Therapist's Guide to Clinical Intervention - Sigmund Freud

18. Loss of family status (family member leaves or is removed from the home,
change in economic level of family)
19. Feeling anonymous and unimportant
20. Peer group activity associated with issue of death
In assessing adolescents, the symptoms of depression may not be indicated as directly as
when assessing an adult. This is referred to as masked depression. Masked depression can
be described in two ways:
1. Classic: Somatic complaints take the place of the general criteria of depression.
There are chronic complaints of headaches, backaches, and stomach ache.
2. Behavioral: Evidenced by acting out behaviors such as substance abuse,
promiscuity, shoplifting. These are all representations of ways of converting
affective state interpreted as boredom into something exciting. Young people
are sometimes ineffective in expression depression. Therefore, they translate it
into something else and project it outward, finding boredom in school, peers,
and family. The use of substances may be an attempt to cope with emotional
distress, lack of identity, or boredom. They may see the world as boring and
unfulfilling. Males tend to act out more aggressively in their environments.
TREATMENT FOCUS AND OBJECTIVES
The type of intervention is based on efforts to problem solve and provide a safe environment
for the suicidal person.
1. Outpatient Therapy and Management: Utilized when the risk of suicide is
low, the precipitating crisis is no longer present, there is an adequate support
system, and the person contracts that they will contact the therapist if they are
unable to cope. Least restrictive and appropriate means of intervention are
always utilized.
2. Hospitalization: Utilized if the person is at high risk for suicide, lacks adequate
social supports, lacks adequate impulse control, is intoxicated or psychotic. For
the benefit of the person, initially pursue the least restrictive course of a
voluntary admission. If they are unwilling and the criteria are present an
involuntary admission is warranted which will necessitate an evaluation by the
appropriately designated persons/facility in your area.
3. Techniques
A. Alleviate the person's isolation by recommending that they stay with family or
friends
B. Facilitate the removal of weapons or other means of a suicide attempt from their
environment. Deal with issues of substances (abuse) if necessary
C. Support the development and utilization of a support system, or the reestablishment
of their support system
D. Facilitate the appropriate expression of anger or other feelings which are
contributing to self-destructive impulses
E. Validate the person's experience of the crisis, but also identify their ambivalence and
the fact that suicide is a permanent solution to a temporary problem
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