Introduction
Suicide remains a leading cause of death globally, necessitating research and clinical efforts. According to Moscardini et al. (2020), suicide accounts for approximately 1.3 million suicidal attempts and 45,000 deaths in the United States per year. Most individuals struggling with suicidal thoughts often fear asking for help and constantly search for a means to end their frustration and suffering. Overwhelming feelings of pain, hopelessness, and isolation can trigger suicidal thoughts and plans.
In addition to psychological factors, environment and genetics heighten the risk of suicidal ideation. Some of the effects of suicide include shame, guilt, anger, and even death. Therapists can use the ABC model of crisis intervention to identify and assess the antecedents of a problem behavior and design interventions to improve patient outcomes. Employing robust systemic analyses allows clinicians to get a reliable and valid measure of suicide risk, which informs the development of effective interventions.
Applying the ABC Model to Suicidal Ideation
The first stage of case intervention, as per the ABC model, is focused on establishing a relationship to understand the factors that trigger suicidal behavior. Phillip et al. (2020) highlighted that rapport entails the physical and emotional aspects that are used for mutual connection. In essence, rapport relates to parity, and when practiced effectively, it improves patient satisfaction and engagement levels. The first step to achieving rapport is removing obstacles between the female patient and the therapist as a sign that all the attention is given to them.
During the previous assessment, the client revealed a suicidal attempt by overdosing that resulted in hospitalization. By building rapport, the client feels that they can relate with the counselor and become more open to contributing to the session (Nagy et al., 2022; Phillip et al., 2020). Next, the therapist can achieve emotional rapport by validating the client’s feelings of rejection and anger, which stem from ongoing anger toward her mother and an unhealthy professional relationship with the boss. Creating a safe space for the patient allows them to share their concerns freely.
In the second stage of the ABC model, the problem is identified. The therapist should focus on the aspects of suicidal attempts, including emotional distress, cognitions, and impairments in social, occupational, and behavioral functioning. The client’s recent suicidal ideation is reported to have been triggered by her relationship with her employer. Using open-ended questions can encourage open communication and vulnerability when discussing the night calls with the boss.
According to Moscardini et al. (2020), suicidal thoughts often result when certain events overwhelm an individual’s coping mechanism. The client plans to drive off a bridge that she passes frequently on her way to work. Therefore, understanding the relationship between the client and her boss, whether professional or romantic, will help assess their suicidal risk and the urgency of a safety plan.
Additionally, the client attended the therapy session while drunk, raising a concern about driving under the influence. Some individuals engage in excessive drinking and smoking as coping mechanisms for stress, anxiety, and depression (Koob et al., 2020). Although the mother means well by not allowing the client to smoke or bring men to their home, she may feel isolated and misunderstood.
Strategic Coping and Crisis Intervention
After identifying the problem, the therapist and client can establish the most effective coping mechanisms. Coping mechanisms help manage internal and external stressors more effectively (Phillip et al., 2020). For one, this might include advising the woman to take another route home or a different mode of transportation whenever she passes the bridge on her way home from work.
Exploring the client’s thought process regarding her relationships with her mother and her boss will further facilitate the development of coping mechanisms to establish healthy boundaries. Emotional support is critical, especially when a person has suicidal thoughts. Therefore, the therapist should help the client identify emotional triggers in her relationship with her mother and boss and discuss the adverse consequences of detrimental strategies such as smoking and alcohol consumption.
Furthermore, intoxication strains relationships with family and colleagues and impedes personal growth and development. The client had made a previous suicide attempt by overdosing, which led to hospitalization. Upon sobering, the client denied suicidal ideations, an indication of impaired coordination and judgment. Addressing the impact of intoxication on cognitive functioning will ensure the client’s safety and well-being.
Suicidal Ideation: Balancing Safety, Bias, and Autonomy
Suicide remains a psychiatric emergency that renders early treatment and intervention a core element of healthcare practice. According to the ABC model, a therapist must first understand the client’s emotional response during a crisis. The 33-year-old white male reported ingesting 20 sleeping pills the previous night and got scared to ask for help, which forced him to induce vomiting. People usually feel uncomfortable discussing suicidal ideation since the topic goes against societal norms and expectations.
Ying et al. (2021) stated that some therapists may experience negative emotions such as contempt, anger, impatience, and hostility when working with suicidal individuals. Recognizing these biases as a therapist could help identify those at risk for imminent suicide. Individuals who attempt suicide often experience overwhelming psychological stress coupled with fear and shame, driving their need.
When the client called crisis the following morning, he reported ongoing suicidal thoughts. Heightened thoughts of self-harm can potentially result in fatal outcomes. The man refused to disclose his location, necessitating police involvement. Stage A of the ABC model emphasizes acknowledging and validating the patient’s hopelessness and creating a safe space that allows them to express themselves freely.
Furthermore, predictive suicidal behaviors such as plans and attempts necessitate including a person’s intent to die during risk assessment. The man reports ongoing frustration and hopelessness, having recently lost his job and broken up with his girlfriend. With two prior suicide attempts, the therapist’s primary role is ensuring the client’s safety, and this might involve a multifaceted approach to determine the validity of past suicidal attempts as indicators of future risk. The therapist can use instruments such as the Suicide-Intent Scale (SIS) or the Suicidal Behaviors Questionnaire-Revised (SBQ-R) to identify the risk of suicidality (Ibrahim et al., 2022).
Although the client currently sees a therapist, he still isolates himself from friends and family, indicative of an escalation of the crisis. Recent research has established that less communication of suicidality is linked to an elevated risk of suicide plans and attempts. Based on the client’s current mental state and risk level, the counselor should work collaboratively with the patient while considering their needs and preferences. Communicating openly with the client and respecting their autonomy and confidentiality will help to establish trust and address underlying issues.
Integrated Crisis Intervention
Suicidal cognition is a defining attribute of current and future suicide risk. Identifying and challenging the cognitive distortions that contribute to substance use and feelings of frustration and hopelessness is crucial (Koob et al., 2020; Ying et al., 2021). Despite the reluctance to talk about his suicidal thoughts, the client admitted that the overdose of sleeping pills was impulsive and regretted his actions immediately. He had engaged in excessive alcohol consumption the night before the overdose, and there is a high likelihood of using other drugs, such as marijuana.
By repeatedly using the ABC model to monitor the client’s behavior, the therapist can establish a baseline of antecedents. Moreover, the man struggles with chronic pain due to an untreated back problem, limiting his productivity. The combination of these antecedents, from chronic pain to work-related stress, increases the patient’s risk of suicidal behavior. Maintaining close and ongoing monitoring, including regular follow-up sessions, creates a safe space for the client to reach out when having thoughts of self-harm (Costanza et al., 2020).
Most importantly, engaging support systems during the client’s recovery can help ensure their well-being and safety. However, the therapist must obtain the client’s consent before involving the client’s family members and friends. Nonetheless, crisis intervention is an ongoing process, and the therapist must remain vigilant for the client’s continued progress.
Conclusion
In summary, affective, behavioral, and cognitive aspects are crucial to validating the evaluation of suicidal risk. Despite increased public awareness of mental health and research efforts, suicidal rates continue to rise. The first step toward recovery is seeking help from a therapist who must then create a safe space for the client. Utilizing crisis intervention models in clinical practice can help identify individuals at risk of current or future suicidal attempts. However, the client and therapist must work in synergy to resolve the current problem. Counseling suicidal patients can be challenging, and implementing an evidence-based intervention establishes a standard of care.
References
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