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Adolescent Case

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Adolescent Case Program Transcript

INTRODUCTION

Warning: The following scenario discusses depression and suicide. It can be emotionally triggering. The scenario lasts 8–11 minutes. If you need to exit the scenario, please stop at any time. You are preparing to meet with a high school student who has abruptly started skipping classes and failing assignments. A friend of the student recently committed suicide, which may be the cause of her disengagement. The parent and school administration have agreed the student will leave early today to attend counseling. You are waiting for her to arrive.

NOTE: When you click on a hyperlink in this document, you will move to the intended result of the described response or action.

YOUR OFFICE

(You are seated behind your desk facing your closed office door. There is a knock on the door, it opens, and your client enters your office.)

CLAIRE: Hi, I’m here for my appointment. I’m Claire. (closes door)

(Your client is seated on the couch with her arms crossed and looking toward the ground.)

o Click here to continue to Decision Point 1.

Adolescent Case

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DECISION POINT 1 First, assess your client’s body language; something you should be doing constantly. What do you interpret?

1. YOUR RESPONSE: She doesn’t want to be here. RESPONSE OPTION 1 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 1 -OR-

2. YOUR RESPONSE: She looks uncomfortable. RESPONSE OPTION 2 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 1 RESPONSE 1 – FEEDBACK

• Right. There are lots of ways to interpret body language. Make sure you are doing these kinds of mental checks often.

o Click here to continue to Decision Point 2. RESPONSE 2 – FEEDBACK

• Right. There are lots of ways to interpret body language. Make sure you are doing these kinds of mental checks often.

o Click here to continue to Decision Point 2.

Adolescent Case

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DECISION POINT 2 How do you begin the session?

1. YOUR RESPONSE: Ask about her day. RESPONSE OPTION 1 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 2 -OR-

2. YOUR RESPONSE: Let her know this space is safe and confidential. RESPONSE OPTION 2 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 2 RESPONSE 1 – FEEDBACK

• Starting with small talk works, but before asking what’s going on, make sure she knows that this space is safe and confidential, unless she mentions hurting herself or others.

o Click here to let her know this space is safe and confidential. RESPONSE 2 – FEEDBACK

CLAIRE: So, you can’t tell anyone about this? (shakes head as though she’s confused) OK.

• Right. There are lots of ways to interpret body language. Make sure you are doing these kinds of mental checks often.

o Click here to continue to Decision Point 3.

Adolescent Case

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DECISION POINT 3 How do you proceed?

1. YOUR RESPONSE: Tell her that her parents are worried about her. RESPONSE OPTION 1 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 3 -OR-

2. YOUR RESPONSE: Ask her about problems at school. RESPONSE OPTION 2 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 3 -OR-

3. YOUR REPONSE: Ask her why she’s here. RESPONSE OPTION 3 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 3 RESPONSE 1 – FEEDBACK

CLAIRE: (sarcastically) Sorry! o Click here to ask her why she is here.

RESPONSE 2 – FEEDBACK

CLAIRE: (defiantly) What problems? o Click here to ask her why she is here.

RESPONSE 3 – FEEDBACK

CLAIRE: My dad said I had to. (shakes head) It really sucks. Like, I didn’t choose to be here.

o Click here to continue to Decision Point 4.

Adolescent Case

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DECISION POINT 4 Active listening can inspire trust and encourage her to interact with her emotions. Indirect questions like these can help facilitate direct mental health questions later on.

1. YOUR RESPONSE: “Sometimes we have to go places we don’t choose.” RESPONSE OPTION 1 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 4 -OR-

2. YOUR RESPONSE: “Your dad only said that because he cares.” RESPONSE OPTION 2 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 4 -OR-

3. YOUR REPONSE: “It sounds like things are out of your control. How does that feel?”

RESPONSE OPTION 3 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 4 RESPONSE 1 – FEEDBACK

CLAIRE: OK, I get it. You don’t have to talk to me like a kid.

• Be careful, this may come off as condescending. You want to create a comfortable environment.

o Click here to say, “I apologize, that was insensitive. Can we start over?”

CLAIRE: Yeah, fine. Let’s just get this over with. (looks out the window)

• Since the client didn’t choose to be here, ask if she feels like things are out of her control.

o Click here to say, “It sounds like things are out of your control. How does that feel?”

Adolescent Case

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RESPONSE 2 – FEEDBACK CLAIRE: What the hell! Whose side are you on here?

• Be careful, you are meant to be a neutral party. It’s important to maintain trust through active listening.

o Click here to say, “I apologize, that was insensitive. Can we start over?”

CLAIRE: Yeah, fine. Let’s just get this over with. (looks out the window)

• Since the client didn’t choose to be here, ask if she feels like things are out of her control.

o Click here to say, “It sounds like things are out of your control. How does that feel?”

RESPONSE 3 – FEEDBACK

• Affirming your client’s feelings is a great way to keep building trust. o Click here to Continue to Decision Point 5.

