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Suicide Assessment Interview Clinical Interviewing 1 — Transcript

by Aja Wallace, LMHC · 3,275 words · 565 segments · language en · Watch on YouTube

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0:06In this section, we're going to
0:07demonstrate a suicide assessment
0:09interview. We're going to see John
0:12working with a young woman named Tommy,
0:14who's been referred by staff at Trapper
0:18Creek JobCore, where John has seen Tommy
0:21one other time in a group setting. So,
0:24he doesn't know her very well. The staff
0:26is worried about her because she's moody
0:29and she's had intermittent suicidal
0:31ideiation. So, they want a mental status
0:34sort of check in on that. Um, you will
0:38see as the tape begins that we're a
0:40little ways into the session. John
0:42started an assessment of mood and
0:44depression because Tommy's indicated
0:46she's a little bit down and also she's
0:49talked a a small amount about her family
0:52troubles and some other areas of concern
0:55like personal insecurities that are
0:57affecting her mood. So, we'll go ahead
1:00and and watch some of this tape.
1:03>> I know from our conversation before also
1:06that um you're a Native Alaskan.
1:10>> Yes. And you're from a tribe in Alaska.
1:14That's your main tribal
1:16>> Yeah.
1:17>> connection.
1:18>> Yep.
1:19>> And that's the
1:20>> UPIC tribe.
1:22>> The Yup.
1:26Okay.
1:27And as we're talking today, you know, if
1:30there's anything that
1:33um maybe from your cultural background
1:35or from your tribal perspective
1:39that I maybe am not getting, I hope that
1:43you would feel free to to say, "Hey,
1:46John,
1:48um from my perspective or from my
1:50cultural perspective, this is the way we
1:53think about it or this is the way we do
1:55it." And so would that be okay if you
1:58let me know if I'm
2:01going the wrong direction or
2:04>> that'd be fine.
2:05>> Okay.
2:07All right. Um and sometimes when people
2:11are down, it affects them in a lot of
2:14different areas.
2:15>> And one of the places it can affect you
2:17is the way you think. Okay. It can
2:20affect some thoughts that you have about
2:22yourself.
2:23>> Yeah. or about the world or about the
2:26future. So, I'm wondering if in
2:29particular you're having any negative
2:31thoughts about yourself or the world or
2:34the future outlook of things.
2:41>> Sometimes I feel really hopeless.
2:44>> Mhm.
2:47I don't know. Like
2:52things seem to get worse all the time.
2:57So
3:00I don't really think about the future.
3:06>> Sometimes people when they're feeling
3:07down, they have some physical symptoms
3:09too. Like sometimes people have trouble
3:11sleeping. Sometimes they have trouble
3:13eating. Or then sometimes they sleep too
3:16much and sometimes they eat too much.
3:18Have you had anything like that going
3:20on?
3:23>> Yeah,
3:26I haven't been sleeping.
3:29Can't really sleep when you're too busy
3:31thinking.
3:34>> So
3:35>> So your mind is kind of buzzing along
3:38>> at night. And so it's hard to lay down
3:40and really
3:42get yourself to go to sleep. Yeah, but
3:44once I do sleep, I don't want to wake
3:47up. I'd rather stay asleep and dream
3:51>> than actually have to wake up and deal
3:53with reality.
3:54>> Yeah.
3:55>> So,
3:57>> sometimes people have their social
3:58relationships sort of affected by when
4:00you're down, too. And I'm wondering how
4:02your social life is is going. Is it um
4:07is it going okay? You have some contacts
4:10and connections? Um,
4:13I have friends, but I don't know. It
4:16seems like everyone's having fun and I'm
4:18there just to be there.
4:21>> Mhm.
4:21>> Like they call me a zombie.
4:25>> So,
4:26>> um, I'm going to just ask this question
4:28directly. Um,
4:31tell me because sometimes when people
4:34feel uh down, it's really not unusual
4:38for people to also think about suicide
4:41or about death. And I'm wondering if
4:44you've had any thoughts about suicide or
4:47about death
4:50um and stuff like that.
