|INTERVIEWING TIP OF THE MONTH
# 89 July 2007
"Uncovering Hidden Suicidal Intent as Related to Potential Life Stressors"
TISA Description of the Problem: There are a variety of ways to try to carefully and sensitively uncover suicidal plans and the client's intent towards carrying them out. The number of different plans, the extent of action taken on them, and the amount of preoccupation the client has with them can all be reflections of the client's intent to proceed with suicide. Trying to ferret out - from the client's perspective - what he or she feels may be most likely to intensify the intent to proceed with suicide can be pivotal information in performing a sound suicide assessment. Sometimes clients, after describing one plan, may also show a tendency to withhold other plans (some of which may include the plan that the client most intends to utilize). The following useful tips, provided by Liz Masco, NPP can help an interviewer to uncover the truth more reliably, perhaps saving a life.
Tip: After having explored suicidal ideation for awhile with a client, I find that the following question sometimes comes up with information regarding the client's likelihood to proceed with it in the near future. It is particularly effective if the client and I have previously been openly exploring stresses and situational tensions:
"What would have to happen for you to try to kill yourself."
This question is also useful if the client has already attempted suicide as with, "What would have to happen for you to try it again."
From a similar but subtly different perspective, I find it useful if I am aware of the client's main stresses or problematic relationships, to ask:
"If (clinician states the stressor that is likely to happen) should occur, what do you think you will do?"
By way of illustration, with a client in an ugly custody battle where it looks like he or she may lose custody of the children, I would ask, "If you should find out in court on Thursday that you are losing the custody of your children, what do you think you will do?"
TISA Follow-up: These are excellent questions, that can help us to ferret out suicidal intent. With the latter questions in which a specific stressor is stated by the clinician, the client may also share nonsuicidal plans that may be problematic in nature or - in a positive sense - show evidence of ego strength, resiliency, or good problem-solving skills. The questions may also give rise to collaborative problem-solving between the clinician and the client.
Sometimes an interviewer might intuitively feel that a similar question, but more specific to the information that has already been shared about suicidal planning, may yield better results as with: "If you should find out in court on Thursday that you are losing the custody of your children, do you think you might actually try to shoot yourself?" Every interview is nuanced and unique. The above interviewing techniques provide further options for our creative use.
Tip provided by:
Liz Masco, NPP
Rochester, New York