Child Planning: A Treatment Plan Overview for Children with Suicidal Ideation

Transcription

1 COURSES ARTICLE - THERAPYTOOLS.US Child Planning: A Treatment Plan Overview for Children with Suicidal Ideation Treatment Plan Overview for Children with Suicidal Ideation Duration: 3 hours Learning Objectives: Obtain a basic understanding of how to identifying, causes, symptoms of children with lying problems or history, and learn different options to complete a treatment plan that includes: a. Behavioral Definitions b. Long Term Goals c. Short Term Goals d. Strategies to Achieve Goals e. DSM V diagnosis Recommendations ***For a full list of 16 short term goals with dozens strategies listed next to each goal check the Child Treatment App for Windows or Apple PC and Android Devices, under our main menu Windows-Apple Apps. Download the Free Demo to Evaluate*** Course Syllabus:

2 Introduction Probable Causes Symptoms Diagnosis and Treatment Steps to Develop a Treatment Plan that includes Behavioral Descriptors, Long Term Goals, Short Term Goals, Interventions/Strategies and DSM V CODE Paired with ICD_9 and 10-CM Codes for ODD Sample Treatment Plan Introduction: Although suicide is considered a leading cause of death for all age groups, resources and recommendations regarding methods of assessment of suicide risk in children appears to be scattered across related disciplines. Most risk assessment measures for "youth" are intended for use with adolescents, and the nature of children's developmental functioning presents particular challenges for accurate assessment. This article includes a brief review of risk factors and recommendations for preparing to conduct suicide risk assessments with children. Guidelines for mental health counselors who conduct developmentally appropriate risk assessments with children are detailed, and suggestions for consulting with caregivers are provided. RISK FACTORS FOR SUICIDE A variety of theoretical and conceptual models related to suicidality are available to guide one's interpretation and understanding of suicide risk factors. Although some models are grounded in specific biological, psychological, or sociological theories, Berman et al. reported "an increasing emphasis on theoretical integration, particularly among psychological theorizing" (p. 66). In this spirit, Stillion and McDowell provided a multidimensional Suicide Trajectory Model that aids in exploration of common risk factors and triggering events that may lead to suicidal ideation and behavior within and across developmental stages. Stillion and McDowell (1996) proposed that individuals who experience certain biological, psychological, cognitive, and environmental risk factors will be more apt to respond to stressors with suicidal ideation or behavior. Although not all individuals who experience these risk factors become suicidal, the majority of those who are suicidal experience a

3 number of such risk factors. Examination of risk factors, then, assists the clinician in calling attention to children who may need more comprehensive assessment (Wise & Spengler, 1997) and evaluating risk levels of individuals who present with suicidal ideation (Weller, Young, Rohrbaugh, & Weller, 2001). Specific risk factors for children ages 5-14 are reviewed in the following paragraphs. Biological Risk Factors Biologically, children are at risk for suicide due to higher degrees of impulsivity, and this greater degree of impulsivity is reflected in suicide attempts and gestures that are closely related to opportunity and require little planning (e.g., running in front of a car or jumping out a window) (Stillion & McDowell, 1996). Juhnke (1996) also identified biological risk factors including sex and age. Although very young boys and girls have similar rates of suicide attempts and completions, sex differences in rates of completed suicide emerge by age 10 (Wise & Spengler, 1997). The gap between the number of males and females who complete suicide continues to increase as age increases (Gould et al., 2003); by adolescence, boys complete and girls attempt suicide more often (AAS, 2006). In addition, the rates of suicide are very low among the very young and continue to increase as children mature (Juhnke); thus, age may be considered a risk factor even among 5 to 14 year-olds. Psychological Risk Factors Stillion and McDowell (1996) identified psychological risk factors among young children to include feelings of inferiority and the "expendable child syndrome" (p. 60). Children at risk for suicide frequently experience disturbance in psychological functioning and in one or more diagnosable mental health disorders (Brent & Kolko, 1990; Gould et al., 2003; Weller et al., 2001; Wise & Spengler, 1997). Common symptoms most often include depression (Juhnke, 1996; Wise & Spengler) but may also include anxiety, aggression, and impulsivity (Weller et al., 2001). Similarly, these children are more likely to internalize problems and stressors (Weller et al.) and present with poor coping skills (Wise & Spengler). As such, many children may present as hopeless about the future (Brent & Kolko; Juhnke; Stefanowski-Harding, 1990). Cognitive Risk Factors Cognitive risk factors for childhood suicide include immature views of death, concrete thinking styles, and a child's degree of attraction and repulsion to life and death (Stillion & McDowell, 1996). Certainly, a child who does not understand the nature of death and engages in rigid thinking will be less capable of understanding the implications of her or his behaviors. Juhnke (1996) further identified rational thinking loss as a risk factor for childhood suicide. Similarly, Pfeffer (2003) discussed the need for clinicians to be aware of potential auditory or visual hallucinations. A child who reports hearing voices commanding him or her to engage in specific behaviors, especially self-harm, should be considered as experiencing serious suicidal ideation because he or she is likely to experience decreased loss of control and ability to differentiate her or his own thoughts from the hallucinations. Similarly, rational thought loss and increased impulsivity resulting from recent drug and/or alcohol use are frequently associated with completed suicides in adolescents and adults