4:54>> There's been some.
4:56>> Okay. So, you've had some thoughts.
4:58Yeah, more than some. Probably daily
5:02basis.
5:04>> Okay.
5:06Think about that.
5:08Most of the day, part of the day,
5:15>> whenever.
5:17Sometimes it's never, but maybe.
5:21Sometimes it's like
5:24throughout the day, but
5:26>> Okay. What are some things when um what
5:30are some times when you're not thinking
5:32about death or suicide? Um what's
5:36usually going on when you're free from
5:38those thoughts?
5:44>> When I'm not thinking about suicide?
5:46>> Yeah.
5:47>> Probably
5:49singing.
5:51>> Okay. When you're singing.
5:53>> Mhm.
5:53>> Okay. so kind of engaged in making music
5:58in some ways and that sort of
6:01>> takes you away from those more
6:04>> negative and sad
6:06>> yeah I write poetry too
6:09>> okay
6:10>> so
6:10>> and that's helpful
6:14>> okay
6:17um
6:20sometimes when people think about
6:24suicide.
6:25Um, they think about it in a very active
6:29way, like, "Oh, here's how I think I
6:33would kill myself." And sometimes people
6:35think about it in a very, well, a less
6:38active way. It's like, "Oh, I just kind
6:40of wish I was dead."
6:42Um, but I don't really have a plan or
6:46any specific ideas about how I might end
6:51my life.
6:54Which is more true for you? Is do you
6:56have some specific ideas about a plan or
7:00a way that you would end your life or do
7:03you just sort of think I wish I
7:08>> Well,
7:12I have a couple plans, but there's days
7:16where
7:17it's inactive.
7:20>> Mhm.
7:22inactive in that it's not
7:24>> it's like I wish I was dead,
7:26>> okay?
7:26>> Or the world would be better without me
7:28or something like that.
7:30>> Okay.
7:31>> So, I could hurt the people in my family
7:38and they would feel bad
7:40>> for it.
7:42But
7:44I was either going to shoot myself, but
7:46that was out of the plan cuz there was
7:48no guns in the house. So, I was going to
7:51hang myself in my room and write on the
7:54walls
7:57everything that ever hurt me to my
8:00parents.
8:00>> Mhm.
8:02>> So, whenever they decided, "Wow, she's
8:04been in her room too long," they could
8:06go in there and tada.
8:12>> Yeah.
8:12>> So, one of the parts for you is to is to
8:15send a message
8:16>> to your parents about
8:18>> how you feel. Yeah.
8:20>> about how you've been treated.
8:22>> Mhm.
8:25>> Well, it's certainly clear that not all
8:28of these interactions are scripted or
8:31planned ahead of time. They're very
8:33real. And so, they're not perfect. We'll
8:36talk about some things that happened
8:38that went well and some things that
8:40maybe you wish you had included.
8:42>> Right.
8:44So, one thing I noticed right away was
8:46kind of an interesting where where she
8:50spelled the name of her tribe and at
8:52that moment in the interview, her mood
8:54lifted. She smiled. Just kind of
8:57interesting.
8:58>> Yeah, I noticed that also. I thought it
9:00was interesting. Uh I'm not sure what to
9:02make of it.
9:03>> Um it's one of those things I kind of
9:04put in the back of my head. Might be
9:06worth exploring somewhat later. Maybe
9:09there's something meaningful and a
9:11effectively uplifting about her
9:13connection with her tribe.
9:14>> Yeah, there was something there. I also
9:17noticed that she was speaking and
9:19processing pretty slowly. She wasn't at
9:22all agitated or hostile, but her tone
9:25was actually almost kind of flat.
9:28>> Yeah. And that's not very unusual um for
9:30people who have sort of a unipolar um
9:33depression that doesn't have much
9:35agitation in it,
9:36>> right? Um, and I noticed that what I was
9:40trying to do was to assess her
9:42cognitive, her physical, and her social
9:45depressive symptoms. I noticed she had
9:47some symptoms in each of those areas.
