|INTERVIEWING TIP OF THE MONTH
# 24 February 2002
The Hidden Value of Asking About Accidents
TISA Description of the Problem: It is useful with any client to take a history of accidents simply to be sure that trauma to the brain may not have happened at some point. This is particularly important with the elderly where even apparently subtle blows to the head can result in subdural hematomas, a type of slow growing blood clot between the skull and brain often seen after a fall in this age group. Subdural hematomas can trigger many psychiatric symptoms including depression, anxiety, and confusion. Furthermore, the symptoms may not show up for many months after the original fall that triggered the development of the slow growing blood clot. But there is another value, a hidden value, for inquiring about accidents with all clients, as pointed out in the following intriguing tip
Tip: As a routine part of my initial interview, I find the following question to be of use, for it can uncover some very interesting and important material regarding the client's potential for self destructive behaviors:
Clinician: "How many accidents have you had during the past year?"
This question sometimes leads to unexpected hints that the patient may have been contemplating suicide, as reflected by car "accidents" which, in reality, were suicide gestures or may have been examples of practicing in preparation for a more serious attempt. Accidents such as falling down stairs, as well as car accidents, can also point to alcoholism where such accidents are common. In either case, valuable information and discussion may emerge from this apparently innocuous background question.
TISA Follow-up: I have found the above tip from Matt MacDonald to be quite useful. It can also lead to discussions of episodes of domestic violence, which are initially couched as accidents. In this light another useful question to ask that can uncover hidden domestic violence is, "Have you been to the emergency room during the past year?"
Tip provided by:
Matt MacDonald, MSW, LADC
Resource Management Consultants
(800) 332-7998, Ext. 6478