Empirically Supported Counseling Procedure

Demonstration of Empirically Supported Counseling Procedure

PSY 6092

Counseling Skills & Procedures

James Smith is a 29 year old Caucasian male, recently released from prison after being convicted

on stalking, possession of illegal substances and fire arms. After serving 5 of an 8 year prison

sentence, and being released on good behavior, James was court mandated to attend consistent
Empirically Supported Counseling Procedure
2

therapy sessions as a diversion technique for both drug activity and stalking. He currently lives

with his mother, who is 50 years old and his 16 year old half-brother. James is an avid marijuana

smoker which is how he began dealing the drug, when he was arrested he had 45 lbs of

marijuana in the trunk of his car. As he became known in the drug community he began to carry

a gun as many drug dealers had recently gone missing or were killed during robberies. Though

he possessed the gun he had never actually fired it, he only needed to brandish it a couple of

times. Through his dealings he met his ex-girlfriend Gina, Gina was a graduate student at the

university in his town and an avid marijuana user as well. He became her dealer and gradually

they got to know each other and began dating. Gina broke up with him after a year as she had

begun an affair with her professor and wanted to pursue a real relationship with him. James

didn’t understand why she had originally broken up with him and decided in a drug haze that he

was going to go and find out. After showing up at her door and Gina not answering James made

it a habit of showing up every night and banging on her door, this continued over a period of two

months before Gina got a restraining order. James stopped showing up at her house but he

consistently broke the restraining order and began following her boyfriend around town scaring

them both. Gina and her boyfriend reported him and a warrant was put out for his arrest, during a

routine traffic stop he was arrested for the warrant and a search of his car revealed the drugs in

the trunk and the unregistered fire arm under the front seat. James not only resents Gina but her
Empirically Supported Counseling Procedure
3

boyfriend as well and believes they are the reason his life was ruined when he had never been

arrested before this incident.

Transcript

Counselor: Hello, My name is Jameelia Bowie, I have been assigned to your case by the district,

it’s very nice to meet you.

Client: Nice to meet you as well.

Counselor: So, I have a general background on why you went to prison and why you were

mandated to see me, however I would like to get to know you and learn a little bit about you

before we get into that, ok?

Client: Ok, that’s cool.

Counselor: First thing first, you can simply call me Jameelia, is there another name you go by

other than James or is that ok?

Client: James is ok, I have other nicknames but I haven’t been called them since before I went to

jail so James is fine.

Counselor: Ok James, tell me a little bit about yourself

Empirically Supported Counseling Procedure
4

Client: I come from a pretty normal family and had a normal childhood. I played sports, hung out

with friends. Mom and dad were together until he died of a heart attack in my junior year of

college and I still graduated which is actually a surprise because of how much weed I smoked.

Counselor: How did you get into smoking marijuana?

Client: During college, it was just one of those things that everyone does, but I noticed that it

helped me focus on my homework, so I started using it more and more after my dad died, I guess

I was just so depressed that the weed numbed everything.

Counselor: Im sorry for your loss, it’s never easy losing someone especially a parent, its actually

very common for people to use drugs or alcohol as a coping mechanism after a tragedy and to

cope with depression. Are you still depressed about your dad or any other situation in your life?

Client: Honestly I’m not feeling anything right now. I’m pissed off because of my situation but

I’ve been pissed off since I got arrested, but I’m not sad.

Counselor: Anger among many other things can be a sign of depression. You mentioned you’ve

been angry since you got arrested, are you angry at your ex or is there another reason?

Client: Yes I’m angry at her, I admit that I shouldn’t have been showing up at her house, but I

missed her. After she got the restraining order I never deliberately showed up in front of them
Empirically Supported Counseling Procedure
5

they were just everywhere that I was and I kept getting angry seeing her with him. But I wasn’t

stalking her at all, it’s not my fault we ended up at the same places.

Counselor: Ok let’s back track a little bit, you stated that you never showed up in front of them

after the restraining order, can you tell me why you initially began consistently visiting your ex?

Client: Gina broke up with me because she was being a whore and cheated on me with her

professor. I could have forgiven that, I loved her. I just don’t know why she had to break up with

me

Counselor: Can you tell me a little bit more?

Client: I was completely in love with her, I was there for her when her mom died and her dad

stopped speaking to her. I was there when her dog died. I helped her study for her dissertation

and then she’s just going to break up with me for some 50 year old man whose kids are the same

age as her. It just wasn’t fair, all I wanted to do was talk and maybe get another chance.

Counselor: Why did you see it as abandonment rather than a simple break up?

Client: Because I loved her and she left just like my dad and mom.