9:49>> And then I asked directly about suicide,
9:51and I was glad of that, but I felt a
9:53little bad that I never explored the
9:55frequency, duration, and intensity of
9:57her suicide ideation very completely.
10:00>> Right. Frequency, duration,
10:03>> intensity.
10:04>> Yeah.
10:06But you did ask directly about suicide
10:10and about wanting to die or kill
10:12herself, which is very hard to do.
10:14>> Yeah.
10:14>> And you did it in a way that I thought
10:16was acceptable. She went with it. She
10:19answered you. And you know, the other
10:20thing I liked is you asked her about
10:22times that she's free of any suicidal
10:25ideation,
10:26>> which I think is really important to
10:27sort of flow into some positive emotions
10:32or positive situations as much as
10:34possible during a suicide assessment
10:37interview.
10:38>> And you know, when someone um admits to
10:41suicidal thoughts, it's also important
10:43to check on suicidal plan. And the plan
10:47can be something that's sort of
10:50underneath the surface that you need to
10:52ask directly about as well.
10:55>> Tried two times and I realized
10:58that
11:01I was being selfish.
11:04So
11:08I guess I don't know
11:15mostly selfish like
11:22>> so you you tried a couple of times and
11:26um it sounds like after those
11:28>> your conclusion what you came to in your
11:31mind was that feels selfish and that
11:34you're not really wanting to do that or
11:38>> Well,
11:40tried two
11:42times to kill myself, two different
11:44occasions.
11:45>> Okay.
11:46>> So,
11:52I just thought,
11:54well,
11:57two times of trying to kill yourself and
11:58you didn't die.
12:02Why? Like, why didn't I die? Like, maybe
12:06I'm supposed to be here. So,
12:10I don't know. I I've been trying to
12:12think positive, but I don't know.
12:15>> So,
12:15>> maybe surviving means something.
12:17>> Yeah.
12:17>> It's maybe that's a message kind of from
12:20the universe or from
12:21>> something.
12:22>> Yeah.
12:24>> Wow. That was that was an interesting
12:26exchange. You know, I had the feeling
12:28that she really wanted you to ask her
12:32more about those two suicide attempts.
12:34>> You know, I think you're probably right.
12:36And it was a hard choice.
12:38>> Um, I ended up deciding to go with
12:41exploring the meaning of her staying
12:45alive, which seemed also important to
12:47her. That's one of the challenges in the
12:49suicide assessment interview is do you
12:51go more for deeper assessment of suicide
12:55or suicidal plans or thoughts or even
12:57previous attempts or do you focus a
12:59little more strategically on the
13:02positive and more hopeful parts of the
13:05interview?
13:06>> Yeah. Okay. Well, let's watch a little
13:08bit more.
13:10Well, I guess there's no good reason to
13:12commit suicide, but
13:15you know,
13:17I don't know what I'm trying to say, but
13:21my friend committed suicide because he
13:24got caught with a can of chew. He got
13:26kicked off the wrestling team.
13:31>> Okay.
13:34>> Yep. He shot himself in the head.
13:41And as you say that to me, I think that
13:43it sounds like you feel both sad and a
13:46little bit angry that he killed himself.
13:49>> Well, I'm sad. Don't get me wrong. He
13:52was a good kid, but
13:57it makes me angry because you hurt a lot
14:00of people
14:02when you take your life. Like who are
14:06you to take your own life? Like you are
14:10hurting your family,
14:13your friends.
14:15I don't know.
14:18So
14:19>> yeah.
14:20Yeah. So I hear you saying reasons to
14:24live. One is
14:27it's suicide. You kind of hurt people,
14:29maybe even people you don't intend to
14:31hurt. Mhm.
14:32>> Another reason is you've got a brother
14:34who you think the world of and you want
14:36to help him in his life.
14:38>> Yeah. I definitely I guess I don't want
14:40him to end up like me.
