to get an accurate understanding of the client’s problems early on so the counselor will be able to help treat the individual correctly. It is also important because with enough information the counselor has more room for exploring deeper feelings and thoughts that the individual might discover. Having an accurate understanding will also help give an accurate diagnosis, and a proper treatment plan so that the individual receives the best care and is able to work through their problems efficiently and appropriately.

    One of my main concerns about treating a suicidal client is not being able to help them correctly. I fear that I may say something that may trigger the wrong thoughts, or even try to talk them through it but have it go south. I am also nervous that the client may express suicidal ideation but not be honest with me on where they rank on a 1-5 scale and rates themselves lower than what they really are, and we plan for safety incorrectly. It’s nerve-wracking thinking about this and the possibilities of what could happen. I want the safety plan the client and I create to be effective and help prevent anything from happening.

    Reply

    • Taylor Poland
      Oct 06, 2022 @ 18:30:35

      Hi Rena,
      I agree with you completely. The thought of the client withholding information or not accurately answering the assessments is causing me to feel a bit nervous. This aspect makes me nervous because it is something that I have little control over. I hope we learn more about how to navigate situations like these in class this year before we start meeting with clients.

      Reply

    • Alyson Langhorst
      Oct 07, 2022 @ 22:25:44

      Hi Rena!

      I also worry that I might not be able to help a client who’s suicidal. Kind of like you said, I worry that I could make a mistake and end up making the situation worse. You touch on a good point that in order for the plan (and this can really go for any treatment plan, not just for someone who is suicidal) to be effective, there has to be an honest conversation and making sure every party involved is on the same page. It’s a therapist’s job to get an accurate understanding of the client– but even this could be incorrect if the client is dishonest and inflating certain parts while deflating others. Expressing this worry could be helpful in building rapport. I think, as the chapter stressed, building rapport is a big part of therapy. Being able to be honest and open with the client and hearing them out may go a long way in getting them to feel like they can open up– especially when it comes to topics such as suicide.

      Reply

    • Maria Nowak
      Oct 08, 2022 @ 19:49:11

      Hi Rena,

      You really hit home for your concerns on suicide. Sometimes we may think we are being helpful or saying the right things and it is not interpreted how we wanted it to be. I also think about the patient lying to me and how bad of a situation that could turn into. So much would be going through my head like if there was something more I could do to prevent it. Did I miss a question? Did I miss interpret something they said? It is one of the most nerve-wracking things as their life is kind of in your hands.

      Reply

  15. mikayladebois
    Oct 05, 2022 @ 23:19:10

    The initial sessions of therapy are so key to the rest of the relationship. If we can’t determine what the real problems are that the client is facing, we won’t be able to treat them in a way that will actually benefit their situation. Beyond the diagnosis and treatment, there are so many factors that influence a person’s journey to where they are when we will be meeting with them. I think it is important to understand their history and culture as much as possible because as soon as we can see through their lenses, the exploration stage becomes a lot easier.
    When dealing with suicidal clients I am mostly concerned about how I will respond internally. I know that we are going to learn more in our classes about how to address those situations in session and so that area isn’t quite as concerning to me at the moment. If I have gotten to know a client and then find out that they have committed suicide, I can imagine myself having a very negative reaction. Based on previous experiences of suicide within the community, I know for a fact that I was not okay, so if or when I lose a client, I will need to have better coping skills than what I had in the past. As a therapist in session, we need to be able to give our full attention and effort to the client in the room but if I am preoccupied with something else, I won’t be able to give that client their due. I know that I wouldn’t be able to properly handle a suicidal client right now, but I also know that we will have access to guidance and supervisors at every stage of our professional careers.

    Reply

    • Emily Forde
      Oct 06, 2022 @ 09:37:29

      Hi Mikayla, I really resonate with your fear of having a negative reaction if a client says they are planning on committing suicide. I agree that we, as therapists, need to give our clients our full attention, despite the emotions that we may be facing at that moment. However, this makes me wonder if maybe a negative reaction, in this case, would be beneficial to the client in some way. Maybe seeing the sadness and worry of their therapist would validate that they have someone in their life that cares about them.

