# 54 August 2004

"People are like stained-glass windows. They sparkle and shine when the sun is out, but when the darkness sets in, their true beauty is revealed only if there is a light from within."

Elizabeth Kubler-Ross

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# 54 August 2004

Helping Clients to Share Their Opinion of Their Own Suicidal Risk

TISA Description of the Problem: One piece of information in the puzzle we call suicide risk assessment is the client's opinion of his or her own risk. The client's opinion can be misleading - and represents only one of many factors to consider - but it is a valuable factor in many instances. Robert Niccolini, M.D., offers a nice way of helping clients to share this opinion by comparing it with past suicidal intent.

Tip: If a client has had past suicidal ideation, I have found that it can be useful as a benchmark with which to compare current intensity. I accomplish this process in the following fashion by first focusing on the past event:

"If I were to ask you to imagine a scale of 1 to 10 that measures a person's suicidal intentions (with one being low potential and 10 being high potential), how would you score your level at that time?"

"How would you score your level today?"

TISA Follow-up: The above quite useful tip can help a client - especially those clients prone to exaggeration, vagueness, or over generalization - to be more specific, for the past suicidal ideation provides a concrete memory for the purposes of comparison. This technique can also be very useful in ongoing therapy, where it is modified by the fact that both the clinician and client may have memories of the event.

Tip provided by:

Robert Niccolini, M.D., RACSB
Fredericksburg, Virginia