14:42>> Mhm.
14:43>> So,
14:45>> I just want to check in with you on
14:48maybe a little plan for you to stay safe
14:53because I know you've had some thoughts
14:55about suicide. Sounds like for the most
14:58part, and let me know if I've got this
14:59right, that for the most part, you're
15:02pretty clear that you want to live and
15:06move forward toward your dream and be a
15:08positive influence with your brother. I
15:10got that right.
15:11>> Mhm.
15:12>> That's the main thing. Now, if you were
15:14in a situation and you were feeling
15:16suicidal, what would help you feel
15:20better?
15:28That's a really hard question because
15:30when something really gets me down
15:34>> and
15:36I don't really think about
15:40what makes me happy.
15:41>> Yeah.
15:42>> Kind of pessimistic in some way.
15:47>> But the good thing is right now you're
15:50at a three or a four. So you're not all
15:51the way down there at a zero or a one.
15:54>> So right now when you're feeling a
15:55little better,
15:57>> what do you think? What could you remind
15:59yourself? Oh, here's what I think I
16:01should do when or if I start to feel
16:05more suicidal. What would be a healthy
16:07thing you could do?
16:10>> Well, I'd say eat, but that's not too
16:12healthy. Um,
16:13>> depends on what you eat, I guess.
16:15>> Well, I binge eat sometimes. So maybe
16:18having a small nutritious meal.
16:21>> No, maybe the working out or
16:23>> Okay.
16:24>> singing karaoke or something.
16:26>> Working out, singing. Okay, those would
16:29help. Would it help to call somebody,
16:32>> talk with a friend?
16:34>> I don't really like to talk to people
16:36about things they've never went through,
16:40>> okay?
16:40>> They don't understand. They can sit
16:43there and be like, "Yeah."
16:46>> Anybody on your list of friends who
16:48might understand?
16:49>> Nope.
16:49>> Nope. Not even the person who was on the
16:51phone with you for three hours.
16:54>> They'd be able to understand,
16:56>> but I'd rather call my sister cuz
16:59>> Okay.
17:00>> We grew up together. We know
17:04what we went through.
17:05>> So,
17:07>> okay. So, the possible things you might
17:09do is you might work out, you might
17:10sing, you might call your sister. Mhm.
17:12>> Anything else that would help
17:14a tiny bit
17:23write some good poetry.
17:25>> Yeah.
17:25>> Yeah.
17:26>> Write some poetry.
17:28>> You know, one of the things I just want
17:30to say and and then we'll probably stop
17:32here in just a minute is that, you know,
17:35you it's hard to know when people are
17:38going to feel down, right? Mhm.
17:40>> Um, and so it's good to have a plan
17:43ahead of time for what you're going to
17:45do because when you're feeling down,
17:47then sometimes you're not very creative
17:49and you can't think of all the good
17:51options. So, what I'm wondering is if
17:53you and I can agree that if you have a
17:55really down time that you will try
17:57working out, singing, calling your
17:59sister, writing poetry, and maybe even
18:01add that, you know, to
18:04if you really were terribly suicidal,
18:07maybe even call 911, try to get some
18:09help.
18:10>> Yeah.
18:13>> So, you know, this section is really
18:15tough and this whole enterprise of
18:18suicide assessment is tough. people are
18:21unique and there is no exact formula for
18:26assessing suicidality.
18:28Uh I really appreciate the way you work
18:31to make the assessment a positive
18:35therapeutic experience but it's also a
18:38scary endeavor.
18:39>> You know it was stressful and
18:41challenging. Uh Tommy I think is a very
18:43interesting and complicated young woman.
18:46It's hard. I think at times she was very
18:50cooperative with me and there were other
18:51times when she was much more
18:54challenging. Um she's a bright young
18:56woman. There are a lot of factors mixed
18:58in there. I think I probably if I aired
19:01on one side it was toward being more
19:04positive and focusing on maybe more
19:07therapeutic questions and what's going
19:09well for her and maybe ignored a little
19:12bit of the negative side. One
19:14interesting thing that I didn't bring up
19:16earlier is that when she talked about
19:19her suicidal plan, which had been in the
19:21past, and that was a good thing,
19:23>> right?
