Introduction
Suicide has been something that people had committed since the time of human inception ssesnd ever since there had been made approaches to remedy the situation and motivate people to live. Various therapies had been proposed by doctors and philosophers around the world to allow suicidal patients to effectively overcome their obsession with suicidal thoughts. In the following essay I will speak about one of the suicidal clients and explore the formal approach to handling suicidal clients in a greater detail.
Profile and description of a suicidal client: Assessment
I would like to start by saying that the patient, Mark, a 62-year-old white male, currently has several problems that need to be addressed simultaneously in order to ameliorate his health. One first of all needs to assure that he quits smoking, which is a truly serious problem for a person of his age. He is a middle class widower living on his own. He had two married children (son and daughter) who never call him or pay him a visit. Three years ago his wife died of cancer and ever since he had different obsessive thoughts about committing a suicide and leaving this life as early as possible.
Description of client’s presenting problem
The client appears to have several events impacting his life, which can be all three: situational, developmental and traumatic. The application of these two different events is seen below:
Situational. The patient is seen as experiencing one of the most powerful stressors: the death of a spouse. The individual knew that his wife was sick and she would have a surgery and underwent chemotherapy in 7 years ago. Still, ultimately she died from cancer.
In the past two years she had been in constant pain and suffering and that is in my opinion would negatively impact the mental and psychological condition of the patient. Also I need to note that the lack of communication with the friends and children “also contributed the patient’s desire to end his life” (Erens 2001). His children are all married and have several children of their own; still none of them would visit the patient after the death of his spouse. The grand children would not call or visit the patient either making him think that he is not needed or that as he noted it was his time to die, too.
Developmental even is about the current situation in which a person progresses through life. As we see the patient is relatively old and thus is more prone to depression and stress. Unlike other people who have the whole life in front of them and who strive to do everything possible to get affection from their peers and members of the opposite sex, the person who is 62 years old when speaking about the life typically looks back at what had happened rather than what will happen. Unlike young people who think about making a career and giving birth to children, the 62-year old man does not think about creating a family especially after recently having lost a spouse with who he lived most of his life. The patient understands that he had achieved many things in his life career wise and family wise. He had his own house, a car and stable income from the share in a mutual fund. To him now it appears that as he achieved many things already and as he does not want anything more in his life (no point of living) he indeed was considering several times how to end his life, before he would get terminally ill.
Traumatic. The patient after the death of a spouse had suffered heart attack and had been hospitalized twice. His overall health condition can be characterized as average, while the patient considers himself to be rather sick and not ready for anything in this life. The patient appears to be suffering from depression and lack of motivation, which is seen in all his speeches, conversation and actions. The patient currently has high blood pressure and high cholesterol levels. He oftentimes gets short of breath and considers himself bovine and too slow. I understood that the patient also had a rather low self-esteem and no purpose to live whatsoever. Indeed “once the person sees no point of living, he is included to commit a suicide“(Skelton 1996).
Mapping out client’s crisis event based on assumptions of crisis theory
Speaking about the assumptions of crisis theory and its relevance to the client I would like to note that it focuses on the routine stressors which surround us on a daily basis and accompany us throughout our life in the physical and social environment. Typically people are believed to react to stress via adaptive or maladaptive ways. Adaptive way is about reducing the stress, sadness and anxiety through changed lifestyles, regular exercise, relaxation techniques, and some extreme sports and feelings expression in counseling groups or with friends. Maladaptive ways are about using some external things like drugs, alcohol and cigarettes as well as denial of reality, psychosomatic complaints, social withdrawal and attempts to commit suicide. While adaptive ways allow people to remain psychical, emotional and functional equilibrium, the maladaptive ways only aggravate the situation and typically result in patient’s inability to function in the society and suicide attempts. For Mark routine stressors are those of many other people around him: strange noises outside his house at night, rude people on the streets or on the high way and communication problems with the shopping assistants who develop that strange way of communication with senior citizens.
In addition to routine stressors, people oftentimes experience extraordinary stressors which when accompanied by routine stressors only aggravate the situation and make the life of a patient more terrible and hard. The extraordinary stressors are unique, non-routine stressors, which because of their rarity have a more powerful and unexpected impact on the patient. The extraordinary stressor can be the loss of a spouse or close relative, loss of job, changing the apartment or a car, the car accident or a violent robbery. For Mark the extraordinary stressor can be considered the death of a spouse, but I chose to place the death of a spouse in the catastrophic stressors.
Developmental stressors are those related to ageing or changing stage of life from child to an adolescent, to adult, to a married adult, to a parent, to a pensioner. Developmental stressor as they take place usually causes much stress to people as they impact their mental and psychological health over a prolonged time period. The developmental stressors for Mark are certainly the absence of communication with his children as well as seeing many of the people around him die: his friends and former coworkers.
