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Arianne Broadnax

CNS 793-Clarke
Assignment 7.1 Skills Assessment Paper
April 23, 2015
Practicing crisis intervention skills surrounding suicide assessment, was very
enlightening for me considering this is an area that creates discomfort having to
face other individuals feelings of hopelessness. Reflecting on the session, revealed
two vital occasions where I experienced the most discomfort. Learning about the
client, Hollys previous suicide attempt (cutting her wrist) precipitated the initial
alarm. The disclosure of a previous attempt upped the ante, as far as the
probability for Holly to commit suicide. I became more aware or in tune to my
personal feelings of anxiety during the session. A second indicator occurred as I
continued to actively listening to Holly, attempting to seek out avenues for support.
I recognized the limitations in her proximity to social support from her family due to
feelings of rejection. Secondly seeking access of support through her religious
affiliation was also limited due to their belief system being in opposition to suicide.
Holly mentioned having some contact although limited with a previous
roommate/friend from school and the school counselor on site since returning home
after graduation. Concerns related to Hollys increased isolation triggered ongoing
discomfort (anxiety).
Reflecting on this discomfort I experienced was helpful because it permitted
increased awareness of my internal compass. Holly continued to disclose more
about her current state regarding thoughts of suicide and earlier attempt. I
attributed the escalation in anxiety as an internal indicator for the increased
urgency to help. I recognized that my feelings were beginning to mirror Hollys.

This can be very helpful in that although I am sensing and empathizing with what
she is experiencing (feeling), I must continue to portray calmness (the opposite).
This helped me to see the power of reflection moving beyond reflections of a clients
feelings in a scripted manner verbally but most importantly being a model for the
client for self-regulation. As a counselor I am to serve as a mirror for the client that
in those reflections of their thoughts and feelings that bring about discomfort,
calmness and stability can also co-exist. Another analogy of this would be
perceiving a visual picture of balance stableness despite the wave of emotions. As
Holly continued to share, I became increasingly anxious as I attempted to assess for
any lifebuoys or preservers -external/internal supports. I also considered the
compounding factors such as Hollys diagnosis of depression, maladaptive coping
mechanisms (alcohol abuse) I noted conceptually how I crossed these off the list of
further exploration (parents, church, friends close to home) and therefore
responding by shifting my focus on more internal supports (coping mechanisms) she
had used in the past to help her. I counseled Holly in accessing things that she
knows and can implement to help bring her back aboard, to a place of stability.
Using and recognizing awareness of my internal compass can be very beneficial to
having insight with clients in the future as to how to respond (meeting the clients
where they are, sitting with them and being present as they share their story and
guiding them to meet their own needs so they can continue their journey.
Looking deeper into the employment of skills in accessing risk through
conducting a suicide assessment, I noted several strength areas as well as areas of
weakness. My ability to maintain a calm presence/demeanor throughout the
session although internally my feelings were very different was a plus. Holly also
pointed this out during debriefing after the role play. This is highly important in

conveying to the client a supportive, inviting, atmosphere as a platform to work.

Again this come naturally and is a feature of my personality that is advantageous in
the field of counseling. Secondly, I was able to demonstrate use of assessment
skills (SIMPLE STEPS) and boldly asking the taboo question. I utilized skills involving
assessing FDI-frequency, duration, and intensity of the suicidal thoughts Holly was
experiencing and attempted to access supports (internal/external). Another area I
closely viewed was the manner in which I was able to decipher which questions to
ask based on the information that was provided by the client which in turn saved
time and allowed the spotlight to be on more important aspects of the client
(Hollys) story in order to know where I could help. I also recognized the
importance of aligning with Holly and helping her to perceive through our dialogue
was conveyed well. There were strengths noted in my ability to prompt and guide
Holly toward brainstorming positive coping strategies (internal) that she could
access to alleviate the pressure, isolation, & rejection she stated she was
experiencing. Utilizing the lifelines (coping skills and external supports) created
avenues for Holly to shift focus on ending life but helping her to perceive that
although she is feeling depressed and hopeless, she could seek some level of
recuperation through accessing these.
Aside from the strengths which I was quite surprised at, having only
conducted two triads to practice these skills, there were areas I felt could use
improvement. One area is being more specific and intentional with questions which I
perceive will improve as I gain more experience. I noted how I asked Holly about
activities or things that she engages in (exploring internal supports) that make her
feel calm. Although this was a good attempt/avenue to help her with alleviation of
the pressure, but she stated she was experiencing feelings of hopelessness, despair