      Reply

    • Abby Sproles
      Oct 06, 2022 @ 10:14:37

      Hi Mikayla! I totally agree. I think sometimes we forget we are humans with emotions, too. We do not have to have a personal relationship with the client to be affected by their loss. When I worked at a bereavement center, my instructors told me to leave all of the sadness and worry in the building, and to not bring it home. Self-care and setting work-life boundaries can help us not get overwhelmed by our clients’ problems.

      Reply

    • Maria Nowak
      Oct 08, 2022 @ 19:06:19

      Hi Mikayla!

      There are several points you made that I agree with. Understanding a client’s history and culture is significant in understanding why they are the way they are. It is also essential to understand a person’s culture as that can be a large influence on their decision making. I like how you described it as looking through their lenses. This is something we should be doing in general! I also did not even think about my coping skills. I can also imagine myself having a negative reaction to a client committing suicide. I mean how can something like that not affect us? Especially after developing a therapeutic relationship with the client.

      Reply

  16. Emily Forde
    Oct 06, 2022 @ 09:33:03

    It is tremendously important to get an accurate understanding of your client’s problems early in therapy because it allows for sessions to be effectively tailored to their problem. For example, if the determined client problem is difficulty in social situations, it may not be helpful to them to ask open-ended questions the whole session regarding eating problems or body dysmorphia. But instead, the therapist should ask questions regarding the problem in order to determine the root and how it is affecting them on a daily basis. However, the sessions should not disregard other mental health disorders completely in case comorbidity is occurring in the client.
    It is also important to get an accurate understanding of the client’s problem so they can come up with a proper treatment plan and make goals based off their main problem(s). Additionally, if the therapist is not understanding the client’s main problem, the client may not feel heard or validated by the therapist, which can damage the therapeutic relationship.
    When it comes to suicide, I am worried I may say the wrong thing. I am also concerned that my client will not be completely honest about their suicide risk.

    Reply

    • Alyson Langhorst
      Oct 06, 2022 @ 16:58:26

      Hi Emily!

      I agree that it’s important to tailor questions to the prioritized problem but to also not discount other potential issues. There should be a balance of questions to rule out other problems early on so that treatment can be tailored for the problems that they want to work on. You also bring up a good point that part of that initial intake/the first few sessions are also about building the therapeutic relationship. The questions that a therapist asks should not feel like an interrogation or feel closed off. They should initiate a conversation and allow the client to open up. It’s also important to consider how the therapist reacts to the client when they’re answering questions. Body language is another important part and clients can read the therapist and how engaged they are in the conversation. If the therapist is giving off signs that they don’t care or aren’t listening, then the client will be less likely to open up and be honest- which can also affect quality of treatment.

      I have similar worries to yours in regards to clients who have suicide ideation. I like to think of worries in two categories; those within or control and those outside of our control. In the case of a client who is dishonest or doesn’t feel comfortable opening up about suicide ideation, we can’t control their response or what they choose to share- we also can’t force them to share anything they don’t want to. In this case, it’s important to understand what we can control. For example, we can control the environment during the therapy session (creating a comfortable environment that allows them to feel like they can open up and feel safe). We also have control over what kinds of questions we ask. Trying to pick up on hints and ask questions that indirectly related to suicide (such as bringing up questions related to hopelessness, future plans, goals, support systems, etc.), can help us determine who is at risk for attempting suicide.

      Reply

    • Lucy Rising
      Oct 08, 2022 @ 08:48:01

      Hey Emily, I liked what you said about not using open ended questions regarding an unrelated issue than the one the client is presenting to you in the session. It got me thinking about the appropriate use of the helping skills from 600. Too much of one skill can come off like inattentiveness or nosiness, especially in the initial intake. We want to make sure we are getting an accurate account of what our client’s problems are, but be aware enough of ourselves and how we go about doing so.

      Reply

    • rena yaghmour
      Oct 09, 2022 @ 18:44:52

      Hi Emily,

      I think you made a really good point about not asking open ended questions to topics that have no association with the clients problems. By doing that the client isn’t getting help on what they are meant to get help on and in a sense wasting their time. it may even drive them away from the counselor believing they don’t know what they are doing. However, like you said comorbidity does occur. I also have similar concerns about being confronted with a suicidal client. One of my biggest concerns is whether they are being honest with me or not on where there suicidal ideation is on a scale of 1-5. I want to be able to help them but worried they won’t tell me the truth which may lead to more serious confrontations.

