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Two essential clinical skill-sets for counselors: The mental status exam and suicide assessment

Two essential clinical skill-sets for counselors: The mental status exam and suicide assessment. The Plan. Very quick overview of MSE and suicide assessment procedures The emphasis is on material you can use in your courses. MSE Purpose.

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Two essential clinical skill-sets for counselors: The mental status exam and suicide assessment

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  1. Two essential clinical skill-sets for counselors:The mental status exam and suicide assessment

  2. The Plan • Very quick overview of MSE and suicide assessment procedures • The emphasis is on material you can use in your courses

  3. MSE Purpose • 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

  4. MSE General Categories • Appearance • Behavior/psychomotor activity • Attitude toward examiner (interviewer) • Affect and mood • Speech and thought • Perceptual disturbances • Orientation and consciousness • Memory and intelligence • Reliability, judgment, and insight

  5. Video Clip – Carl • 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

  6. MSE Common Pitfalls • 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

  7. Cultural Issues • 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

  8. Cultural issues – assignment: Generating Possible invalid conclusions

  9. Part II: Suicide Assessment

  10. Preparation I • Self-Preparation: Questions to ask yourself • What 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

  11. Preparation II • Class 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

  12. Setting the Tone • Opening with a personal story about working with a suicidal client can help set the tone as: • Serious • Reflective • Personal • Professional • Open

  13. Essential Content • Bust the big myth • Get students more comfortable with this topic and with asking about suicide • Introduce core knowledge (suicide assessment interview components and a good reading assignment) • Practice a few skills (make it real) • Emphasize professional and ethical standards • Introduce suicide intervention • Outline decision-making components

  14. 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

  15. The New Narrative • Suicide thoughts and gestures don’t represent deviance • Suicide thoughts and gestures represent DISTRESS • And 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

  16. New Narrative II • The old narrative emphasized diagnostic interviewing • The new narrative implies: • Using strength-based paraphrases • Carl Rogers with a twist (O’Hanlon) • Exception and externalizing questions • Resource questions • No assumption of mental illness

  17. Video Clip • Tommie and John • Watch for directness • Watch for Tommie’s not always positive or cooperative responses

  18. Suicide Interview Components • Suicide risk factors • Suicide ideation • Suicide plan (SLAP) • Self-control • Suicide intent

  19. Classroom Activity I • Practice 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

  20. Classroom Activity II • Use interview tag-team to practice interview parts • Rapport and exploring risk factors and depression • Exploring suicide ideation and plan • Evaluating suicide intent and self-control • Try out an intervention or two • Caucus together to talk about ethics, professional standards, and decision-making

  21. Closing Comments • 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

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