KHA711 Lecture Notes - Lecture 4: Gender Dysphoria, Posttraumatic Stress Disorder, Dysphoria
25 Jun 2018
School
Department
Course
Professor
Current Issues in Assessment
Week 4
Suicide and Self-Harm: Risk Assessment and Response
Intake Interview Notes:
- Practical skill development
- What do I want to know and what can I gain from this assessment piece
- Feedback:
oTake it on
oThink about what I want to learn
- 1. Greet client and make small talk
oWhen you’re ready would you like to come through?
- 2. Explain what I am: Provisional Psychologist
oIf you haven’t said your name in the waiting room
- 3. Confidentiality limits
obecause we are at the uni clinic and I am continuing my training, there
are video recordings which I use for my own training
oI may go through these with my supervisor to get feedback in my
therapy style and ways to improve.
- 4. Explain the process of the session:
oIntake
oHow it will differ from normal sessions
oThe first time we meet I tend to… and how I think the two of us we
can work together
oFeel free to ask question back
oAnd at the end of today’s session we will bring all that together, to
come up with some goal that we will work on in the coming sessions
- 5. Guts:
oPresenting issue: can you tell me about what bought you here
today/when you saw Dr. what did he say?
Do not exist on their own
oPatterns and themes:
What they think during the problem
What they feel
What emotions
What they are doing to right now to cope with the problem
Thoughts feeling behaviours
oTake a break:
If you get stuck
I just have to stop and have a think about some of the things
you have told me, I just need to think of the
questions/information I need to get next
Summarise
In the summarising process, it may become clear where
you need to go with your questions
Go back to the case formulation: P’s
oMicro- skills
oGet some goals
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find more resources at oneclass.com
oHow motivated is my client?
Ask them: based on all of the things we have spoken today,
how would you feel about coming back for some more therapy
session
Okay, what would make it more comfortable?
Is there anything that will get in the way of our therapy sessions
oDo you have any questions about today? Or what may come up next
that you would like to discuss
Risk Assessment:
- The guiding principles
oSchneidman (1972): why is this happening
oWhy are certain people in certain situations doing this, when others
aren’t
Choosing it as a behaviour strategy
NOT JUST why did this person do this
oWhy do certain groups use this as a behavioural strategies
All behaviour is purposeful
This is why people engage
Produce a feeling or to reduce a feeling? Self harm
oIdentify the person’s source of pain
oTreat the person, not the behaviour
Don’t treat the suicidal behaviours
Why does this person need this behaviour? What is happening
for them that makes them think this is the best and only option
they have
oProtecting factors
Surprising, but they are often the maladaptive behaviours we
identify in other groups
Need to replace the behaviour if we are removing one
oPeople don’t change their behaviour without motivation
Buy in that change is possible
Even if it is small, they need some idea that change is possible
- Risk definition:
oImportant for ethical and professional conduct: need to understand
exactly what is and isn’t a risk
oSuicide prevention
Mentally assessing risk
Formally assessing risk
This may be regular with some clients, others not
oRisk: the likelihood of an adverse event or outcome
oRisk factors: particular features of illness, behaviours or circumstances
that alone or in combination lead to an increased risk
oRisk assessment: an estimation of the likelihood of particular adverse
events occurring under particular circumstances within a specified
period of time
oRisk formulation: is a process of summary and organisation of the risk
data, and identification of the risk factors
- Characteristics of risk
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find more resources at oneclass.com
oVariable: doesn’t stay the same
oAs you develop therapeutic relationship, you will get a sense of the
level of variation that is normal
oSeek the information if you think that something is different about
your client
oAssessment prediction is more accurate in the short term
Never 100% accurate
If two years have passed, you have no idea how their lives have
gone
All we can ever do, is ask ourselves at that point in time- why
did we stop therapy? What was going on at that time that lead
me to the decision
We are not responsible for what has happened in the mean
time- if someone asks for a risk assessment down the track
Only provide a risk assessment based on the time you were
seeing the client
- Clinical risk assessment:
oMental disorders
What diagnosis does my client have, if any
Risk of harm is not the same across disorders
And within disorders, it is variable in age groups
oSuicide rarely occurs outside of a disorder
93% of the suicides are in people with mental disorders
The 70% met the criteria for persistent depressive disorder or
MDD with psychotic features
Must remember this is only the sample of suicides that they had
the information on
oDepressive disorders
Persistent depressive disorder
Chronically low- debilitating but not as severe lacking
spark/low
The very biology of this disorder makes it a risk
Self medication is common
oAlcohol
oIn order to produce the spark
oThe risk becomes high
Sense of hopelessness
oBy the time they are an adult, why do I really
need to keep doing this? If I don’t
oSignificantly increases risk
oIf self medication happening and there is
hopelessness = HIGH RISK
Self medication
oThese are the risk factors
MDD
Self medication doesn’t increase the risk
MDD with psychotic features
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
What do i want to know and what can i gain from this assessment piece. Do not exist on their own: patterns and themes: What they are doing to right now to cope with the problem. Thoughts feeling behaviours: take a break: I just have to stop and have a think about some of the things you have told me, i just need to think of the questions/information i need to get next. In the summarising process, it may become clear where you need to go with your questions. Ask them: based on all of the things we have spoken today, how would you feel about coming back for some more therapy session. Or what may come up next that you would like to discuss. The guiding principles: schneidman (1972): why is this happening, why are certain people in certain situations doing this, when others aren"t.