      Reply

  17. Wendy Fernandes
    Oct 06, 2022 @ 13:55:34

    Getting an accurate understanding of client problems early in therapy can allow the therapist more time to formulate appropriate treatment plans. In the beginning the client may mention why they are coming in but over the course of the initial intake the counselor may discover that the client has multiple issues, and it is important for the counselor to address all the issues. For example, a client may walk in wanting to get help for depression and while talking or doing assessments the counselor may discover that the client also has a substance abuse problem. It is essential that the counselor uncover as much relevant information as they can to assist the client in getting proper treatment. I was also struck by the comment about not underestimating the severity of the clients’ problems which is common with new counselors. Underestimating problems would mean that the counselor is not getting an accurate understanding of the clients struggles. In early therapy, counselors should also be mindful about keeping eye out for client who mention suicide or suicidal thoughts or substance abuse concerns. These topics may be an indication that there should be some immediate follow-up.
    I was surprised and sad about the statistic that stated 71% of counselors have worked with individuals who had attempted suicide and 28% of those practitioners had a client who committed suicide. I didn’t realize the number was so high. I know I will receive training in how to talk to people who are having suicidal thoughts, but my main concern is saying the wrong thing to them, and if I was the last person they speak with I’m not sure how I would handle that. Logically I know there was probably nothing I could do, but that would be a very hard situation for me to live with. Another aspect of this that concerns me is that maybe the client doesn’t mention suicidal thoughts, but maybe there are signs as a therapist that I should have picked up on.

    Reply

    • Esther Konadu
      Oct 07, 2022 @ 13:23:45

      Hi Wendy,

      You are absolutely right – that kind of emotional toll is not an easy thing to live with. But I love how you are aware of this and it is in the back of your mind, it shows that you are empathetic and passionate about this field. When other clinicians (whether it is therapists or in the medical field) stop having empathy for their clients, they lose their passions. Remaining appropriately connected to our clients is how we give them the best we have to offer, and also give them the respect that they deserve.

      Reply

  18. Lucy Rising
    Oct 06, 2022 @ 14:42:38

    It is important to get an accurate assessment of the client’s problems in early sessions because understanding your client’s problems will inform, influence, and direct your course of treatment. As was said in the lecture videos and in Abnormal yesterday, we want to compose a treatment plan that is centered around the problems the client is facing and not necessarily the diagnosis they are presented with. The diagnosis can help to influence how the treatment is structured, but the specific problems the specific client is facing will be the main focus for constructing treatment. In addition to the importance of assessing the client’s problems is also the importance of assessing them accurately. As mentioned in the video lecture, newer helpers tend to underestimate the severity of their client’s distress and this could hinder the client’s healing process if the treatment being provided is not as intensive or “serious” as the client requires at the moment. So knowing the problems is not enough, we must also be sure to assess them as accurately as we can.
    I want to work with queer individuals, so I know suicidality will be an inevitability One of my concerns working with this demographic when this issue arises is being able to be a solid help resource to help them through these thoughts. Because I know I, especially early on in my career, won’t be as solid as they need me to be. I fear that my own anxiety will get in the way of effectively helping them with these thoughts. And when I do have a client who attempts suicide (because there is a scary high percentage of suicide rates in trans people) I am worried about how I will be able to cope with the feelings of not having done enough to help them.

    Reply

    • Gitte Lenaerts
      Oct 07, 2022 @ 12:40:26

      Hi Lucy, I liked that you brought up what we learned in Abnormal that we want to create a treatment plan that is centered around the problems the specific client is facing and not focusing entirely on the diagnosis. Though a diagnosis is helpful with therapy, it is not the root of treatment. The client’s attending problem/concern is the source of treatment. That’s why gaining as much information early in sessions is helpful so we as therapists can better facilitate helping the client. Additionally, I agree with your statement about not feeling like you have done enough to help out a client who attempts suicide. You mentioned how you want to work with queer individuals and there is definitely a high percentage of suicide rates with trans individuals. It is a terrifying feeling, and I feel like there will always be a sense of feeling like we could’ve done more. However, it is essential to remind yourself that you are doing more. You are the one that is there and listening to them and guiding them. Thank you for sharing! Great post!

