26 June 2020 — Solution Focused Support Group discussion on helping suicidal clients.

A few colleagues come together for our monthly solution-focused approach peer support session.

The plan was to discuss and share our reflection upon reading Chapter 1 of Heather Fiske’s “ Hope in Action: Solution-Focused Conversations About Suicide.”

Notes of discussion

1. It is often uncomfortable to talk about suicide and death. Usually, when a client verbalises their wish to suicide, it can cause the worker to feel anxious and overwhelmed. The worker gets into the “suicide risk assessment” mode to do a risk assessment, which is part of the organisational policies.
2. However, if the worker only focuses on “doing risk assessments”, either to fulfil specific standard operating procedures, he/she may lose an opportunity to do equally important intervention work; to connect with the client as a person, and help them remember hope.
3. Reflection for therapists, “What is giving me hope to live?”. “Am I anxious to broach the topic of death, suicide, living?”.

What are some of the possible responses to the following statement?

“I don’t want my family to know (about the suicide plan).”

1. Explain why is there a need to inform their family. — e.g. “I am committed to helping you, but I need you to keep alive. As I can’t be there with you 24 hours, I need someone to help look out for you. You are experiencing a crisis, and it is not fair for you to have to face this alone, or for us to work alone.”, “Let’s explore who can be there to support you.”
2. The conventional way will be to explain the need to break confidentiality to protect them.
3. Transparency and disclosure.
4. The client may wonder what the worker will disclose to their family members.
5. Tip: Go through with them what we are going to say to their family to reduce the client’s anxiety.
6. We can check with the client what they would like to omit.
7. Also can invite the client to join in when the worker contacts the family. “e.g., If you like, you are welcome to sit in when I talk to your mum/dad, so you can hear what we talk about.”

“I don’t fit in”.

• Empathy, Reflect emotions.
• Solution Focused language, we can say something like “With what is going on, I can see why you would think that way now”.
• It is a presuppositional statement. By saying “now”, it is signalling that things change.The implicit, unspoken communication is that “It will get better”.
• “Was there any point the past that you could fit in a little bit?” By asking for an exception, and saying “even for a little bit”, we signal respect to the client because we recognise how difficult their situation is.

“I have seen other therapist before, and they are not helpful”.

• From a solution-focused perspective, the client is saying they want help, “Work with me in a way that is helpful to me”.
• Process that statement with the client, and we can reflect the client’s strengths!
• That statement demonstrates clients perseverance, but they have not given up seeking for help
• It exhibits their competence because after seeing so many different therapists, they know what is helpful and not helpful.
• As a therapist, we can ask “What can I do to be helpful? “How would you like me to support you?” “You have seen different therapists before, you know what is not helpful, what would I need to do to be helpful to you?”
• Why do we ask that question? We are signalling to the client:
• We respect them,
• The client has the answers
• Their answer will guide us to know what we need to do to be helpful.

26 June 2020

Interests in stoicism, psychotherapy, international relations, exercising, meditation. Friends welcome! View all posts by Moses Hng

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Originally published at http://moseshng.wordpress.com on June 27, 2020.