Counselor: I understand how death can seem like an abandonment and I am sorry about your

loss, the key is to remember that it is not so much abandonment but rather an attempt to cope

with the grieving process.

Empirically Supported Counseling Procedure
6

Client: I know. I guess it just felt like abandonment for so long because of my mom.

Counselor: Can you tell me a little bit about that?

Client: She just emotionally checked out. I was away at college when it happened but I came

home for 2 weeks to be with her and my little brother but she just emotionally checked out, it

was only me and my little brother. I had to take care of him I didn’t even get the chance to grieve

for my dad. I planned the funeral and left right after.

Counselor: Did you go back to school to get away from it all?

Client: She kicked me out after the funeral, told me to leave because she didn’t want to see my

father’s face. I guess I look just like him.

Counselor: If she hadn’t told you to go back would you have stayed?

Client: Of course, before my dad’s death we were really close. I mean I was close to my dad but

my mom was my world.

Counselor: Do you think she knew you would stay?

Client: Probably, I didn’t care about school at the moment I would have dropped out instantly to

be here with her and maybe none of this would have happened.
Empirically Supported Counseling Procedure
7

Counselor: It doesn’t seem like she would have been happy with you dropping out to be there

with her.

Client: I guess, she was always saying how important school was and how she wanted me to be

like my dad, get a good job and have a nice family.

Counselor: Sounds like she was worrying about you in the midst of her grief.

Client: No, she didn’t care. If she did she could have did it another way.

Counselor: So it’s the way that she did it that made you think she doesn’t care about you?

Client: Yes, all she wanted was to keep my father preserved through me, keep the image of a put

together family when all I wanted to do was be there for her and my brother. It’s not like I

wouldn’t have went back to school. I would have eventually.

Counselor: Did you know that statistically it Is harder to continue school after deciding to take

time off, most people either don’t go back at all or end up going back after a considerable

amount of time has passed.

Client: That doesn’t apply to me, I finished anyway and my life still went to hell. Once I got

back nothing was the same anyway, I barely graduated and can’t even get a job in the field so

what was the point anyway.

Empirically Supported Counseling Procedure
8

Counselor: Do you think that those around you were proud of the fact that you graduated?

Client: Before my dad died, my mom would have been proud, but after she wasn’t happy or

proud, just glad that I was able to pull it off without having my dad here.

Counselor: Why do you think she wasn’t genuinely happy for you?

Client: She showed up to my graduation late, didn’t even watch me walk across the stage, she

just showed up after the entire ceremony. No one except friends screamed my name as I walked

across the stage, but she loves to fake it and explain to all of her friends how she jumped up and

down and screamed at the top of her lungs while I walked across the stage. She’s a liar.

Counselor: So what I’m hearing is that you feel that your mother viewed you as a trophy,

something to show off but forget about once people are away.

Client: Yes, that’s it exactly!

Counselor: I would like to just back track again here to when you mom kicked you out and you

went back to school, was this when you began to heavily use marijuana?

Client: Yes, I mean it happened gradually but essentially yes.

Counselor: Did you interact with your mom after she sent you back, were you all checking on

each other?
Empirically Supported Counseling Procedure
9

Client: Honestly, half the time I was high, but now that you mention it she texted me every

morning asking how I was doing. I just assumed she meant in school so I never texted her back, I

was just so mad at her.

Counselor: Maybe she was asking in both sense, how are you after losing you father and how are

in school. It seems like she was trying to be supportive in her own way while dealing with her

grief.

Client: I guess I never thought of it that way. Now that I’m older I do see how much I look like

my father but she still shouldn’t have pushed me away like that, it hurt. I know my dad was her

best friend but she was mine and for her to just turn her back on me when I needed her most I

can’t forgive her for that and I really don’t want to. At least not right now I just want to be mad

at everyone.

Counselor: How is your current relationship with her?

Client: I’ve been in prison for 5 years I was 24 years old when I got arrested. I refused her

visitations because I didn’t want to see her, and when she’s home I’m at work so it’s basically

nonexistent.

Counselor: Would you like to develop a relationship with her?

Empirically Supported Counseling Procedure
10

Client: I think at this moment I’m more hurt about the past then angry now that I’m talking about

it. I would, I would like my old mom back, and I want to be able to talk to about how I’m

feeling. I’m at the point where I just want to end it all.

Counselor: Can I ask what you mean by that?

Client: It feels like I’ve lost everything, what’s the point in anything anymore.

Counselor: Is it that you feel alone right now, you feel like theres no out?

Client: That’s exactly right, everybody tears me down anyone, why not just kill myself, that’ll

prove to everyone that I’m not just a screw up. You know everyone feels sorry once someone is

dead, maybe I should just make everyone sorry for what they did to me.