      Reply

    • Ariannah Zagabe
      Oct 07, 2022 @ 20:36:56

      Hi Lucy,

      You’re right on point about how it’s crucial to create a treatment strategy that is focused on the issues the client is encountering, rather than just the diagnosis that has been given to them. Although a diagnosis may influence a treatment strategy, it is important to concentrate on the particular problems that the client is struggling with

      Reply

  19. Ariannah Zagabe
    Oct 06, 2022 @ 16:26:42

    Early in therapy, it’s important to accurately identify the client’s issues so that you can start looking for solutions and creating a treatment plan. Gaining a thorough understanding of your client’s problems will assist you in gaining a thorough sense of how they are feeling and thinking. By doing, you’ll be in a better position to decide how to assist your client in recovering. You’ll risk not having an early start in really getting to know your client early on in therapy if you don’t have a thorough understanding of their issues.

    I’d like to think that by the time I’m a professional therapist, I’ll be trained and equipped to deal with this circumstance but thinking about if I ever was faced with a client who was suicidal, I’d be anxious. Even though I would adhere to the procedures I have been instructed to follow in this circumstance, I would still worry that I am not doing enough to assist them. If in the unfortunate case that they do commit suicide, I’m honestly not sure how I would handle that (emotionally). However, I am aware that it is a possibility when working in the mental health field.

    Reply

    • Chandal Powell
      Oct 08, 2022 @ 21:52:29

      Hi Ariannah,
      I also would worry about not doing enough for a suicidal individual. Even with training as therapist we are still humans and it’s inevitable that we will have some emotional response. Whether it’s anxiety, worry or even regret, however, we will have resources available to us to utilize to provide support in the event a client completes suicide. As therapist we are helpers but it’s important for us to be able to recognize when we need help as well. I believe being aware of one’s limitations and asking for and accepting help when necessary will make us the best therapist for our clients.

      Reply

  20. Alyson Langhorst
    Oct 06, 2022 @ 16:36:16

    It’s important to get an accurate understanding of the client’s problems early on because therapy sessions build off one another. If you perceive a client as being anxious early on, your plan of treatment will look different than if you think your client is depressed. If you overlook something or don’t ask enough questions, you may miss important issues that they may be struggling with. In some cases, not accurately understanding your client could cause them harm. This is especially true in the case of clients who may try to harm themselves or attempt to commit suicide.
    Another reason why it’s important is because understanding your client is part of the rapport building process. The textbook suggests that building rapport in the beginning of the therapeutic relationship is crucial for positive outcomes of treatment. If you actively listen and ask appropriate questions to your client to understand them better, it will show that you respect them and that you want to help them. Subsequently, half listening and asking close-ended questions may cause the client to feel more reserved and less likely to trust or open up to you. It’s also important to get an accurate understanding of the client’s problems because a client may not fully understand them, so if you interpret them incorrectly, you may end up giving them misinformation. Subsequently, not fully understanding your client and what they want/need help with can lead to an ineffective treatment plan.

    I’m a bit concerned about being able to differentiate passive and active suicidal ideation, and when to take action about it. Suicide is still a fairly taboo subject, and the client (depending on their upbringing and culture) may not directly say they have these feelings, or may not be open to sharing their feelings about it. In this scenario, I’m worried that I might not pick up on certain hints. I’m also unsure exactly what the steps would be to handle a client who is planning to commit suicide, however I’m assuming that organizations have strict guidelines concerning what to do. The overarching concern is that I might make a mistake or might not ask the right questions. In regards to a client that does commit suicide, I’m worried about not being able to cope emotionally.