4 (Juhnke) and may also be considered risk factors for children. Environmental Risk Factors Environmental risk factors include a constellation of early loss, parental conflict, chaotic or inflexible family structures, abuse, neglect, and parental suicidal behaviors (Stillion & McDowell, 1996). Mental health counselors should consider family factors key to identifying those at increased risk. The quality of family environment and the ability of caretakers to provide safe and nurturing relationships and environments can not be underestimated (Brent & Kolko, 1990; Gould et al., 2003; Stefanowski-Harding, 1990). Families experiencing increased distress, dysfunction, or violence frequently have difficulty providing for the needs of a distressed child (Wise & Spengler, 1997). Risk for the child increases dramatically when one or both parents are experiencing mental health problems and/or suicidal behavior (Brent & Kolko; Gould et al.; Stefanowski-Harding; Stillion & McDowell; Weller et al., 2001). Similarly, children at risk for suicide are frequently isolated and alienated from their peers (Stefanowski-Harding, 1990), have poor social support (Weller et al., 2001), and display poor social skills or ability to function in social situations (Brent & Kolko, 1990). These children often feel lonely, disconnected, and do not enjoy the protective benefits of acceptance and peer group identification. In addition, suicidal children frequently present with problems at school including learning disabilities and/or academic failure (Gould et al., 2003; Stillion & McDowell, 1996; Wise & Spengler, 1997). Causes or Precipitating Events of Suicide: The presence of recent stressors and precipitating events must not be overlooked (Gould et al., 2003; Roberts, 2000; Stillion & McDowell, 1996; Weller et al., 2001; Wise & Spengler, 1997). Psychosocial stressors or changes may be particularly hard on a child and may include loss or threatened loss (Stefanowski-Harding, 1990) such as moving, crises in the family, health problems, and other events toward which the child feels little or no control. Similarly, environmental factors including recent exposure to suicide or "contagion" (Brent & Kolko, 1990; Gould et al.) may place a child at even higher risk for considering suicide as a solution to her or his stressors. Stillion and McDowell advised that triggering events for high-risk children often appear trivial to adults and may include events as simple as a denied privilege or seemingly ordinary punishment. Further, reviews of empirical literature indicate that prior suicidal ideation and attempts are the most predictive risk factors for future suicidal behavior and completion (Gould et al.; Juhnke, 1996; Weller et al.; Wise & Spengler). Thus, mental health counselors should consider children who have previously coped with stressors by thinking about suicide or attempting to take their lives particularly vulnerable to continued coping in such a manner. Finally, those with an organized plan for suicide should be considered as presenting with a much elevated risk. Possible Symptoms or Warning Signs of Suicide:

5 Making suicidal statements. Being preoccupied with death in conversation, writing, or drawing. Giving away belongings. Withdrawing from friends and family. Having aggressive or hostile behavior. It is extremely important that you take all threats of suicide seriously and seek immediate treatment for your child or teenager. If you are a child or teen and have these feelings, talk with your parents, an adult friend, or your doctor right away to get some help. Other warning signs can include: Neglecting personal appearance. Running away from home. Risk-taking behavior, such as reckless driving or being sexually promiscuous. A change in personality (such as from upbeat to quiet). Identifying Suicidal thoughts and suicide attempts: Certain problems increase the chances of suicidal thoughts in children and teens. Other

6 problems may trigger a suicide attempt. Problems that increase the chances of suicidal thoughts include having: Depression or another mental health problem, such as bipolar disorder (manic-depressive illness) or schizophrenia. A parent with depression or substance abuse problems. Tried suicide before. A friend, peer, family member, or hero (such as a sports figure or musician) who recently attempted or died by suicide. A disruptive or abusive family life. A history of sexual abuse. A history of being bullied. Problems that may trigger a suicide attempt in children and teens include: Possession or purchase of a weapon, pills, or other means of inflicting self-harm. Drug or alcohol use problems. Witnessing the suicide of a family member.