Counselor: How many times have you thought about suicide?

Client: I’ve been thinking about it for years, ever since college just never got the courage to do,

even while I was in prison I couldn’t do it but now there really is nothing and no one left to live

for.

Counselor: Have you thought about how you would do it?

Client: A gun, driving my car off the bridge, I was going to do it tonight if my brother hadn’t

forced me to come to this stupid session.

Empirically Supported Counseling Procedure
11

Counselor: You feel that bad that you were planning to kill yourself tonight?

Client: He was supposed to be at a friend’s house today he wasn’t supposed to come home,

without him I wouldn’t be here but I still don’t see the reason for living anymore.

Counselor: To me it sounds like you brother is an anchor, maybe you should grasp it. Often

time’s people who feel like they don’t have a reason to live actually do, for you your brother

stopped you just by being there, why do you think that is?

Client: I don’t want him to go through that and find me, he was pretty young when dad died and

I know despite everything he still looks up to me I just don’t feel like being alive anymore.

Counselor: Do you feel like you’ve lost all hope of even possibly gaining that will back?

Client: I do, I really don’t know what else to do anymore.

Counselor: Well how about we find a solution to together, that way you aren’t in this alone, Can

we do that?

Client: Why would you even help me, I’m just an ex-convict

Counselor: Everyone no matter who they are, ex-convict, therapist even the president could use a

little help every once in a while and I would like to help you, Is that ok?
Empirically Supported Counseling Procedure
12

Client: I guess so, I haven’t had anyone to really talk to in a while. Plus I feel hopeless but I’m

not fully sure I want to die just yet; it just feels like a perfect way out.

Counselor: We can discuss that, only if you are willing though, there is no pressure; court

mandates you come to address your previous issues but we can always expand beyond that.

Client: I think I would like that.

Empirically Supported Counseling Procedure
13

Session Review

During this interview it can be assumed that James is suffering from Major Depressive

disorder. This particular disorder is characterized by symptoms such as diminished interest in

almost all activities, insomnia, fatigue, feelings of worthlessness and recurrent thoughts of death

(APA,2018). By continuing psychotherapy, James and the therapist can come up with a good

approach to addressing his suicidal thoughts. An article in the Psychiatric Times noted that a

sound suicide assessment approach or protocol is made up of three major components

“Gathering information related to risk factors, protective factors, and warning signs of suicide,

collecting information related to the patient’s suicidal ideation, planning, behaviors, desire, and

intent and making a clinical formulation of risk based on these 2 databases (Shea, 2009). He,

James, has never addressed the possibility that he could be depressed, by showing James that his

emotions and thoughts were causing not only his behavioral issues but also played into his

suicidal ideation he can begin to work on successfully completing the treatment plan.

Having been recently released from prison and mandated to show up for therapy it is wise

to note that many recently released inmates tend to suffer from depression either while

incarcerated or after being released. In fact in many countries former prisoners continue to be at

dramatically elevated risk of adverse mental health outcomes and suicide (Thomas, 2015). When dealing

with high risk clients such as those who has recently been released back into the world from a controlled
Empirically Supported Counseling Procedure
14

environment, continuing therapy is recommended however mental health services for the average

individual can be quite costly especially if health insurance becomes an issue. Additionally when working

with a client who has been recently released from prison and has also shown suicidal ideation it is wise

to caution oneself when paraphrasing during a session as prison is a very hostile environment and one

thing can set someone off. For James although he did not show any hostility during this session, his

record shows that he was very hostile during therapy sessions in prison, reaffirming that reluctant or

mandated clients tend to become hostile when attending therapy (Tambling, 2013). Unlike many

mandated clients who are only there in an attempt to balance, judges, lawyers, and family

members all the while trying to appease the therapist, James is showing an effort to get the help

that he needs (Rosenberg, 2000). It is clear that James is at risk of suicide and has been for years;

currently his present situation serves as an ideal factor into his past and current suicidal ideations,

plans and reasons for completion. Now is an opportune time to address these feeling as 33% of

people who commit suicide had been in contact with mental health services at least a year before

their death and 20% within the last month on their life (Merril, 2013). Suicide occurs because of

a convergence of genetic, psychological, social, and cultural risk factors, combined with

experiences of trauma and loss; James began showing early signs at the time of his fathers death

but have never been able to address it due to his anger towards his mother (Aini, 2017).

