|INTERVIEWING TIP OF THE MONTH
# 173 July 2015
A Method of Sensitively Raising the Topic of Suicide with an Adolescent
TISA Description of the Problem: In "Psychiatric Interviewing: the Art of Understanding, 2nd Edition", I introduced into the clinical interviewing literature the term "shame attenuation" as a type of "validity technique" for making it easier for clients to share sensitive and taboo material. The term "attenuate" means "to decrease or dampen down". Thus with the use of shame attenuation emotions such as shame and guilt are decreased.
When using shame attenuation to raise the topic of suicide, the interviewer meta-communicates that it is safe for the interviewee to share a sensitive or taboo topic by indicating that the interviewer understands the intensity of the patient's pain and consequently would understand how thoughts of suicide may have crossed the client's mind. A common use of shame attenuation in raising suicidal ideation is to simply acknowledge the client's pain as follows, "With all of your pain have you been having any thoughts of killing yourself?"
Shame attenuations can be modified in many different ways so as to capture the feelings of the unique client. Some clients, with intense suicidal ideation may identify more with the severity of their situational stresses than with their "pain" per se. The following tip by Catherine Adamek, nicely demonstrates the flexible use of shame attenuation, in this instance, with an adolescent.
Tip: I have found that some adolescent patients, in fact a large number of them, may associate the word ?pain? with physical pain as opposed to emotional pain. Consequently, when raising the topic of suicide, I often find it useful to use a shame attenuation that emphasizes the adolescent's situational stress as follows:
"With all of the things that have been going on at school and at home, have you been having any thoughts of killing yourself?"
TISA Follow-up: The above style of shame attenuation is also quite useful with adult patients as well. I have found that some clients, who have been dealing with extreme emotional angst for many months or years (as seen with recurrent severe depressions, unrelenting PTSD, and difficult to control schizophrenia) often respond well to shame attenuations focused upon their pain, for it is relief from their agonizing pain that is often the driving force behind their suicidal thoughts. On the other hand, many other types of clients will more strongly identity with their situational stresses (divorce, foreclosure, death of a partner) as the driver of their suicidal thoughts, in which case a shame attenuation, as described by Catherine Adamek above - emphasizing situational stress - may be more effective. The beauty of shame attenuations is that we can adapt them to fit the unique needs of our individual clients.
Tip provided by:
Tip provided by: Catherine Adamek, LPCC-S, IMFT-S
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