7 Problems at school, such as falling grades, disruptive behavior, or frequent absences. Loss of a parent or close family member through death or divorce. Legal or discipline problems. Stress caused by physical changes related to puberty, chronic illness, and/or sexually transmitted infections. Withdrawing from others and keeping thoughts to themselves. Uncertainty surrounding sexual orientation. Signs of Depression: Signs of depression, which can lead to suicidal behavior, include: Feeling sad, empty, or tearful nearly every day. Loss of interest in activities that were enjoyed in the past. Changes in eating and sleeping habits. Difficulty thinking and concentrating. Complaints of continued boredom.

8 Complaints of headaches, stomach aches, or fatigue with no actual physical problems. Expressions of guilt and/or not allowing anyone to give him or her praise or rewards. Other Symptoms to Look for: 1. Frequent thoughts of death or fixation with death 2. Frequent suicidal thoughts without any arrangements 3. Suicidal thoughts with a definite plan or recent suicide attempt 4. Suicide attempts that required professional help 5. Family record of depression 6. Family record of fixation with suicidal thoughts 7. A hopeless, depressing attitude about life 8. Recent life events that strengthen a sense of hopelessness 9. Lack of interest in life with verbalization of wanting to die 10. Abrupt change in attitude from being depressed to cheerful 11. Feels there has been no real solution to any dilemmas, issues, or problems 12. Making statements such as 'i'm going to kill myself' - 'i wish I were dead' etc. 13. Getting the means to take your own life, such as buying a gun or stockpiling pills 14. Withdrawing from social contact and wanting to be left alone 15. Having mood swings, such as being emotionally high one day and deeply discouraged the next 16. Changing normal routine, including eating or sleeping patterns 17. Giving away belongings or getting affairs in order

9 18. Developing personality changes or being severely anxious or agitated 19. Saying goodbye to people as if they won't be seen again 20. Increasing use of alcohol or drugs Diagnosis and Treatment: Although clinicians are likely to address suicide at some point in their careers, many mental health counselors remain uncomfortable regarding the prospect of addressing suicidal patients. These feelings are frequently amplified when attempting to address suicidal issues with children. A low occurrence of childhood suicide, creates myths and misconceptions, and a general lack of awareness about this phenomenon making assessment of childhood suicide one of the most difficult of diagnostic tasks. It is possible that the prevalence of suicidal behavior in children is grossly underestimated due to statistical classification errors and adults' unwillingness to believe that children can and do plan and implement suicides. There is a lack of preparation for dealing with child suicide, discomfort, and denial as key elements to clinicians' difficulties in addressing child suicide. Nonetheless, mental health counselors must be prepared to assess for child suicide and intervene appropriately. Although mental health counselors are often on the front lines for assessing, referring, and treating children, information regarding suicide risk in children and recommendations for assessing suicide risk in this population tend to be scattered across disciplines. Evidence indicates some commonality of risk factors and course of suicidal behavior among children, adolescents, and adults, but the unique nature of children's developmental functioning presents unique risk factors and particular challenges for accurate assessment. Assessing Children for Suicide: Before engaging in a crisis where suicidal assessment or intervention is required, there is a particular need for the mental health counselor to prepare by addressing their own thoughts, feelings, and fears regarding conducting this particular suicide assessment. Preparation assists in recognizing the difficulties inherent in crisis work with children and minimize the likelihood of denying the seriousness of the situation. It is important not to acting on misinformation, or nervously rush through an interview. In addition, the use of typical adapting questions used in a suicide assessment to cover a range of developmental levels. :

10 Ask directly if the client has thoughts of suicide. Have you thought of committing suicide? Are you thinking of killing yourself? In this case, subtlety is counterproductive. If the answer is anything but a confident No, then assessment should proceed. Even in cases when a client answers by saying No, continued exploration and discussion of what the client has said or presented that may be related to suicidal ideation is warranted. Have there been previous attempts? (When, surrounding circumstances, rescuer?) For example: When? How often? What happened? What was going on in your life at the time? If attempts were made, then exploration of method and rescuer should be explored. If the client indicates having thoughts or having made attempts in the past, even if there is no current ideation, past experiences should be thoroughly explored. If the client does not answer questions about suicide, the answers are vague, or if the client conveys that he/she has entertained thoughts of suicide then Are the thoughts pervasive or intermittent? When was the last time the thought occurred to the client? Do these thoughts typically occur in times of crisis? Is there a specific precipitating event? Even if answers to these questions continue to be vague or seem to be more intermittent, ideas of how the person might commit suicide need to be explored. Is there a plan? What are the details of the plan? How extensive is the plan?