Suicide rates vary between countries with developing countries having higher rates than

those who are already developed, in America alone, suicide rates have been sky rocketing
Empirically Supported Counseling Procedure
15

recently, there are some people who are at risk that attempt to find help however finding not only

the right type of therapy but also the right psychologist can be daunting. Throw in age, gender,

ethnic origin, employment status, and occupation the rates are even higher. Most people who die

by suicide have psychiatric disorders, notably mood, substance-related, anxiety, psychotic, and

personality disorders, with comorbidity being common (Hawton,2009). We know for a fact that

James needs to seek additional counseling as prisons tend to have higher rates of suicide with

added risk factors of being confined to a single prison cell, previous attempted suicide, recent

suicidal ideation, and psychiatric disorder (Hawton, 2009). Unfortunately like many other aspect

of a prisoners life, suicide has also been historically ignored, this has only been a recent change

because of increasing litigation (Bonner, 2000). In the past decade or so, the younger generation

has pushed back in regards to many social injustices that have been overlooked for years. Many

times the focus is on the prison system or injustices dues to discrimination, young people are

frequently involved in recognition, referral, and suicide prevention strategies for youth (King,

1998). As he seems to have multiple factors contributing to his depression it is recommended

that he begin psychotherapy to discuss his symptoms, especially since it can help him not only

come to terms with his depression but also the underlying reasons for the suicidal ideation.

During these sessions the therapist needs to make note of past suicidal ideation in order to make

sure that it is documented in case James does decide to go through with his plans. During

sessions with a suicidal client one will need to pay special attention to their attending skills.
Empirically Supported Counseling Procedure
16

Being able to find out what specifically works for the patient can have a huge impact on whether

or not the patient decides to continue therapy. One thing that was demonstrated above and that

needs to be addressed in a real mandated therapy session is not only the willingness to engage in

criminal behavior but also the need to protect his brother from seeing traumatizing events which

is indicative of underlying relational deficits (Beneviste, 2012).

The treatment goals for James needs to be that he should be put on medication, this will

help regulate is mood and help him feel less suicidal. He also needs to begin working on building

a relationship with his family, by pushing them away he is actually contributing to his illness. It

is recommended that group therapy begin as soon as possible so that he can begin building a

source of support. Involving his family into his treatment allows not only him but them also a

better chance at understanding what is going on with him, how he is coping and improve the

communication between them all. Although family therapy has been proven to be effective as a

general intervention, different approaches should also be considered in order to address

suicidality and attachment styles (Prabhu,2010).

Understanding the full intent behind suicidal ideations is really important as well, james

mentioned that he had no hope, the fact that he is sharing his intent is indicative of him showing

that he is not as committed to the idea as he lets on, those who harbor suicidal intent are more

often than not vehemently opposed to engaging in meaningful interventions that might challenge
Empirically Supported Counseling Procedure
17

that intent (Jofee,2008). By sharing this information is it possible to begin thinking of

intervention strategies that would best benefit James. When looking at intervention programs that

have been available throughout the years and until recently, most programs have been met with

negative concerns and responses that often surrounds direct efforts to confront the problem of

suicide, except in the face of immediate requirements for action, may seriously impede efforts to

mount necessary programming (Silverman, 1995).

Suicidal ideation and major depressive disorder coincide with each other fairly often, looking at

it from a more general stand point the prevention of suicide is simply part of more general health

problems. If guided by social, psychological and behavioral science theories and health

behavioral change it is most likely not only going to benefit the patient but the community as

well(Joe, 2008). One strategy that can be used fairly early in James treatment is assessment

taking. Using the Beck Hopelessness Scale to measure his subjective feelings of hopelessness,

the therapist can get an even deeper look at what kind of risk James is to himself. The assessment

is a 20 item true or false self-report that ask participants to accurately describe their attitude

during the past week (Rudd, 2006). By completing the assessment James may have a better feel
Empirically Supported Counseling Procedure
18

of where his thoughts have been for the past week which may not have been as negative as he

once thought, either way he will need to begin learning how to cope with his depression as this

disorder is something that can come and go. Ultimately, the goal is to divert james attention

away from his suicidal ideations, suicide itself is reflects diverse risk factors and is a complex

paradigm of social, behavioral and psychiatric factors (Knox, 2004). In terms of family sessions,

gatekeeper training programs, public information and any type of campaigns dealing with suicide

should be brought to their attention because without having proper knowledge it could lead to

tragic outcomes despite increasing awareness at the individual level. (Sandals,2003)

 
Empirically Supported Counseling Procedure
19

References

Aini, K. (2017). A systematic review of suicide prevention strategies. European Psychiatry,41.

doi:10.1016/j.eurpsy.2017.02.155

Benveniste, D. (2012). Relational quandaries in the treatment of forensic clients.Clinical Social

