1. CHAPTER 3: Safety-Related Clinical Issues and Treatment Treating Those with Mental Disorders: A Comprehensive Approach to Case Conceptualization and Treatment Victoria E. Kress and Matthew J. Paylo Prepared by Neil R. Meloro © 2015 by Pearson Education, Inc. All Rights Reserved

2. 1-2 Kress & Paylo, Treating Those with Mental Disorders: A Comprehensive Approach to Conceptualization and Treatment. © 2015 by Pearson Education, Inc. All Rights Reserved Counseling Suicidal Clients –Counselor Considerations When working with suicidal clients, counselors should: Managing one’s own reactions to suicide, Maintaining a sense of collaboration in treatment, Understanding the construct of suicide, Possessing appropriate risk assessment and intervention skills, Developing an effective crisis plan, Keeping appropriate documentation related to suicidality, and Understanding potential legal and ethical issues in the treatment of suicidality

3. 1-3 Kress & Paylo, Treating Those with Mental Disorders: A Comprehensive Approach to Conceptualization and Treatment. © 2015 by Pearson Education, Inc. All Rights Reserved Counseling Suicidal Clients- Characteristics Potential Indicators of Suicide  Past suicide attempts  Substance abuse  Impulsivity  Aggressiveness  Thoughts of hopelessness  Loss of control  Mental health disorders  Recent life stressors  Abrupt, significant changes in mood

4. 1-4 Kress & Paylo, Treating Those with Mental Disorders: A Comprehensive Approach to Conceptualization and Treatment. © 2015 by Pearson Education, Inc. All Rights Reserved Counseling Suicidal Clients-Assessment Potential suicide risk should be assessed at each of the following points in time: At intake/admission to treatment, At any time suicidal ideation arises or the counselor suspects possible suicidal ideation, When a client experiences a sudden change in mood or behavior, and At the time of discharge from treatment

5. 1-5 Kress & Paylo, Treating Those with Mental Disorders: A Comprehensive Approach to Conceptualization and Treatment. © 2015 by Pearson Education, Inc. All Rights Reserved Counseling Suicidal Clients—Treatment Assessment Mnemonic: IS PATH WARM IIdeation SSubstance Abuse PPurposefulness AAnxiety TTrapped HHopelessness WWithdrawal AAnger RRecklessness MMood Changes

6. 1-6 Kress & Paylo, Treating Those with Mental Disorders: A Comprehensive Approach to Conceptualization and Treatment. © 2015 by Pearson Education, Inc. All Rights Reserved Counseling Suicidal Clients—Treatment  Establish therapeutic alliance  Build upon client’s reasons for living  Commitment to Treatment Statements  Emphasize client’s positive coping skills  Determine appropriate level of care: inpatient, partial hospitalization or outpatient

7. 1-7 Kress & Paylo, Treating Those with Mental Disorders: A Comprehensive Approach to Conceptualization and Treatment. © 2015 by Pearson Education, Inc. All Rights Reserved Counseling Homicidal Clients— Characteristics No single personality profile  May exhibit lack of empathy  Possible history of harming others or animals  Destructive behaviors  Disregard social norms and rights of others  Diagnoses include conduct disorders, psychotic disorders, cluster B personality disorders, and delirium  Intimidating or stalking behaviors

8. 1-8 Kress & Paylo, Treating Those with Mental Disorders: A Comprehensive Approach to Conceptualization and Treatment. © 2015 by Pearson Education, Inc. All Rights Reserved Counseling Homicidal Clients— Treatment  No comprehensive interventions exist  Treatment tailored to client’s unique situation  May involve treating co-occurring disorders/issues  Include client’s family/significant others in counseling  Identify adaptive coping methods  Encourage self-awareness  Strengthen social support networks  Creation of a safety plan

9. 1-9 Kress & Paylo, Treating Those with Mental Disorders: A Comprehensive Approach to Conceptualization and Treatment. © 2015 by Pearson Education, Inc. All Rights Reserved Counseling Interpersonal Partner Violence Victims- Characteristics Intimate Partner Violence (IPV) physical, sexual, or threatened abuse from a current or former romantic partner Most frequent between male perpetrator and female victim Psychological abuse: such as verbal abuse, isolation, stalking, financial abuse, destruction of property Involves individuals from all SES statuses, ethnicities, genders, ages and sexual orientation Related to development of other psychological issues

10. 1-10 Kress & Paylo, Treating Those with Mental Disorders: A Comprehensive Approach to Conceptualization and Treatment. © 2015 by Pearson Education, Inc. All Rights Reserved Counseling Interpersonal Partner Violence Victims- Characteristics  May experience: PTSD, depression, substance use, and anxiety disorders  Perpetrators often isolate victims from their social networks  May involve medical or physical issues that need further medical evaluations  Young, unemployed, low SES are at greater risk of being abuse  Situations that heighten risk: include relationship instability, or conflict, and financial hardships

11. 1-11 Kress & Paylo, Treating Those with Mental Disorders: A Comprehensive Approach to Conceptualization and Treatment. © 2015 by Pearson Education, Inc. All Rights Reserved Counseling Interpersonal Partner Violence Victims—Treatment  Psychoeducation on IPV may be necessary  Formal self-reports and administrated assessments such as WAST and AAS  Creation of a safety plan  Multidisciplinary, collaborative approach including other health care professionals  Couples counseling should be avoided in actively violent situations  Use of exposure-based CBT Interventions