19:24>> Um, she also was talking about an
19:26underlying motive, and that's often the
19:29case with a suicide plan. And for hers,
19:32it was a little bit of a revenge motive,
19:34a little bit of a send a message to my
19:36parents motive,
19:38>> right? And so I think that's a place
19:40where you can take the opportunity to
19:42turn a discussion about a plan into
19:46something that's more therapeutic and
19:47help her focus on how could she give
19:49that message to her parents without
19:51having it involve anything to do with
19:53suicide.
19:54>> Right? So even though every suicide
19:59assessment is unique, there are some
20:02factors that should be considered in
20:05each interview.
20:07That's absolutely true. And now if you
20:09look at the slide, um you can see that
20:12the first part of a comprehensive
20:14suicide assessment interview involves
20:17evaluating suicide risk factors. And
20:19oftentimes you don't do all that
20:21directly, but you find out about the
20:24different suicidal factors that may be
20:26operating.
20:28>> Typically, you do a depression
20:29assessment,
20:30>> right?
20:31>> Because almost always there are some
20:32depression symptoms. You do an
20:35exploration of the suicide ideation. You
20:38ask directly,
20:39>> right?
20:39>> You want to frame that in a way the
20:40client can answer truthfully. Also, you
20:43explore the suicide plan and move on to
20:47trying to determine whether or not the
20:49client has a high level of suicide
20:51intent. And one of the ways of doing
20:53that is to check into their reasons for
20:55living.
20:57>> And then the last categories are to try
20:59to infer the client's level of
21:02self-control. And one way of doing that
21:04is to try to develop a collaborative and
21:07cooperative safety plan between you and
21:10your client.
21:12>> So if we were going to do a little
21:14summary,
21:16>> Tommy has tried suicide twice by her own
21:19account. She has a good friend who
21:22killed himself. Her family background
21:25includes some substance abuse and
21:29probably some physical abuse and a very
21:33serious addiction problem that Tommy
21:35herself has. So certainly she's in a
21:39high-risisk population, but on the other
21:43hand, she's future oriented and she's in
21:46a setting that's structured
21:49>> and is providing her with opportunity to
21:52work on vocational skills and on her
21:55sobriety. What you're saying reminds me
21:57of the fact that we need to talk about
21:59decisionmaking and that can be one of
22:01the most stressful and tormenting things
22:03I think for a mental health professional
22:05is deciding well how do I act in this
22:07particular situation
22:09>> I think because of the things you said
22:11including the fact that she has a pretty
22:13high mood rating and she collaborated on
22:15a safety plan that in fact I probably
22:18wouldn't go toward hospitalization
22:20>> right
22:21>> but it's really important to integrate
22:24or to weave in some documentation of
22:27what you're doing and some consultation
22:28with other professionals in order to
22:31protect yourself from liability and to
22:33make sure you're doing a thorough
22:35comprehensive suicide assessment.
22:37>> Right. Yeah. And you know that not only
22:41brings us to the end of this section but
22:43to the end of the DVD.
22:46And you know, one thing I'm struck at
22:48the end of this whole production is just
22:52how much there always is to learn and
22:55how complicated individuals are and how
22:58many different ways you can look at the
23:01clients with whom you're working and how
23:03many different ways there are to
23:04approach the clinical interview.
23:06>> Right? You know, if I was going to offer
23:09a summarization of that, I'd pretty much
23:11say you think that it's a lifelong
23:15learning process.
23:16>> And you'd be pretty much right about
23:18that.
23:19>> And we both hope that this has been
23:22helpful to you in your journey toward
23:24becoming a really excellent clinical
23:27interviewer. Thanks,
23:32[Music]
23:55Heat. Heat.
24:00[Music]

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