Two essential clinical skill-sets for counselors: The mental status exam and suicide assessment
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Transcript of Two essential clinical skill-sets for counselors: The mental status exam and suicide assessment
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TWO ESSENTIAL CLINICAL SKILL-SETS FOR
COUNSELORS:
THE MENTAL STATUS EXAM AND SUICIDE
ASSESSMENT
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Very quick overview of MSE and suicide assessment procedures
The emphasis is on material you can use in your courses
THE PLAN
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The MSE is a method of organizing clinical observations pertaining to current mental status or mental condition.
The MSE is also a primary method for communicating about cognitive or psychiatric symptoms within medical settings
Sample MSE reports are available at johnsommersflanagan.com
MSE PURPOSE
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AppearanceBehavior/psychomotor activityAttitude toward examiner (interviewer)Affect and moodSpeech and thoughtPerceptual disturbancesOrientation and consciousnessMemory and intelligenceReliability, judgment, and insight
MSE GENERAL CATEGORIES
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Watch for movement back and forth from the technical task of conducting the MSE interview and less directive listening
Think about what symptoms you see and hear about and how you might articulate them in an MSE report
The protocol I’m using is published and also available online
VIDEO CLIP – CARL
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Lack of focus on or knowledge of the categories
Single symptom generalization
Interpretation of client symptoms can become very idiosyncratic and based on our own experiences
MSE COMMON PITFALLS
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It’s important for students to understand how culture can affect MSE process and MSE reports
Examples from my favorite MSE and Culture assignment follow
CULTURAL ISSUES
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Category ObservationInvalid Conclusion Explanation
Attitude toward examiner
Uncooperative and hostile
Oppositional-defiant or personality disorder
Has had abusive experiences from dominant culture
Affect and mood
No affect linked to son’s death
Inappropriately constricted affect
Expression of emotion about death is unaccepted in client’s culture
Reliability, judgment, and insight
Lies about personal history
Poor reliability
Does not trust White interviewer from dominant culture
CULTURAL ISSUES – ASSIGNMENT: GENERATING POSSIBLE INVALID
CONCLUSIONS
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PART II: SUICIDE ASSESSMENT
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PREPARATION ISelf-Preparation: Questions to ask yourselfWhat issues/ideas, etc., activate my suicide buttons?
What content is most important for me to cover?What skills, if any, do I want to integrate into this suicide assessment presentation?
More extensive info is available online
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PREPARATION IIClass Preparation: Ideally, do this the week before, by looking forward to talking about suicide and emphasize: Suicide is a provocative topic
We need to be skilled talking about it directly
We face the issue and side with life
Please come to class ready to deal with this issue
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SETTING THE TONEOpening with a personal story about working with a suicidal client can help set the tone as:SeriousReflectivePersonalProfessionalOpen
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ESSENTIAL CONTENT1. Bust the big myth2. Get students more comfortable with this topic
and with asking about suicide3. Introduce core knowledge (suicide
assessment interview components and a good reading assignment)
4. Practice a few skills (make it real)5. Emphasize professional and ethical standards6. Introduce suicide intervention7. Outline decision-making components
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BUSTING THE BIG MYTH (NARRATIVE)
The Big Myth or Old Narrative
Suicide ideation and gestures are signs of DEVIANCE
This is the old medical model perspective
It suggests that we, as medical authorities, assess and intervene with suicidal patients
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THE NEW NARRATIVESuicide thoughts and gestures don’t
represent devianceSuicide thoughts and gestures represent
DISTRESSAnd so we have empathy WITH clients and
their distress, viewing suicide ideation and behavior as a means through which they express their distress or unhappiness
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NEW NARRATIVE IIThe old narrative emphasized
diagnostic interviewing
The new narrative implies:Using strength-based paraphrasesCarl Rogers with a twist (O’Hanlon)Exception and externalizing questionsResource questionsNo assumption of mental illness
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VIDEO CLIPTommie and John
Watch for directness
Watch for Tommie’s not always positive or cooperative responses
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SUICIDE INTERVIEW COMPONENTS
Suicide risk factors Suicide ideationSuicide plan (SLAP)Self-controlSuicide intent
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CLASSROOM ACTIVITY IPractice asking directly about suicidal
thoughts
Pair up
Say the words – don’t beat around the bush . . . use “suicide” or “kill yourself”
Rita S-F and the Cincinnati police
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CLASSROOM ACTIVITY IIUse interview tag-team to practice interview partsRapport and exploring risk factors and depression
Exploring suicide ideation and planEvaluating suicide intent and self-controlTry out an intervention or twoCaucus together to talk about ethics, professional standards, and decision-making
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Thanks for listening and participating
Feel free to access free resources at: johnsommersflanagan.com
For detailed information on suicide assessment interview content, see: Sommers-Flanagan & Sommers-Flanagan (2012). Clinical Interviewing (4th ed., update). Chapter 9; Hoboken, NJ: Wiley
CLOSING COMMENTS