final exam Flashcards
SAD PERSONS
A psychological assessment tool used to assess suicidality by looking at the risk factors of suicidal behavior.
Sex: Men Age: 15-24, males 75+, females 45-54, 65+ Depression Prior History Ethanol abuse Rational thinking loss (psychosis) Support system loss Organized plan No significant other Sickness (self or partner)
1 pt for each: 0-2 keep watch 3-4 send home; call often 5-6 consider hospitalization 7-10 hospitalize
Things to ask about when assessing for suicide risk
Ideation: passive or active? frequency?
Plans: Have they thought about how they would do it?
Means: Do they have access to means to complete plan?
Intent: Do you think there’s a chance you may act on these impulses? (over course of next week, etc.)
Risk factors for suicide
Diagnoses: depression*, schizophrenia, PTSD
Other psychiatric risk factors: eating disorders, borderline personality disorder, antisocial personality disorder
Symptoms: hopelessness/desperation, anxiety, aggressiveness/rage or anger, impulsivity/unnecessary risks, recent hospitalization
Past history: history of childhood trauma or abuse, history of being bullied, family history of death by suicide, past attempts are best predictor
Behaviors: Making a plan, giving away possessions
Sociodemographic: male, age 45-64, white, separated widowed, divorced, living alone, being unemployed or retired
Occupation: health-related occupations higher (dentists doctors, nurses, social workers) * especially high in women physicians
Safety plan steps
- Recognize warning signs
- Identify internal coping strategies
- Identify people and social settings that can provide distraction
- Family members and trusted friends who could offer support
- Professionals and agencies to contact for help
- Making environment safe
Example of making environment safe
When making the safety plan, Jim says that he has both a gun and ammunition at his home. He lives alone. I suggest and he agrees to call a friend who can go to his home and remove the gun (or at least the ammunition) before he gets home from the session.
Boundary crossing v. boundary violation
Boundaries are a frame that protect the therapeutic relationship in an ethical practice. Boundaries may be physical (no physical contact) or behavioral (no gifts, self-disclosure). Therapists who practice ethically must use careful clinical judgment when deciding if it is beneficial to the client to cross a boundary. A boundary crossing could potentially benefit the client, be neutral, or potentially harm the client. A boundary violation is a boundary crossing that harms the client.
What can we do to manage boundary crossings?
Set expectations for therapeutic frame/structure
* Session day/time; topics/content of sessions; the “ground rules”
If you encounter challenges to boundaries:
- consider the context: late to one session v. a pattern.
- Consider impact on client
- Self awareness is always helpful
- Plan ahead when possible
- Make adjustments when necessary- consider it an ongoing process
- If in doubt, consult
Verbal self-disclosure
A disclosure statement made in the room during therapy.
What should we consider before making a disclosure statement?
Is this in the client’s best interest? What is the goal? What are potential consequences?
Transference
Clients undergoing clinical therapy begin to transfer feelings of a particular person in their lives to their therapist. Transference is often defined as the unconscious act of assigning to another in the present environment, feelings and attitudes associated with someone of significance from one’s past
Countertransference
Client triggers a particular response (or urge to respond) in the therapist
What questions should you consider/ask yourself if experiencing countertransference?
- Is this feeling characteristic of you?
- Are your feelings triggered by something unrelated to the client?
- Is the feeling related to the client in an obvious way? (Feeling put off by a client who is yelling at you is not related to your unique background)
Most important countertransference to notice:
* Is the feeling uncharacteristic of the therapist, a reaction to one particular client, and yet the exact trigger is not immediately obvious?
Behavioral signs a client is ready for termination
- missed appointments
- disengagement/slowed pace of progression
- difficulty finding new areas to work on
- lack of compliance
When would we want to consider bringing up termination to a client (ideally)?
Once client has demonstrated progress.
What topics can be discussed in a planned termination session?
- review progress made
- highlight gains
- identify areas for future growth
- ask about client experience
- share your experience
- instill hope for future
- ultimate goal: process experience
Strategies to increase likelihood of planned termination
- Check in with clients regularly about progress toward goals (ie once a month, once every few session)
- Provides a natural time to assess progress, make adjustments and discuss possibility of termination
- Help client consider if goals are met or close to being met, consider whether client wishes to work on new goals, plan a termination session if client feels they are close to being ready to terminate
Self care practical recommendations
- Recognize the hazards of psychological practice
- Think strategies, as opposed to techniques/methods
- More specific than just “take care of yourself”
- Self awareness
- Embrace multiple strategies
- Employ stimulus control and counter-conditioning
- counterconditioning: action oriented/skill building techniques
- Emphasize the human element (human connection)
- Seek personal therapy
- Avoid wishful thinking and self-blame
- Diversify your professional work
- Appreciate the rewards