    Reply

    • Esther Konadu
      Oct 07, 2022 @ 13:36:26

      Hi Alyson,

      I understand where your concerns about suicidal clients come from! As you mentioned, suicide is stigmatized in our society, and the times it is shown in pop culture, it usually is some terrible representation. From what I have learned, passive suicidal ideation can sometimes be a person mentioning “I want to die,” but there is no action plan behind it. But for active suicidal ideation, the person is seriously considering suicide and has a plan ready to go. So if a client said, “I do not want to live so I am going to do … x,y, and z,” that would be active ideation. The hotline that I volunteered for trained us to consider someone as an active risk if they had the means and plan within the next 24 hours. So the timeframe for us played a part in whether or not we flagged someone. I do not know if that timeframe is the same for other organizations, but that is something I think we will find out during our field experience.

      Reply

    • Lucy Rising
      Oct 08, 2022 @ 09:26:17

      Hey Alyson, I liked your emphasis on the appropriate timing of skill usage. Certain helping skills, it seems, are more appropriate at certain times than others and can influence the therapeutic relationship, especially at such an early stage. Like you said, excessive use of closed ended questions could make the client shut off and feel interrogated in a first session. It will be important for us to remember to not hang up too much on “gaining information” and focus on building that trusting rapport

      Reply

    • Vic White
      Oct 08, 2022 @ 23:30:49

      Hi Alyson,

      I like how you said about therapy sessions building off of one another and how the early diagnosis can help aid a treatment plan and the sessions. Understanding the client is definitely good for building rapport, that is something I hadn’t thought of until I read your post! I wish suicide wasn’t a taboo subject, and that people felt that mental health in general wasn’t taboo, but I do think as a generation we are getting better and hopefully with that it will become easier to talk about suicide and feelings of such. And as for your feelings on if someone did commit suicide, I feel the same. I also think I would feel some kind of guilt that I wasn’t able to help them.

      Reply

  21. Maria Nowak
    Oct 06, 2022 @ 17:05:16

    It is important to get an accurate understanding of the clients problem early in therapy because a client typically comes into therapy with multiple issues that need to be addressed. Although, there is generally a dominant issue that is the core of other problems the client may have. In order to give proper treatment to the client the dominant issue needs to be addressed in early stages. The therapist would not be able to guide the individual in the right direction if they did not know what the main issue was. In addition, if the main issue isn’t addressed early on, the client may feel like going to therapy is pointless because the dominant issue they are having is not getting any better.

    A few initial concerns I have when being confronted with a suicidal client is the fear of not knowing how far they will go. Are they only having thoughts? Have they thought about how they could successfully commit suicide? Have they attempted it before? What if I misjudge the situation and they end up committing suicide? Do I have enough information to section them? Of course, most of these questions I would be asking the client, but I feel like this is one of the most difficult situations to be in. All in all, misjudging the likeness of the client attempting suicide would be my main concern.

    Reply

    • Melissa Elder
      Oct 07, 2022 @ 09:33:58

      Hi Mariah,
      I agree with you regarding why it is important to gather as much information in early sessions with a client, it helps us accurate guide and treat them.
      I liked that you addressed that you would ask most of your questions revolving suicide straight to the client and I agree that it is a very difficult situation. I feel the same way and I believe many others do too, misjudging the situation is a huge fear of mine but I feel like once we are in the situation the way we act upon it will be different and we will always be guided by supervisors !

      Reply

  22. Magdalen Paul
    Oct 06, 2022 @ 17:48:54

    It’s crucial to get an accurate understanding of a client’s problems early in therapy because this will set the stage for the remainder of sessions. This will ensure that you will know how to proceed properly and effectively to produce the best outcomes for your client. Without a thorough and accurate idea of what your client is struggling with and why, how can you confidently and successfully proceed with treatment—but especially treatment that will be most beneficial? Therefore I believe it is critical to establish rapport and start building that therapeutic relationship early on in sessions, so that the client feels safe to discuss the heart of their concerns, to hopefully promote transparency. If the type of relationship you establish with a client lacks trust and causes a client to build up walls, it may be difficult to treat the client to the best of your ability.

