|INTERVIEWING TIP OF THE MONTH
# 171 May 2014
Uncovering Murder/Suicide: An Ultra-Sensitive Area
TISA Description of the Problem: Few topics can be more difficult to raise in a sensitive fashion than the possibility that a client is considering murder/suicide with a child. Stephen Durrenberger M. D. provides a nice gateway for one such moment.
Tip: When a patient responds to a question about "What stopped you from going through with suicide?" with a comment such as, "I couldn't do that to my kids" or some similar comment, if I am suspicious of possible murder/suicide, I will immediately ask gently, "Have you ever had thoughts about taking the kids with you?"
TISA Follow-up: I find Dr. Durrenberger's clinical interviewing tip to be spot-on. He adeptly moves with the natural gateway at hand and does so in a non-invasive fashion. Keep in mind the importance of his timing and of the gentle nonverbal quality of the inquiry.
High rates of suicide after filicide (killing a child) have been noted. 16-29% of mothers and 40-60% of fathers take their life after killing a child. If you have never asked (or almost never ask) potentially suicidal clients about killing their children, you are not asking enough.
Charles Scott in his chapter "Forensic Issues" in the book Violence Assessment and Management edited by Robert I. Simon and Kenneth Tardiff and published by American Psychiatric Publishing, Inc., in 2008 delineates an excellent listing of other useful questions that can help us in exploring this ultra sensitive area:
1. "What do you believe will happen to your child if you die or commit suicide?"
2. "Do you have any fears or concerns that your child may be harmed by others?"
3. "Do you have any worries regarding your child?s health or unnecessary suffering?"
4. "Are you having any thoughts about harming your child?"
5. "Have you taken any steps to harm your child?"
6. "If you had thoughts of harming your child, what has kept you from doing so thus far?"
Tip provided by:
Stephen Durrenberger, MD
TISA is a site dedicated to advancing the science and art of preventing suicide and teaching clinical interviewing