Adolescent Case

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CLAIRE: It feels awful. Like no one’s listening to me. (shakes head) At least I don’t have to go to rehearsal anymore.

DECISION POINT 5 Now that the client has opened up, what can you do to keep the conversation going?

1. YOUR RESPONSE: Ask about problems at school. RESPONSE OPTION 1 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 5 -OR-

2. YOUR RESPONSE: Ask what she does for fun. RESPONSE OPTION 2 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 5 -OR-

3. YOUR REPONSE: Ask about rehearsal. RESPONSE OPTION 3 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 5 RESPONSE 1 – FEEDBACK

CLAIRE: What problems? Why does everyone think there is some kind of big problem? I’m fine. What’s your problem? (gestures toward you)

• Don’t be too quick to jump to a “problem.” This kind of language can make a client think they’ve done something wrong.

o Click here to say, “You’re right. I was out of line.”

CLAIRE: Whatever. (looks out the window)

• Try asking about rehearsal because she just brought that up. o Click here to ask about rehearsal.

RESPONSE 2 – FEEDBACK

CLAIRE: I don’t know…stuff. (looks away shaking her head)

• Claire already mentioned an interest, so this question might come off like you aren’t listening.

o Click here to ask about rehearsal.

RESPONSE 3 – FEEDBACK CLAIRE: It’s nothing. It’s just a dumb play. I don’t really want to talk about it. (looks out the window)

o Click here to continue to Decision Point 6.

Adolescent Case

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DECISION POINT 6 Notice how she shuts down after being asked about the play. This may require a more direct approach. How should you proceed?

1. YOUR RESPONSE: Change the subject. RESPONSE OPTION 1 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 6 -OR-

2. YOUR RESPONSE: Keep the discussion focused on rehearsal. RESPONSE OPTION 2 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 6 RESPONSE 1 – FEEDBACK

• She may be backpedaling from emotional tension. It’s important to recognize she can’t work through her emotions if she avoids them.

o Click here to keep the discussion focused on rehearsal. RESPONSE 2 – FEEDBACK

• Pushing on a point of tension can be uncomfortable, but your role is to help her work through emotions. She can’t do that if she avoids them.

o Click here to continue to Decision Point 7.

Adolescent Case

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CLAIRE: (looks directly at you) Oh, you want to hear about the play. (sarcastically) It’s great. So great Jules would rather kill herself than be in it.

DECISION POINT 7 Careful. Claire is starting to talk flippantly about suicide. How will you proceed?

1. YOUR RESPONSE: Tell her she shouldn’t joke about suicide. RESPONSE OPTION 1 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 7 -OR-

2. YOUR RESPONSE: Ask about Jules. RESPONSE OPTION 2 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 7 RESPONSE 1 – FEEDBACK

• This isn’t the recommended way to treat someone dealing with loss. Strong reactions may be coping mechanisms.

o Click here to ask about Jules. RESPONSE 2 – FEEDBACK

• It may be tough, but she brought Jules up, so it makes sense to stay on the topic.

o Click here to continue to Decision Point 8.

Adolescent Case

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CLAIRE: She was my best friend, and she’s gone. Everyone keeps telling me, “You’ll be OK Claire,” but … (shrugs) I honestly don’t think I will. And my parents are all, “Keep doing the play, Claire. It’s good for you, Claire. Keep hanging out with your friends, Claire. Keep being normal, Claire.” And I have to keep playing along and going to those stupid rehearsals even though it reminds me of her. (crying as she puts her head in her hand).

DECISION POINT 8 How should you proceed when a client starts crying?

1. YOUR RESPONSE: Get up and sit next to her to reassure her. RESPONSE OPTION 1 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 8 -OR-

2. YOUR RESPONSE: Tell her it will be alright. RESPONSE OPTION 2 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 8 -OR-

3. YOUR REPONSE: Let her cry, offer tissues. RESPONSE OPTION 3 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 8 RESPONSE 1 – FEEDBACK

• Careful. You want to avoid crowding people who are crying. You are there to create a relaxed, safe place.

o Click here to let her cry and offer tissues. RESPONSE 2 – FEEDBACK

• You can’t guarantee it will be alright, and saying it can minimize someone’s feelings, making them feel even worse.

o Click here to let her cry and offer tissues.

RESPONSE 3 – FEEDBACK

• This is the correct course of action. o Click here to continue to Decision Point 9.

Adolescent Case

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DECISION POINT 9 What do you say next?

1. YOUR RESPONSE: “What’s the thought that made you cry?” RESPONSE OPTION 1 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 9 -OR-

2. YOUR RESPONSE: “Don’t you feel better?” RESPONSE OPTION 2 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 9 -OR-

3. YOUR REPONSE: “Can we talk more about what you’re feeling?” RESPONSE OPTION 3 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 9 RESPONSE 1 – FEEDBACK

• Make sure your client continues interacting with her feelings, not just her thoughts.

o Click here to ask, “Can you talk more about what you’re feeling?” RESPONSE 2 – FEEDBACK

• Try not to assume her feelings. Instead, ask about the cause. o Click here to ask, “Can you talk more about what you’re feeling?”

