More Questions for Uncovering Suicidal Ideation and Reflected Intent

“For only by confronting the issues that bedevil us when we confront the finality of death can we start to understand the darkness in ourselves.”

Ellen Datlow
Editor, The Dark: New Ghost Stories

More Questions for Uncovering Suicidal Ideation and Reflected Intent

TISA Description of the Problem: Uncovering the amount of thinking about suicidal planning and the amount of action taken on it may be a better reflection of the client’s actual intent than what the client claims his or her intent to be. There are many reasons, from stigmatization to fear of ramifications (unwanted hospitalization) to a pervasive desire to actually kill oneself, for not sharing one’s true intent. Such indirect indicators of actual intent have been called “reflected intent.” (see article below) There are many practical nuances to this concept, that I think may help us to save a life. I was recently fortunate to have the Psychiatric Times ask me to describe these practical nuances in a short article called: Suicide Assessment — Part 1: Uncovering Suicidal Intent — A Sophisticated Art. It describes a concept called the “Equation of Suicidal Intent”. I hope you and your trainees will find it useful, and you can find it posted on the web for free at: www.psychiatrictimes.com/display/article/10168/1491291

In this light, Bernie Gottschalk, Ph.D. shares three very nice clinical interviewing tips that can help one to better understand the amount of reflected intent that may have surrounded a recent overdose. See what you think.

Tip: I am sometimes surprised at how much suicidal ideation clients are withholding. The following three questions often open up some secrets about an overdose:

1) “Did you do anything else (last night) to try to kill yourself besides taking the pills?”

2) “What other methods did you consider at the time?”

3) “Why did you decide to use (name of the pill)?”

TISA Follow-up: All sorts of useful material, that may better reflect the client’s true suicidal intent, can surface with these simple yet effective interviewing techniques provided by Bernie. For instance, the client’s answer as to why he or she chose a particular pill to take may give excellent insight into how much he or she wanted to actually die (e.g. The client chose aspirins – potentially very lethal – over some stored up antibiotics – much less lethal).

I hope that you enjoyed these tips and will enjoy the short article on “reflected intent” as you continue your efforts to fine-tune and to teach the art of clinical interviewing.

Tip provided by:

Bernie Gottschalk, Ph.D.