which are also symptoms of depression. I could have potentially gained access to
more information if I had posed the question of, Tell me what makes you feel joy,
happiness and tied this into reasons for living.
Another area to highlight is I could use room for improvement was being able
to balance flowing the clients conversation while compartmentalizing information
given to access risk level (SIMPLE STEPS). I want to strive to improve on these skills
becoming more natural and fluid. There were some points within the context of
Hollys sharing that I could have phrased questions in a more open manner as
opposed to closed. There were moments in the session where looking back on the
video I recognized that I could have sat with Holly on subjects more to gain more
information (using open questions to explore her alcohol abuse, eating/sleeping and
mainly when she is challenged most with suicidal thoughts). Instead of exploring
these I bounced off to questions that could easily sidetrack the conversation slightly
blocking access to information.
It is important to note that considering the fact that it is not every day that
professional counselor is faced with a client who is contemplating suicide, one query
I have is how I would further development and achieve retention of skills?
Continuing education or training opportunities would be a beneficial approach to
learn more about suicide risk assessment. Another avenue would be to seek out
opportunities to learn more about effective interventions related to suicide
prevention/crisis management specifically for me in working with the
child/adolescent population. Methods for learning could be through reading
literature, or engaging in dialogue with other professionals in the field. Clinical
supervision also would be a key means to discuss intervention and assessment for
suicide risk as well as initiating requests for role play sessions during this time to be

able to practice skills more. I also have considered the possibility of volunteering
with a suicide hotline to gain exposure to observe how others who area trained in
this area work in order to further learn skills.
The case of Holly, presented an array of information during the assessment in
which I was able to determine her risk level for suicide. I admit the case was quite
challenging. Key factors I considered in this case is her history of a suicide attempt
(cutting her wrist), and clinical diagnosis of depression (feelings of hopelessness,
rejection) to start off with. I learned through active listening, Hollys method of
getting a gun, as a means to complete suicide although she clearly stated she
had no access (I dont know where to go to get a gun). Compounding factors such
as her increased use of alcohol also played a role in the lethality as well as her
accessibility to sharp objects bearing in mind her previous suicide attempt which
also plays a major role in this case. Holly also shared her difficulties with eating and
sleeping. Past history of experiencing loss (breakup and now rejection from getting
into med school were factored in. Her support system was limited but identified as
a friend/roommate who witnessed and assisted with Holly accessing help with 1 st
suicide attempt and the school counselor at the university who has counseled Holly
and diagnosed her with depression. Other important information to consider in the
session is that she was willing to consent to refrain from suicidal acts for 72 hours.
She was also open to exploring alternatives to suicide. All these facts considered
helped me to formulate the assignment of Holly to stage III (Moderate risk level).
The challenge of the case helped me recognize my desires to be better at accessing
risk quicker which can be attributed to increased experience with conducting suicide
risk assessments.

Last but not least, viewing the video, there were several steps I would take if
the session were to continue beyond the 30 minute limit. I believe it would be
important to progress forward with safety planning, considering Holly and I had
already began brainstorming possible coping mechanisms. I would attempt to
explore with her more, her reasons for living as well as increase my affirmations to
help her grasp the positives (coming in to talk, despite her feelings). I would have
wanted to expand further with brainstorming rephrasing questions to address what
activities bring her joy, hope and happiness. It would also be beneficial to ask Holly
the miracle question, If you could have the ideal appear tomorrow tell me what
that would look like? Another thought is the exploration of her drinking further to
gain an understanding of the severity of her drinking and its involvement in
thoughts of self-harm as well as warning signs or feelings that led to suicidal
ideation. I noted Holly discussed her awareness of drinking in combination with
prescribed psychotropic medication as contrary to what she should do, I wondered
how this factors into suicidal thoughts and potential risks in this area. I also wanted
to explore further options for self-care considering how rejection to med school has
impacted her physically (loss of weight, resistance to eat) coupled with decreases in
self-image, loss of identity.
This assignment, although previously an area of challenge for me, has truly
helped me to feel more competent and confident in working with clients who
contemplate suicide. I recognize that having completed this assignment I have a
strong desire to learn more about this topic rather than being aversive to it. I am
particularly interested in working with youth/adolescents and growing in knowledge
surrounding the components of suicide risk with this population. Adolescence is the
most volatile period of transition cycle of development, and coming from an early

intervention framework, I believe it would be a crucial area to target (Berman, Jobes

& Silverman, 2006; Maples, Packman, Abney, Daughtery, Casey, & Pirtle, 2005;
Pfeffer, 2006). Projecting forward I am inspired to avidly work toward accessing all
the knowledge and support I can to better prepare for the mission I am called to! It
has truly been a pleasure to learn and grow through this course!

James, R. K., & Gilliland, B. E. (2013). Crisis intervention strategies (7th end).
Belmont, CA: Brooks/Cole.
Maples, M.F., Packman, J., Abney, P., Daughtery, R., Casey, J., & Pirtle, L. (2005)
Suicide by teenagers in
middle school: A postvention team approach. Journal of Counseling &
Development, 83(4), 397-405.
Pfeffer, C. R. (2006) Suicide and suicidality. In M. K. Dulcan & J.M. Wiener (Eds.),
Essentials of child and
adolescent psychiatry (pp.621-632). Washington DC: American Psychiatric