RESPONSE 3 – FEEDBACK

CLAIRE: (crying) I was … I was remembering Jules and how happy she was last year during callbacks. Callbacks were posted, and she got the part she wanted. I think that was the last time I saw her so happy. (pauses, then with voice quivering) And now I won’t see her that happy again. (continues to cry and puts her head in her hand)

• The client seems to be opening up more. o Click here to continue to Decision Point 10.

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CLAIRE: (crying) I’m sorry. It’s been so hard to deal with her (pauses), with her being gone. I felt really alone. I haven’t talked about it with anyone since it happened.

ACTION POINT At this point, it might be a good idea to perform a suicide assessment.

DECISION POINT 10 What signs (if any) have you noticed up to this point that could prompt a mental health evaluation?

1. YOUR RESPONSE: Recklessness RESPONSE OPTION 1 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 10 -OR-

2. YOUR RESPONSE: Dramatic changes in mood RESPONSE OPTION 2 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 10 -OR-

3. YOUR REPONSE: Withdrawing from friends, family, or society RESPONSE OPTION 3 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 10 OR-

4. YOUR REPONSE: Rage or anger RESPONSE OPTION 4 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 10 OR-

5. YOUR REPONSE: None of these RESPONSE OPTION 5 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 10

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RESPONSE 1 – FEEDBACK

• The client hasn’t presented this sign but is withdrawn and has had a slightly unstable mood. You will need to monitor these as you go forward.

o Click here to continue with session. RESPONSE 2 – FEEDBACK

• True. This, as well as withdrawing from school, is a factor you will need to monitor as you go forward.

o Click here to continue with session.

RESPONSE 3 – FEEDBACK

• True. This, as well as changes in mood, are factors you will need to monitor as you go forward.

o Click here to continue with session.

RESPONSE 4 – FEEDBACK

• The client hasn’t presented this sign but is withdrawn and has had a slightly unstable mood. You will need to monitor these as you go forward.

o Click here to continue with session.

RESPONSE 5 – FEEDBACK

• The client has presented a few of these signs. If you have time after completing the experience, go back and rewatch the interactions up to this point.

o Click here to Continue with session.

ACTION POINT Considering the Columbia Suicide Severity Scale, now is the time to ask a suicide ideation prompt. It may seem overly direct, but it’s important to be able to ask this question like you’d ask any other.

o Click here to ask, “Have you had any thoughts about killing yourself?”

CLAIRE: What, of course not. I’m just … I’m trying to not let everyone down. I … I feel like I can’t talk about this with anyone. Everyone is trying to help, but nobody listens. (pauses) You’re not going to tell anyone about this, are you?

• Reaffirm that this conversation is confidential, unless the client mentions hurting herself or others.

o Click here to continue to Decision Point 11.

Adolescent Case

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DECISION POINT 11 The client is still quite emotional but seems to have opened up to the conversation. How will you proceed in a gentle way?

1. YOUR RESPONSE: “It’s not your fault, you couldn’t have known this would happen.”

RESPONSE OPTION 1 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 11 -OR-

2. YOUR RESPONSE: “You have to remember, she’s in a better place now.” RESPONSE OPTION 2 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 11 -OR-

3. YOUR REPONSE: “It’s OK to cry, maybe it would help to talk about what happened?”

RESPONSE OPTION 3 – CLICK HERE TO CHOOSE THIS RESPONSE FOR DECISION POINT 11 RESPONSE 1 – FEEDBACK

CLAIRE: It’s not my fault? How would you even know. You don’t even know anything about it. She told me she was going to do it. She joked about it, and I just ignored her like it wasn’t serious. (shakes head) How is it not my fault?

• Statements like “it’s not your fault” or “she’s in a better place” can minimize a client’s feelings. Remember to give her space.

o Click here to ask, “Can you talk more about what you’re feeling?” RESPONSE 2 – FEEDBACK

CLAIRE: (crying and sarcastically) She’s in a better place now? What does that even mean? She’s gone! You know I … I didn’t listen when she joked about killing herself, and I just … (pauses) I just went about my life like nothing was wrong.

• Statements like “it’s not your fault” or “she’s in a better place” can minimize a client’s feelings. Remember to give her space.

o Click here to ask, “Can you talk more about what you’re feeling?”

RESPONSE 3 – FEEDBACK CLAIRE: I just … (pauses) all I can think about is how Jules joked about wanting to die and how she was going to do it. I just ignored it like it was nothing.

• Though the client is still in obvious emotional pain, it’s a good sign she feels open enough to talk it through.

Adolescent Case

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o Click here to continue to Conclusion.

CLAIRE: God, why is this so hard. I can’t stand feeling like this all the time. It’s made every day a drag. (pauses) I can’t believe I waited this long to talk to someone about it.

CONCLUSION

You’ve completed the exercise.

Click here to start the experience again.