    When considering suicidal clients, I do feel a bit of anxiety. I would hope that in such situations I will feel confident and competent assessing and working with them. I want to feel prepared to ask the right questions and take the proper actions to promote the safety of the client. I have experience with QPR and volunteering for a domestic violence hotline, so I have been in situations where I have used deescalation and support techniques. I have also had to reach out to my supervisors at times to assist in situations where I did not feel fully competent or sure of how to proceed. Therefore, I understand just how important it is to consult people with more experience in this area. We do not have to navigate these situations alone and can always reach out for support ourselves. Thus, I look forward to gaining additional training in this area but am saddened that we as future professionals even need training for suicidal clients due to the amount of people who find themselves suicidal today.

    Reply

    • Ashley Millett
      Oct 07, 2022 @ 09:20:56

      Hi Magdalen,

      I agree that discovering the client’s problems early on can set the stage for the remainder of sessions. If we are able to detect the client’s problems early on, the treatment and other sessions can revolve around that. I feel like discovering the client’s problems early on will make the treatment process easier. We would not have to revolve around different treatments for more possible problems. If we can detect the problem early on, it saves time for the client and also for the therapist. I also agree that it can start building a therapeutic relationship early on. It can make the client feel listened to which can make them open up easier.

      Reply

    • Alysha Benoit
      Oct 08, 2022 @ 22:12:14

      Hi Maggie, I agree that it’s crucial to establish rapport to help build the therapeutic relationship. This is particularly important during the first couple sessions because that is where the client is most likely opening up and expressing their initial concerns. This connection is also important because it helps the client feel like they can tell the therapist more, as their thoughts and feelings develop during a session. I think the experience you have regarding suicide and suicidal patients is extremely important and very useful. I also like the point you made about the unfortunate situation couselors (and more importantly the client themselves) are placed in regarding the proper training and knowledge about addressing suicide and suicidal patients.

      Reply

  23. Taylor Poland
    Oct 06, 2022 @ 18:21:33

    It is very important to gain an accurate understanding of a client’s problems early on in therapy. During the intake session, it is crucial to ask the client about their demographic, medical, psychological, and the client’s presenting concerns. Although it is important to gather information about the client, it is equally important to build rapport with the client. When a client feels comfortable with you and trusts you, they are more likely to share information about themselves. The more information the client shares during the first few sessions, the better the counselor can help the client explore their thoughts in a deeper manner. Research shows that attending to the client’s concerns in the initial stages of treatment is related to a better outcome.
    The thought of assessing suicide can be anxiety-provoking. One concern of mine is grading the assessment incorrectly and underscoring their results. The thought of telling someone that their results are not concerning when in reality the client is actually significantly suicidal sends chills down my spine. Another concern of mine is missing signs or misinterpreting comments alluding to suicide from the client during sessions. When it comes to comments about suicide, I need to address and handle them seriously. Oddly enough, a client of mine today made comments about suicide. I immediately went to my supervisor and contacted counseling services to ensure my client was seen by a professional. My supervisor applauded my urgency and instincts to get my client further help which makes me feel slightly more confident in my abilities to help future clients who are suicidal.

    Reply

    • Melissa Elder
      Oct 07, 2022 @ 09:37:07

      Taylor,
      I liked that you were specific in what information is important to gather within the first session and you mentioned the importance of rapport. It is so true, the more information us as helpers are able to gather the better outcome they will have.
      I thought it was interesting that a fear of yours would be grading the assessment incorrectly, that did not even cross my mind, that is a very good point. I’m happy to hear that you took the right steps with your client, I am sure you were nervous but you did all the right steps! Thank you for sharing

      Reply

    • Wendy Fernandes
      Oct 07, 2022 @ 18:40:39

      Hi Taylor,
      I didn’t even think of incorrectly grading the assessment and underscoring a suicide ideation score. I suppose for other disorders incorrectly scoring an assessment isn’t good, but at least the more immediate concern wouldn’t be death in most cases. Your experience with bringing suicidal comments to the attention of a supervisor gave me confidence also. It gave me a little insight into how someone reacted to this situation recently and I think I’d probably handle the situation the same way.