Work Journal, 40(3), 326-336. doi:http://dx.doi.org.library.capella.edu/10.1007/s10615-011-
0368-8

Bonner, R. L. (2000). Correctional suicide prevention in the year 2000 and beyond.Suicide &
Life - Threatening Behavior, 30(4), 370-6. Retrieved from http://library.capella.edu/login?
qurl=https%3A%2F%2Fsearch.proquest.com%2Fdocview%2F224895927%3Faccountid
%3D27965

Hawton, K., & van Heeringen, K. (2009). Suicide. The Lancet, 373(9672), 1372-81. Retrieved
from http://library.capella.edu/login?qurl=https%3A%2F%2Fsearch.proquest.com%2Fdocview
%2F199037463%3Faccountid%3D27965

Joe, Sean,M.S.W., P.H.D., Canetto, S. S., P.H.D., & Romer, D., P.H.D. (2008). Advancing
prevention research on the role of culture in suicide prevention.Suicide & Life - Threatening
Behavior, 38(3), 354-62. Retrieved from http://library.capella.edu/login?qurl=https%3A%2F
%2Fsearch.proquest.com%2Fdocview%2F224869436%3Faccountid%3D27965

Joffe, P., P.H.D. (2008). An empirically supported program to prevent suicide in a college
student population. Suicide & Life - Threatening Behavior, 38(1), 87-103. Retrieved from
http://library.capella.edu/login?qurl=https%3A%2F%2Fsearch.proquest.com%2Fdocview
%2F224870738%3Faccountid%3D27965

King, C. A. (1998). Suicide across the life span: Pathways to prevention. Suicide & Life -
Threatening Behavior, 28(4), 328-37. Retrieved from http://library.capella.edu/login?qurl=https
%3A%2F%2Fsearch.proquest.com%2Fdocview%2F224895537%3Faccountid%3D27965

Prabhu, S. L., Molinari, V., Bowers, T., & Lomax, J. (2010). Role of the family in suicide
prevention: An attachment and family systems perspective. Bulletin of the Menninger
Clinic, 74(4), 301-27. doi:http://dx.doi.org.library.capella.edu/10.1521/bumc.2010.74.4.301

Rudd, M. D., Mandrusiak, M., Joiner,Thomas E.,,Jr, Berman, A. L., & al, e. (2006). The
emotional impact and ease of recall of warning signs for suicide: A controlled study. Suicide &
Life - Threatening Behavior, 36(3), 288-95. Retrieved from http://library.capella.edu/login?
qurl=https%3A%2F%2Fsearch.proquest.com%2Fdocview%2F224892378%3Faccountid
%3D27965
Empirically Supported Counseling Procedure
20

Sanddal, N. D., Sanddal, T. L., Berman, A. L., & Silverman, M. M. (2003). A general systems
approach to suicide prevention: Lessons from cardiac prevention and control. Suicide & Life -
Threatening Behavior, 33(4), 341-52. Retrieved from http://library.capella.edu/login?qurl=https
%3A%2F%2Fsearch.proquest.com%2Fdocview%2F224887490%3Faccountid%3D27965

Shea, C. (2009). Suicide Assessment. Psychiatric Times,26(12). doi:10.1002/9780470750933.ch

Tambling, Rachel B,PhD., L.M.F.T. (2013). Therapy with coerced and reluctant clients.Journal
of Marital and Family Therapy, 39(4), 539-540. Retrieved from http://library.capella.edu/login?
qurl=https%3A%2F%2Fsearch.proquest.com%2Fdocview%2F1460879389%3Faccount

Thomas, E. G., Spittal, M. J., Heffernan, E. B., Taxman, F. S., Alati, R., & Kinner, S. A. (2015).
Trajectories of psychological distress after prison release: Implications for mental health service
need in ex-prisoners. Psychological Medicine,46(03), 611-621. doi:10.1017/s0033291715002123

Upanne, M. (1999). A model for the description and interpretation of suicide prevention. Suicide
& Life - Threatening Behavior, 29(3), 241-55. Retrieved from http://library.capella.edu/login?
qurl=https%3A%2F%2Fsearch.proquest.com%2Fdocview%2F224885259%3Faccountid
%3D27965

Walker, R. L., Ashby, J., Hoskins, O. D., & Greene, F. N. (2009). PEER-SUPPORT SUICIDE
PREVENTION IN A NON-METROPOLITAN U.S. COMMUNITY.Adolescence, 44(174), 335-
46. Retrieved from http://library.capella.edu/login?qurl=https%3A%2F%2Fsearch.proquest.com
%2Fdocview%2F195939205%3Faccountid%3D27965