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Case Study 16: A Suicidal Teenager
Transcript of Case Study 16: A Suicidal Teenager
Irritable with parents
Says he becomes upset when he can't have his way, then feels "overwhelmed with guilt" from his reactions
Gets high with his friends to deal with pain (parents unaware)
Feels hopeless, angry, and guilty
Girlfriend recently dumped him
Grades have recently been slipping
Has given away some valuable possessions to friends Counselor: I believe I can help you start to climb (out of the dumps)
Frank: I've already found the best answer to my problems
Counselor: I routinely ask people a simple question when they are upset about something. Are you thinking of killing yourself?
Frank: One of my classmates did that last year.
Counselor: Have you thought about joining your friend?
Frank: I think it would be a good idea
Counselor: If you were to try to kill yourself again, how would you do it?
Frank: I was thinking I'd drive my car into a busy intersection at 4:00 p.m. on route 12 when the 18-wheelers are out on the road. It would be quick and would look like an accident.
Counselor: Is there anyone around you with whom you could talk if you start to feel like killing yourself?
Frank: I have an uncle who might listen. I can't talk to my parents
Counselor: Would you be willing to talk to him if you seriously start to want to kill yourself?
Frank: Yeah, that's okay. Dialogue Excerpts How would you rate Frank's risk for suicide? What factors would you take into account? How sure would you feel without conducting a thorough assessment?
Based on your rating of Frank's suicidality, do you feel it would warrant a breach of confidentiality?
What sort of responsibility would you feel towards Frank's parents in this case? What would you do? - (Re: A. 1.) The counselor should respect and promote Frank's welfare. Breaking confidentiality could result in damage to the client-therapist relationship.
- (Re: A.1.d.) The counselor should consider Frank's need for an effective support network (such as his uncle)
- (Re: B.1.c. ) While the client is in danger of harming himself, the counselor must respect the client's right to confidentiality and the importance of protecting the therapeutic alliance
Ethics Code Applied to Frank's Case
A.1. Primary Responsibility, "The primary responsibility of counselors is to respect the dignity and to promote the welfare of clients."
A.1.d. Support Network Involvement, "Counselors recognize that support networks hold various meanings in the lives of clients and consider enlisting the support, understanding, and involvement of others as positive resources, when appropriate, with client consent."
B.1.c. Respect for Confidentiality, "Counselors do not share confidential information without client consent, or without sound legal or ethical justification."
B.2.a. Danger and Legal Requirements, "The general requirement is that counselors keep information confidential does not apply when disclosure is required to protect clients or identified others from serious and foreseeable harm...counselors consult with other professionals when in doubt as to the validity of an exception"
B.5.b., "Counselors work to establish, as appropriate, collaborative relationships with parents/guardians to best serve clients."
Applicable Elements of the Ethics Code Assessing Threat Frank has mentioned a specific plan
Means (car accident)
Location (specific intersection)
No specific date
Frank has self-harmed once before
Frank's classmate has committed suicide
Parents reported that he has given away valuable possessions
Reports he can talk with his uncle Counselor's Contract Counselor makes a verbal contract with client to stay alive for one month
A written contract could be more effective Parental Involvement Important to note that Frank is 17
Frank also does not have a good relationship with his parents
The current level of suicidality most likely does not warrant informing them
Frank was willing to cooperate with the counselor to refrain from self-harm
Counselor could consider involving Frank's uncle in therapy Frank's honesty indicates rapport
The counselor must maintain the therapeutic alliance
Frank's risk for suicide appears to be low - moderate, confidentiality does not need to be broken
Frank is technically a minor, but for the sake of the relationship, the therapist should refrain from informing the parents, unless his risk increases
The therapist helped to instill hope for Frank at the end of the session.
Counselor should have properly addressed informed consent with Frank so that he understands when confidentiality must be broken Conclusions Corey, G., & Herlihy, B. (2006). ACA Ethical Standards Casebook. Sixth Edition. American Counseling Association. Alexandria, VA. Reference - (Re: B.2.a.) The counselor needs to assess the seriousness of the threat:
Is there a plan?
Has the person seriously thought about death?
Does he have the means available to kill himself?
Who could stop him?
What kind of emotional support is available in the family, at home, or elsewhere?
Important that the counselor ask these questions clearly and directly and that the counselor has already established rapport with Frank
Counselor should help the client gain hope without making unrealistic guarantees
- (Re: B.5.b): Frank has made it clear he does not want to talk to his parents about his situation. Therapist could eventually work toward including Frank's parents and strengthening their relationship. Ethics Code Applied to Frank's Case