      Reply

  24. Vic White
    Oct 06, 2022 @ 18:33:27

    During the intake interview and the early sessions with a client, it is important to gather relevant information to define a client’s problems. Problem assessment is vital because it gives the counsellor a clear understanding of the presenting issues. Most people start counselling for a number of different reasons so its important that the counsellor approaches and investigates each issue individually to best help the client. Exploring each problem from multiple perspectives and gathering specific information on them can help aid the counselling when it comes to treatment and what interventions should be taken. In addition, its important to assess the degree to which the client believes their problems can change. Knowing this information can help with providing homework tasks for the client to work on independently and also for future interventions. If a client has been to therapy before and did not find it helpful and it didn’t make them feel better, as a counsellor this is something we should explore to ensure we do not replicate the past. It is also important to get an accurate understanding of the client’s problem early on because you may need to refer the client for a psychiatric evaluation or refer them to another counsellor who is better suited to the client because they could be suffering from something that another counsellor specialises in.
    My initial concerns of being confronted with a suicidal client are what if I can’t help them. What if I say something and it makes the situation worse and it isn’t helpful to the client. I know it is a case that you can break confidentiality in, but that also plays on my mind that what if my client finds it difficult to open up to me in the further. However, I do agree that it is best to have open conversations about suicide with clients, because even if a client isn’t suicidal, it is better to have that conversation than to not have the conversation with someone who is.

    Reply

    • Alysha Benoit
      Oct 08, 2022 @ 22:20:06

      Hi Vic, I really like the points you made throughout your blog. What really stood out to me was the point you made about not repeating the past. I did not initially think about the importance of this however, knowing what did and did not (and why) for a client in the past is super helpful for helping them in the present. I also thought it was extremely valid to say it is better to have a conversation about suicide even if the client is not suicidal than to not have it at all with a client who is.

      Reply

    • Chandal Powell
      Oct 08, 2022 @ 22:20:41

      Hi Vic,
      I really like how you explained the importance of understanding a client’s problem early in therapy. I agree with you that it’s about looking at the whole picture of a client and not just any one aspect because we have so many things impacting our lives. I think its really important to understand the degree to which a client believes they can change. This can actually determine whether or not therapy will be successful. There has to be some sense of accountability and responsibility for a client to have real change and success in therapy.

      Reply

    • Stephanie Lugo
      Oct 09, 2022 @ 00:19:18

      Hi Vic,

      I one hundred percent agree with you that it is so scary to talk with clients about suicide because it is hard to know how to they will act and respond. Being able to know what a client is going through and how to help them can only help build that therapeutic relationship. It also is so important to have open and honest questions with your clients. doing this will allow the client to feel more confutable in therapy, which will make us more comfortable as the counselor.

      Reply

  25. Alysha Benoit
    Oct 06, 2022 @ 18:41:24

    There are many reasons why it is important to get an accurate understanding of the client’s problems early in therapy. Majority of the time a client will be experiencing one or more problem(s) even if they only speak about one issue. Getting an understanding of one issue can lead a client to open up about another. Not only could this help the client open up to a counselor about other problems they are experiencing but also helps the counselor understand the severity of the distress a client may be in. Intake and early sessions in therapy are also important for implementing an assessment to a client. For example, if a client is experiencing depressive symptoms and suicidal thoughts or ideations and a counselor’s initial intake did not address or touch upon both issues, the client could be in serious danger of hurting themselves.

    In terms of being confronted with a suicidal client, I think I might be nervous in that as a counselor you have a responsibility to help a client to the best of your ability. Although I would feel nervous, I would first talk with them about their ideations and try to understand more about the issues leading them to feel this way. For example, feeling isolated, substance use, depression and depressive symptoms, etc. As a clinican it would also be my responsibility to alert a supervisor about this potential risk of suicide. Although at this particular time I feel only somewhat confident in my ability to effecting help a suicidal client, I know this program will give me the knowledge and preparation to work with a client to the best of my ability. In addition, I think once I am confronted with this issue, instinct would also help me in addressing the factors leading to their suicidal thoughts, attempts, or behaviors and then work with other professionals to get them the care and help they need.

    Reply

    • Vic White
      Oct 08, 2022 @ 23:20:59

      Hi Alysha,

      I like how you mentioned about being nervous when confronted with a suicidal client. I think it’s very normal to feel this way and I definitely agree and would feel the same! I like that you mentioned about your instinct as well, that isn’t something I had thought about but its so true! Sometimes just the instinct of wanting to be a caring and helping individual can aid us in this profession!

