Abiola Stella Oloyede April 1, 2014 Crisis Intervention Suicide Assessment Self-Reflection While I think that my suicide assessment
went well, I felt nervous. In my opinion, I could have done a smoother job assessing the client. I feel I started off the assessment strongly, but when she started throwing out curveballs my mind drew a blank. I definitely relied more on my natural counseling skills to get me through the session. I did not know how to intervene a situation that had already happened, and was the clients presenting problem. So, I gathered information and assessed the clients emotional state instead. She was not a difficult client to work with, and was very forthcoming with the details of her attempt. Since she opened up about her suicide attempt and what her plan was, I did not have to do much more than reflect feelings, clarify her story and its timeline, and gather as much information as I could in twenty minutes. I used clarifying questions to prompt the client to repeat her story for continuity and congruency measures. I think I did a good job asking many open-ended questions and balancing them out with a few closed questions. One of the skills that I used with her than I think benefitted the session very well was asking scaling questions. It allowed both the client and me to concretely conceptualize her level of suicidality when she attempted and as she sat in front of me. I did a good job reflecting her feelings, but I wish I had reflected and probed more on her body language. There were times where I summarized what she told me, but they are few and rather short. I did a good job paraphrasing to clarify what the client was saying, and used follow-up questions to further the session along. Found myself inserting questions at the end that added more to her story than ensuring that what I was hearing her say was indeed what she was saying.
I did not realize that I forgot to ask her if she currently had a plan to kill herself until after we stopped recording. Though I have practice with suicide risk assessments at the internship site, not having the checklist that we use to assess a patient in front of me truly tested me. I remembered more than I expected from the risk assessment, but the order in which I asked questions were not the most chronological. I should have asked her if she were having psychotic episodes that contributed to her suicide attempt way before she brought it up at the end of our session. There were moments when she would repeat the same thing and I would wonder if she were in a psychotic fog, but kept forgetting to ask. I found it a little uncomfortable trying to gather information and empathically understand her rationale behind the suicide attempt at the same time. I would empathize and then steer away from being too engrossed in her story so that I could objectively assess her suicide risk. Although I have suicide risk assessment experience at my internship, I have never assessed someone who was admitted for a suicide attempt. There were certain times when the inflections in my voice could have been misinterpreted as judgment. Some of the language that I used with her (i.e. kill yourself) felt inappropriate to me right after I said them. I asked her a why question, and that frustrated me. I wish I had used better wording and more succinct questions. There was a point in the assessment where I feel my statements (what are the reasons you thought dying would be better for you and your family? and to hear you say it as though killing yourself is honorable to your family) were judgmental in phrasing and tone, even though my intention was not to do so. It was my desire to empathically confront her distorted thoughts on her self-worth, her logic behind attempting suicide, and her place in her family and world.
Nevertheless, I believe I did a good job with the overall suicide assessment. I know where I need to strengthen my skills (intervening, gathering information), and what I need to control (voice inflections). It is apparent what I am comfortable doing (paraphrasing, prompting, clarifying, reflecting, and empathizing), and what I have difficulty doing while in such a sensitive setting as this (empathizing while confronting, phrasing, succinct questioning). Although this was a mock assessment, it was my first time being in the moment of a postsuicidal attempt with a client. So I know that I have more to learn and develop within crisis intervention and counseling, and I am willing to do so.