11 Examples: How have you thought of killing yourself? When would you carry out the plan? Do you have a date and time? Where would you be? Who would you want to find you? What is the lethality of the means/method? Is there access to the identified means? Examples: If you were to commit suicide, how would you do it? Do you have the pills? Where are they? What type of pills would you take? What type of gun? Where would you get the gun? Do you have bullets? Where is the gun? The bullets? Do you have a rope/cord? The previous questions have related specifically to suicide ideation. In addition, questions that assess for risk and protective factors are explored. All of this information aids in determining risk and subsequent interventions. Is the client using drugs or alcohol? What are the client s social supports? Does the client have a religious or spiritual affiliation? How is the client discussing suicide and potential aftermath? Do fantasies seem to be positive or painful? Is the client able to see any alternatives to suicide? How does the client respond to challenges to distorted thinking?

12 Plan and Conduct a Crisis Assessment It is important to spend several moments attempting to engage the child in some sort of small talk, conversation, or activity that conveys interest and caring to the child. It is important to communicate to the child the specific reason for the interview and to structure the interview in such a way that is comforting rather and not punitive in nature. When opening an interview, it is important to communicate to the child the specific reason for the interview, that he or she is not in trouble, that it is safe to tell the truth, and that there are no right or wrong answers. The clinician should take breaks during this section to ascertain whether the child is able to understand these instructions; the child should also be provided an opportunity to ask any questions he or she may have regarding the interview. At this time, decisions must also be made regarding who is to be present for which portions of the interview. Although the presence of a caregiver may serve as a support for the child, caregiver presence also increases the possibility of the adult attempting to speak for or correct the child and the adult's emotional reaction to the content. The involvement of adults may result in the child withholding or changing information out of fear of repercussion or worry about upsetting the caregiver. Asking parents and teachers to describe their observations regarding emotional and behavioral themes to the child's play may, however, provide important clues regarding the child's current level of functioning. Indeed, observations of play, drawings, or stories that involve images of death and harm to self may spark parent or teacher concerns and prompt visits to the counselor for children who may have otherwise been unnoticed. Steps to Develop a Treatment Plan: The foundation of a good treatment plan is based on the gathering of the correct data. This involves following logical steps the built-in each other to help give a correct picture of the problem presented by the client or patient: The mental health clinician must be able to listen, to understand what are the struggles the client faces. this may include: issues with family of origin, current stressors, present and past emotional status,

13 present and past social networks, present and past coping skills, present and past physical health, self-esteem, interpersonal conflicts financial issues cultural issues There are different sources of data that may be obtained from a: clinical interview, Gathering of social history, physical exam, psychological testing, contact with client s or patient s significant others at home, school, or work The integration of all this data is very critical for the clinician s effect in treatment. It is important to understand the client s or patient s present awareness and the basis of the client's struggle, to assure that the treatment plan reflects the present status and needs of the client or patient. There 5 basic steps to follow that help assure the development of an effective treatment plan based on the collection of assessment data. Step 1, Problem Selection and Definition: Even though the client may present different issues during the assessment process is up to the clinician to discern the most significant problems on which to focus during treatment. The primary concern or problem will surface and secondary problems will be evident as the treatment process continues. The clinician may must be able to plan accordingly and set some secondary problems aside, as not urgent enough to require treatment at this time. It is

14 important to remember that an effective treatment plan can only deal with one or a few problems at a time. Focusing in too many problems can lead to the lost of direction and focus in the treatment. It is important to be clear with the client or patient and include the client s or patient s own prioritization of the problems presented. The client s or patient s cooperation and motivation to participate in the treatment process is critical. Not aligning the client to participate my exclude some of the client s or patient s needs needing immediate attention. Every individual is unique in how he or she presents behaviorally as to how the problem affects their daily functioning. Any problems selected for treatment will require a clear definition how the problem affects the client or patient. It is important to identify the symptom patterns as presented by the DSM-5 or Diagnostic and Statistical Manual or the International Classification of Diseases (ICD). EXAMPLES OF SUICIDAL IDEATION BEHAVIORAL DESCRIPTOR: 1. Frequent thoughts of death. 2. Frequent fixation with death. 3. Frequent or continuing suicidal thoughts without any arrangements. 4. Constant suicidal thoughts with a definite plan. 5. Recent suicide attempt. Step 2, Long Term Goal Development:

