New
Hope Case Discussion
Dr. Bill
Gaultiere
This
case discussion demonstrates the suicide intervention skills
we teach at New Hope. It's based on actual chatter comments
from a New Hope Online transcript. The chatter's comments are
in regular type and my sample counselor responses are in italics.
My comments and instructions follow each interchange in the
parentheses.
"I
had a stroke. I lost my hand."
"What
do you mean you lost your hand?" (This is an open-ended question
to clarify and to get more information)
"The
stroke took away my life. My whole left side is paralyzed.
I can't use my hand or my foot. I lost my job, my friends."
"It
sounds like you feel devastated." (Reflecting feelings statement
to communicate care, validate feelings, and invite further self-disclosure.)
"I
have a bad artery. Doctor says it was a fluke accident. I
pray for God to heal me, but it don't work. Does that mean
God hates me?"
"It's
discouraging for you that God hasn't answered your prayers for
healing." (Reflecting feelings combined with a summary.)
"If
God doesn't hate me then why won't he heal me?"
"It
seems to you that God is against you." (Don't try to answer
a theological question like this. Instead focus on the pain.)
"Why
did God take away my hand? Why not take it away from murderers
and rapists?"
"It
feels so unfair. You're angry with God about this."
"He
allowed the stroke that took away my life. My life sucks, I
wanna die."
"Are
you having suicidal thoughts?" (Assess for suicidality whenever
it might be present.)
"I
can end it all right now."
"How
would you kill yourself?" (Does he have a suicide plan and
if so is it lethal?)
"I
have a loaded gun with me."
"Do
you intend to shoot yourself?" (His plan is lethal! If you
have any concern that he's liable to pull the trigger today
then contact the police.)
I'm
very concerned for you. Please put the gun away in a safe place
so we can talk. (Try to connect and to establish safety.)
"Okay.
I put it away. It's locked up."
"What
reasons do you have for living?" (Look for positive reasons
for living to reinforce, to give hope.)
"None.
My life is hell since I lost my left side."
"What
is something that you enjoy?" (Don't accept an answer of nothing.
Keep searching).
"I
can't remember the last time I didn't feel bad."
"Tell
me about your family." (This is an open probe to invite self-disclosure,
to find something positive in his life.)
"My
dad died years ago. My mom and my sister said they don't want
to talk to me anymore. I'm a burden to them."
"That's
hurtful." (Instead of finding a positive reason for living
to reinforce, a negative emerged so go back into reflecting
feelings.)
"What
friends do you interact with?" (An open-ended question. Still
searching for something to give hope.)
"I
used to play cards on Fridays with some old friends from college.
Can't now because of my hand."
"I
imagine you miss being with your friends. It would be hard
to play cards with one hand, but you could try." (A reflecting
feelings statement leading into an encouragement to try.)
"I
guess."
"Tomorrow
is Friday. What do you think about calling your buddies to
join them?" (An open-ended question to help him find some positive
motivation.)
"I
don't think they'd want me to play."
"But
you'd like to play cards with your friends and you don't know
if it's an option until you ask." (Reinforcing his implied
desire to play and nudging him to ask.)
"Yeah."
"Will
you call your friends tonight?"
"I
see your point. Playing cards is better than blasting my brains
out! I'll call."
"If
you feel suicidal again will you promise to call us at 714-NEW-HOPE?"
(Set a contract for living.)
"Yeah."
"Would
you like me to pray for you before we say goodbye?"
"That
won't do any good."
"I
believe it will and you could try to believe."
"Okay."
"Dear
God, I thank you that you're listening now and that you are
so concerned for my friend. He's been struggling since his
left side became paralyzed. It just doesn't feel fair. It's
hard for him to manage without his hand. We don't understand
why. But we continue to hope that he'll regain full use of
his hand and left side. In the meantime, we pray that my friend
would rediscover a sense of joy in his life and that he would
have the opportunity to play cards with his friends tomorrow.
In Jesus' name we pray. Amen."
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