MFT Clinical Exam: Top 50 Topics - 4) Suicide and Self Harm

Who else should you include in a treatment plan if somebody comes to see you and they have depression, and you're worried about suicidal ideation?

As part of a treatment plan, you should include a psychiatric evaluation or encourage a client to get psychiatric evaluation.

Order of questions to ask during a suicide assessment

Ask about self-harm. Ask about suicidality. Ask about a history of attempts. Ask about a plan. Ask about means.

What is the right answer to a question on the exam when a client expresses hopelessness, lack of faith that things are going to get better?

Assess for suicidality, ask clients about self-harm. If it's in the answers, check closely, because they don't usually include that if it's not the right answer.

Intervention: Voluntary Hospitalization

If a client is high-risk, voluntary hospitalization is what should could come FIRST, start here, to support client's self-determination, before moving to involuntary hospitalization

Intervention: Increased Contact

Lowest level intervention. Saying to client, you know, If you're feeling this way I want you to give me a call and we can touch base if these thoughts get overwhelming.

Scenario: Your college-aged student is reporting suicidality, should you maintain confidentiality?

No, because if the client kills themselves, parents will be upset they weren't informed that there was suicidal ideation. Clinically the best thing to do in that situation, is find somebody in their life that they can talk to about it, doesn't have to be parents, could be an aunt/uncle, family friend, a friend on campus, somebody else in the support system that you can talk to when you're feeling like this.

Intervention: Involuntary Hospitalization

Only the police can do the involuntary admittance, we can only INITIATE 5150's.

Intervention: No-Harm Contract

Research shows this does not keep people from killing themselves. More important as an assessment tool, to gauge client's willingness to commit to not hurting or killing themselves. If they're extremely resistant to promise safety, then you would likely escalate to another intervention.

Why is it important to psychoeducate family members?

Sometimes family members' responses can make people feel worse, and parents can get really anxious and upset, so you provide psychoeducation to the support system about the best way to respond to your loved ones when they're sharing any of those kinds of thoughts.

What are risk factors for suicide that could be mentioned in the question stem?

Symptoms of depression, lack of enjoyment, disengagement, social isolation, substance use, job loss, loss of status. Hopelessness, making a statement about how they don't think it's going to get better, there's no point in trying

Scenario: A client mentions his wife recently died, and they updated their will

There's clear indication that they're thinking about their own death, then you should ask them (or choose the answer choices that says you ask them) about suicidality.

Intervention: Breaking Confidentiality

We only break confidentiality when absolutely necessary. First we would encourage client to reach out to their support system themselves. If they're extremely resistant to doing it themselves, offer to do it for them + psychoeducate their family. If they're still resistant, you might need to move up to involuntary hospitalization.

Reasons for Living

What is keeping the client from killing themselves, because that's one of the main barriers that's keeping them alive. Very strong protective factors, like having a family (could never do that to my children), so that's something to focus on to help keep them alive. They could be extremely religious, and their faith could help keep them alive.

What danger are clients in, post-hospitalization?

When somebody comes out of a psychiatric hospitalization, they're at an elevated risk for suicide. If somebody has a history of depression, and they're coming out of the depression. People usually don't commit suicide at the depth of their depression, because they don't even have the motivation to do that. But when they start to feel better and come out of it, that's when people have enough energy and motivation to kill themselves, out of a fear of going back into that state.

Intervention: Safety Planning

When you talk through with the client what they would do if those overwhelming thoughts and feelings happen. Identify specific interventions that would help them feel better (call therapist, take a walk, listen to music, contact other social support friends). You create safety plan WITH the client.

What should you do if a client is having disturbing thoughts of death, but doesn't want to reach out to family because they are ashamed of how bad they are doing to want to tell others?

You can work on that shame in session, and you can communicate with the people and be involved, and provide psychoeducation to the family members.