15 This step requires that the treatment plan includes at least one broad goal that targets the problem and the resolution the problem. These long term goals must be stated in non-measurable terms but instead indicate a desired positive outcome at the end of treatment. EXAMPLES OF LONG TERM GOALS FOR SUICIDAL IDEATION: 1. Residency in a suitable level of care to securely attend to the suicidal crisis. 2. Verbalize a sense of hope for self and the future. 3. Relieve the suicidal desire and or mind-set and return to the maximum level of prior daily functioning. 4. Stabilize the suicidal predicament. 5. Stop any hazardous standards of living and solve the emotional divergence that inspire the suicidal pattern. Step 3, Objective or Short Term Goal Construction: Objectives or short term goals must be stated in measurable terms or language. They must clearly specify when the client or patient can achieve the established objectives. The use of subjective or vague objectives or short term goals is not acceptable. Most or all insurance companies or mental health clinics require measurables objectives or short term goals. It is important to include the patient s or client s input to which objectives are most appropriate for the target problems. Short term goals or objectives must be defined as a number of steps that when completed will help achieve the long-term goal previously stated in none measurable terms. There should be at least two or three objectives or short-term goals for each target problem. This helps assure that the treatment plan remains dynamic and adaptable. It is important to include Target dates. A Target day must be listed for each objective or short-term goal.

16 If needed, new objectives or short-term goals may be added or modified as treatment progresses. Any changes or modifications must include the client s or patient s input. When all the necessary steps required to accomplish the short-term goals or objectives are achieved the client or patient should be able to resolve the target problem or problems. If required all short term goals or objectives can be easily modify to show evidence based treatment objectives. The goal of evidence based treatment objectives (EBT) is to encourage the use of safe and effective treatments likely to achieve results and lessen the use of unproven, potentially unsafe treatments. To use EBT in treatment planning state restate short term goals in a way that steps to complete that goal and achieve results. For example, the short term goal 13. Increase positive self-descriptive statements. Can be restated as; By the end of the session the patient or client will list at least 5 positive self descriptions of himself or herself, and assess how they can help alleviate the presenting problem Remember, that it must be stated in a way one can measure effectiveness. It is important to note that traditional therapies usually rely more heavily on the relationship between therapist and patient and less on scientific evidence of proven practices. EXAMPLES OF SHORT TERM GOALS FOR SUICIDAL IDEATION: 1. Reinstate a regular eating and sleeping pattern. 2. Report a reduction in the occurrence and strength of the suicidal thoughts. 3. Express and demonstrate an augmented sense of hope for self. 4. Report no longer feeling the desire to take his or hers own life. 5. Distinguish the positive features, relationships, and achievements in his or her life.

17 Step 4, Strategies or Interventions: Strategies or interventions are the steps required to help complete the short-term goals and long-term goals. Every short term goal should have at least one strategy. In case, short term goals are not met, new short term goals should be implemented with new strategies or interventions. Interventions should be planned taking into account the client s needs and presenting problem. EXAMPLES OF INTERVENTIONS FOR SUICIDAL IDEATION: 1. Probe client's feelings of despair related to his or her family relationships. 2. Hold family therapy sessions to promote communication of the client's feelings of sadness, hurt, and anger. 3. Evaluate the need for antidepressant medication and arrange for a prescription, if necessary. 4. Observe client for effect of and compliance with prescribed medication. Confer with prescribing physician on a regular basis. 5. Form an agreement with client, distinguishing what he or she will and won't do when enduring suicidal thoughts or impulses. Step 5, Diagnosis: The diagnosis is based on the evaluation of the clients present clinical presentation. When completing diagnosis the clinician must take into account and compare cognitive, behavioral, interpersonal, and emotional symptoms as described on the DSM-5 Diagnostic Manual. A diagnosis is required in order to get reimbursement from a third-party provider. Integrating the information presented by the DSM-5 diagnostic manual and the current

