Seiba
Arcanist
- Jun 13, 2021
- 491
I recently discovered a resource complication for suicide and the like. Within it are difficult questions for therapist to ask themselves. I'm interested in what the answers you would post would be. Alternatively, you can try to yourself in that position as as well. Try to keep in mind the legal and ethical standards they are held to, "just don't do anything because suicide is a right" isn't really an answer in this situation unless they want prison time and to have their entire life ruined alongside license lost.
You've been discussing a new HMO patient, whom you've seen for 3 outpatient sessions, with both your clinical supervisor and the chief of outpatient services. The chief of services strongly believes that the client is at substantial risk for suicide but the clinical supervisor believes just as strongly that there is no real risk. You are caught in the middle, trying to create a treatment plan that makes sense in light of the conflicting views of the 2 people to whom you report. One morning you arrive at work and are informed that your clinical supervisor has committed suicide.
Difficult Scenarios and Questions
You've been working with a moderately depressed client for 4 months. You feel that you have a good rapport but the treatment plan doesn't seem to be doing much good. Between sessions you check your answering machine and find this message from the client: "I want to thank you for trying to help me, but now I realize that nothing will do me any good. I won't be seeing you or anyone else ever again. I've left home and won't be returning. I didn't leave any notes because there really isn't anything to say. Thank you again for trying to help. Goodbye." Your next client is scheduled to see you in 2 minutes and you have clients for the next 4 hours.***
- What feelings do you experience?
- What do you want to do?
- What are your options?
- What do you think you would do?
- If there are things that you want to do but don't do, why do you reject these options?
- What do you believe that your ethical and legal obligations are?
- Are there any contradictions between your legal responsibilities and constraints and what you believe is ethical?
- To what extent do you believe that your education and training have prepared you to deal with this situation?
*****
You've been discussing a new HMO patient, whom you've seen for 3 outpatient sessions, with both your clinical supervisor and the chief of outpatient services. The chief of services strongly believes that the client is at substantial risk for suicide but the clinical supervisor believes just as strongly that there is no real risk. You are caught in the middle, trying to create a treatment plan that makes sense in light of the conflicting views of the 2 people to whom you report. One morning you arrive at work and are informed that your clinical supervisor has committed suicide.
***
- What do you feel?
- Are there any feelings that are particularly difficult to identify, acknowledge, or articulate?
- How, if at all, do you believe that this might influence your work with any of your patients?
- Assume that at the first session you obtained the client's written informed consent for the work to be discussed with this particular clinical supervisor who has been counter-signing the client's chart notes. What, if anything, do you tell the client about the supervisor's suicide or the fact that the clinical work will now be discussed with a new supervisor?
- To what extent has your graduate training and internship addressed issues of clinician's own suicidal ideation, impulses, or behaviors?