|INTERVIEWING TIP OF THE MONTH
# 40 June 2003
Assessing Suicidal Pain
TISA Description of the Problem: In assessing suicide risk, it is important to gain an understanding of the intensity of the client's pain and the relationship between the intensity of this pain and the client's perceived need to use suicide as a means of achieving release from this pain. Along these lines, the following question, by Alexander Kechriotis, M.D., was offered to me in a recent workshop on suicide. Alexander reports that the responses are very interesting mostly due to the surprise of the additional material they provide even with patients that he thought he knew well.
Tip: At an appropriate point in the elicitation of suicidal ideation and feeling, I might ask something along these lines:
"How bad would things have to get for you to take your own life?"
Sometimes it helps if I add, "Just as everyone is capable of killing someone else if pushed into an extreme situation, such as a break-in to one's home where a man is trying to kill your children and is holding a gun to your head ? what would it take for you to end your own life?"
TISA Follow-up: This tip moves directly into the heart of the matter. Some patient's may already be experiencing so much anguished anxiety and depression that they might already be close. This might be reflected in answers such as, "I'm already there." or "If I lose this job, I won't be able to stand it any longer." In any case this can be invaluable information in understanding the closeness of the act of suicide. Other answers, such as "I guess I can't imagine anything that would really push me to do it." point in the other direction - towards safety.
Other answers might move the conversation into completely uncharted waters where the client describes situational fears, current stresses, and family secrets that might not have previously been uncovered. In essence, this intriguing question represents an indirect way of monitoring the current intensity of the client's internal anxiety and pain as well as imagined future pain. It's a great tip
Tip provided by:
Alexander Kechriotis, M.D.
Locum tenens psychiatrist
Vista Staffing Solutions