      Reply

    • Stephanie Lugo
      Oct 08, 2022 @ 23:37:10

      Hi Alysha,

      I completely agree with you; being able to know a client and their problems early on allows you to get to know them a hundred times better. When you (the counselor) are able to have a good therapeutic relationship with your client it will make all of the sessions feel and run much smoother. As you said it will also allow the client to feel more at ease and open. As the counselor it is also so important for us to ask the client open ended questions as it can allow the client to openly express more problems and concerns they may have. Making the client feel more comfortable and safe during their therapy sessions will only allow the client to become more expressive and open with the counselor they are working with. It’s important that we remember the client is the main focus in therapy. That is why we must do everything we can to make them feel confident when opening up to us.

      Reply

  26. Stephanie Lugo
    Oct 06, 2022 @ 23:40:42

    It is very important to get an accurate understanding of your client’s problems during intake or earlier in the therapy sessions because it gives the counselor time to plan and work through different techniques that may help the client more accurately and efficiently. It’s hard for a client when they are first starting therapy to be fully open and honest with their therapist. That is why as a counselor it is so incredibly important to make the client feel comfortable and open when they are first starting therapy. The more comfortable and open they feel the more they will express their feelings and struggles with you. Having a strong professional relationship between a client and a counselor can make therapy more helpful to that specific client. If there is not a strong professional relationship between the counselor and the client; the client’s progress can be hindered. Having hindered progress can make it take longer to get to the root of the client’s struggles and cause the client much more suffering.

    Since thoughts of suicide and self-harm are very common topics that counselors and clients discuss during there therapy sessions it is with out a doubt something we should prepare for. I think my biggest fear when being faced with a client threatening suicide is the fact that I may say the wrong thing. Since I have not yet been trained to work with clients who have suicidal ideations I don’t know what to say. Since the specific situation is such an important and delicate topic the conversation needs to be done very sensitively. As a counselor, I fear saying the wrong thing and having them think even more negatively about their situation. Another thing that I fear when thinking about experiencing this type of conversion with my clients is making sure I don’t ask the wrong thing. I don’t want any questions I have about the situation to threaten the relationship I have with the client. Also I don’t want the questions I ask to cause the client to shut down. I think it is so important to try and find out where the client’s boundaries are as I don’t want a misunderstanding to ruin any progress we may make.

    Reply

    • Ashley Millett
      Oct 07, 2022 @ 09:30:13

      Hi Stephanie,

      I agree with what you said that it gives the counselor time to plan out different techniques if we are able to detect the client’s problems early on. It can be easier for the client and the counselor to have a set plan rather than trying to figure out the best form of treatment. We would not want to waste the client’s time and our time as well. I also agree that the therapeutic relationship is highly important when it comes to detecting a client’s problems. Just like you stated, clients may start to open up easier if the relationship is there. I highly agree on saying the wrong thing to a suicidal client. It is scary to think about especially if it is a first intake. You do not know them yet. You would not know their triggers that can set them off. I do believe that with proper training and a lot of observations, it would be better rather than going in blind.

      Reply

  27. Grace Ling
    Nov 17, 2022 @ 15:52:26

    During intake and early sessions, therapists can gather background information on the client to gain better understanding of clients’ problems and goals. Understanding client problems early on in therapy can inform treatment planning and bring up interventions that would best benefit the client. In addition to discovering clients’ presenting problems, the intake session allows for therapists and clients to establish rapport. Learning more about clients’ background can also inform therapists about reasons for what is maintaining clients problems and preventing them from reaching their goals.

    I think my initial concern when confronted with a suicidal client is saying something wrong. I think this fear stems from the client already being in a really bad mental state and I will set them off in wanting to harm themselves or ending their life. But I think something helpful that Professor McGregor has said is that as therapists we are validating the feelings/emotions and not validating the behavior. I think the immediate reaction to trying to help someone who is suicidal is to automatically give advice when sometimes prevention starts with listening and validating their emotions.

    Reply

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Adam M. Volungis, PhD, LMHC

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