18 client s assessment data will contribute to a more reliable diagnosis. it is important to note that when completing a diagnosis the clinician must have a very clear picture all behavioral indicators as they relate to the DSM-5 diagnostic manual. Possible DSM V CODE Paired with ICD_9-CM COdes: Diagnostic Suggestions for Children with Suicidal Problems: (Parenthesis Represents ICD-10-CM Codes Effective ). (. ) Major Depressive Disorder. (. ) Single episode (F32.0) Mild (F32.1) Moderate (F32.2) Severe (F32.3) With psychotic features (F32.4) In partial remission (F32.5) In full remission (F32.9) Unspecified. (. ) Recurrent episode (F33.0) Mild (F33.1) Moderate (F33.2) Severe (F33.3) With psychotic features (F33.41) In partial remission (F33.42) In full remission (F33.9) Unspecified Bipolar I Disorder

19 Specify: Current or most recent episode manic (F31.1 1) Mild (F31.12) Moderate (F31.13) Severe (F31.2) With psychotic features (F31.73) In partial remission (F31.74) In full remission (F31.9) Unspecified (F31.0) Current or most recent episode hypomanic (F31.73) In partial remission (F31.74) In full remission (F31.9) Unspecified Current or most recent episode depressed (F31.31) Mild (F31.32) Moderate (F31.4) Severe (F31.5) With psychotic features (F31.75) In partial remission (F31.76) In full remission (F31.9) Unspecified (F31.9) Current or most recent episode unspecified (F31.81) Bipolar II Disorder Specify current or most recent episode: Hypomanic, Depressed Specify course if full criteria for a mood episode are not currently met: In partial remission, In full remission

20 Specify severity if full criteria for a mood episode are not currently met: Mild, Moderate, Severe (F34.0) Cyclothymic Disorder Specify if: With anxious distress Substance/Medication-Induced Bipolar and Related Disorder Bipolar and Related Disorder Due to Another Medical Condition Specify if: (F06.33) With manic features (F06.33) With manic- or hypomanic-like episode (F06.34) With mixed features (F31.89) Other Specified Bipolar and Related Disorder (F31.9) Unspecified Bipolar and Related Disorder (F41.1) Generalized Anxiety Disorder (F41.8) Other Specified Anxiety Disorder (F41.9) Unspecified Anxiety Disorder (F43.8) Other Specified Trauma- and Stressor-Related Disorder (F43.9) Unspecified Trauma- and Stressor-Related Disorder (F43.1 0) Posttraumatic Stress Disorder (includes Posttraumatic Stress) V62.89 (Z65.8) Religious or Spiritual Problem (F60.7) Dependent Personality Disorder (F60.6) Avoidant Personality Disorder (F60.2) Antisocial Personality Disorder (F60.3) Borderline Personality Disorder

21 (F60.89) Other Specified Personality Disorder (F60.9) Unspecified Personality Disorder Overall Integration of a Treatment Plan: Choose one presenting problem. This problem must be identified through the assessment process. Select at least 1 to 3 behavioral definitions for the presenting problem. if a behavior definition is not listed feel free to define your own behavioral definition. Select at least long-term goal for the presenting problem. Select at least two short-term goals or objectives. Add a Target Date or the number of sessions required to meet this sure term goals. If none is listed feel free to include your own. Based on the short-term goals selected previously choose relevant strategies or interventions related to each short term goal. If no strategy or intervention is listed feel free to include your own. Review the recommended diagnosis listed. Remember, these are only suggestions. Complete the diagnosis based on the client's assessment data. Sample Treatment Plan: Present Behavioral Descriptors of Problem:

22 Frequent thoughts of or fixation with death. A hopeless, depressing attitude about life tied with recent life events that strengthen this. Social estrangement, indolence, and lack of interest with verbalization of wanting to die.. Long Term Goals: Verbalize a sense of hope for self and the future. Relieve the suicidal desire and or mind-set and return to the maximum level of prior daily functioning. Stabilize the suicidal predicament Short Term Goals Objectives: Express and demonstrate an augmented sense of hope for self. Report no longer feeling the desire to take his or hers own life.

23 Strategy or Intervention for Goal 1: Assist client in becoming aware of life factors that were significant precursors to the beginning of his or her suicidal thoughts. Hold family therapy sessions to promote communication of the client's feelings of sadness, hurt, and anger. Support client to be honest and direct concerning suicidal impulses. Strategy or Intervention for Goal 2: Evaluate suicidal thoughts, taking into consideration degree of thoughts, the presence of a primary and back-up plan, previous attempts, and family record. Support client to express feelings related to suicidal thoughts in order to clarify them and increase insight as to the causes. DSM V Diagnosis: (F32.1) Major Depressive Disorder - Moderate - Single episode

24 (F41.1) Generalized Anxiety Disorder Copyright 2011 THERAPYTOOLS.US All rights reserved