Therapist's Guide to Clinical Intervention - Sigmund Freud

118 2. Assessing Special Circumstances
F. Refer for medication evaluation making sure that the physician is aware of the
person's suicidal ideation/impulses
G. Educate the person regarding the impact that a lack of sleep has on effectively
coping, and reassure them that the depression can be managed or eliminated
H. Identify irrational, negative beliefs. Help the person recognize that the associated
negative self-talk contributes to keeping them in a state of hopelessness. Facilitate
the identification of alternatives to the difficulties that they are currently
experiencing
I. Do not verbally or nonverbally express shock or horror
J. Do not emphasize how much they have upset other people
K. Do not offer psychological or moral edicts of suicide
L. Explore with person what they hoped to accomplish by suicide
M. Identify life issues which have contributed to person's emotional state
N. Discuss the fact that suicide is a permanent solution
O. Review resources and relationships (family, friends, family physician, clergy,
employer, police, emergency response team, therapist, community support groups,
12-step groups, emergency room, psychiatric hospital)
P. Be reassuring and supportive
Q. Facilitate improved problem solving and coping
R. Facilitate development of a self-care program
1. Daily structure
2. Inclusion of pleasurable activities
3. Resources/support system (including therapy and medication compliance)
4. Identify crisis/potential crisis situations and plausible choices for coping
5. Identify warning signs (self-monitoring) that indicate that the person is not
utilizing their self-care plan, medication difficulties, etc.
6. Regular aerobic exercise and good nutrition
DEPRESSION AND SUICIDE RISK RELAPSE
Suicide does not begin with the self-destructive gesture. It begins with feelings of isolation,
hopelessness, sleep disturbance, inability to cope, and other symptoms related to change,
loss, or impulse control. Warning signs that serve as a potential red flag that there is an
impending crisis include:
1. A general feeling that things are not going well. A pervasive negative outlook.
They feel that life is not worth living and they cannot manage day-to-day
activities.
2. Denial. A belief that they lack control over their life. Tendency to blame other
people or situations for how they feel. As a result of not dealing with what they
are experiencing, there is a tendency toward decompensation.
3. Attempts to help others while disregarding the priority of self-care. They
become involved in other people's issues and avoid dealing with their own.
4. Defensiveness. Taking the position that they are doing fine and do not need the
help of other people, resources, or medication.
5. Old behavior that the person has changed because of its negative role
emotionally begins to surface. This could be looking at pictures or listening to
songs that make them sad, reading old love letters, etc.
6. Focus on negatives. The person focuses on the view rather than the positive
view of things, which increases feelings of helplessness.