Chronic stressors are those that occur frequently and produce high levels of stress and anxiety in the patient as well as disrupt the patient’s state of peace, tranquility and equilibrium. These include abusive relationships, domestic violence, the sickness of a close relative or a spouse and some stressful jobs. In case of Mark I can say that the spouse’s sufferings for a few years before her death can be called chronic stressors as she would repeatedly and routinely suffer, demand “more attention to herself and services that Mark was willing to provide her” (Alessi 1999).
Catastrophic stressors are sudden and overwhelming stressor, which oftentimes are dangerous to a person or are viewed as extremely significant. These stressors typically cause physical and almost always a mental trauma. These stressors usually degrade “the patient’s self-esteem and personal sense of vulnerability to dangers and harms” (Butler et al, 1998). The death of a spouse I would classify as a catastrophic stressor for Mark, who actually understood that he too sooner or later will end up dying from some disease, so he is thinking about ending his life earlier in manner to avoid pain in the future.
The individual is constantly exposed to different types of stress and thus unless taking proper adaptive approaches is doomed to destruction, depression and suicide. Mark appears to be using only maladaptive approaches and therefore, experiences stress, depression, panic and willingness to die. I have to note here that Mark wanted to die for the past 2 years yet it appears that he had not taken any steps towards committing suicide yet and would like just for his life to end.
The stress theory contains the following premises as shown below:
Patients spend most of their time in the state of equilibrium, where they feel the most comfortable, relaxed and happy. This state of equilibrium is person-specific, based purely on personal view of the world and understanding of the environment in which she/he lives.
Stressors is what moves people out of equilibrium, still most of the time people manage to either remain within the equilibrium “emotionally and physically or would return to the state of equilibrium after short period of being out-of-the-equilibrium” (Blumenthal et al, 1999).
Traumas and catastrophic stresses is what pushes people away from the equilibrium and preserves them from quickly returning to the state of equilibrium. Even when people manage to regain emotional balance and equilibrium, it would be different from the emotional stability, balance and “equilibrium these people enjoyed prior to that particular stress” (Skelton 1996).
The critical theory as applied to Mark dates back to ancient times during which it had been defined and interpreted differently by different political, state and philosophical figures. This theory assumed that emotional crisis could happen only when an individual is unable to cope with the situation and adapt to it. Many modern psychiatrists and psychologists would contribute to modern understanding of a crisis. Crisis therefore, is not viewed as pathology and a bad thing, yet rather is viewed as a struggle for adjustment and personal adaptation in the face of problems that currently face the individual in stress.
The crisis theory with respect to Mark makes the following assumptions as shown in the essay below:
Crisis in the life of Mark is characterized by high levels of subjective distress and inability to modify the source of stress that are directly responsible for the crisis and stress.
Crisis which led to suicidal thoughts in Mark is caused by numerous factors and types of stressors, yet the patient needs to initially focus on the greatest and most important stressors and overcome them before engaging in analysis and understanding of other secondary stressors.
Death of a spouse, loss of children is likely to provoke most intense crisis reactions in most people with Mark being no exception to the rule.
The crisis reaction typically tends to become resolved within 6 to 9 weeks, yet their impact depends fully on the psychological state of an individual and either adaptive or maladaptive choices that that individual makes in life.
Successful crisis intervention is possible and appropriate at the time when individuals respond to environmental stress in which they are temporarily unable to cooperate and function rather than for individuals who suffer from chronic stress and prolonged psychological problems and difficulties.
Role of culture, race and ethnicity in the help-seeking process or symptom expression
It appears that culture might have some importance when playing a role in the help-seeking process, while race and ethnicity might be of lesser importance. Please refer to these roles as presented below:
- Culture. Culture plays an extremely important role in the US society. While the long-term initiatives made every American understand that neither race not ethnicity indeed makes you different from your peers with respect to stress, health, and opportunities, the culture indeed might provide an “extremely important glace at the core problems and opportunities”(Alessi 1999). One could use the culture to motivate an individual live a more happy life and enjoy the moment. During the intervention state I would probably tell Mark about Americans as being the winners and the best, people who never give up on things, let alone on life. Mark would be told that American soldiers during the war era would not give up when seeing their friends die from bullets and mines. Neither would they flee the battlefield when they helped to liberate Europe, Vietnam, Afghanistan or Iraq. Mark will be told that Americans just don’t run and their culture makes them more focused on the long-term and success rather than on some short-term solution as many find in suicide.
- Race. While this is of must lesser importance we should still use it to benefit the “client and help them get out of stress and abandon suicidal thoughts” (Colditz 1997). Thus, Mark should be told that as a white male he is still in control of the world regardless of what one says about racial emancipation and equal opportunities. This should be said in order to give Mark the faith in his future and ability to succeed in his life despite his old age and a major loss in life.
- Ethnicity. Once again, one might have to use maybe even discriminatory language yet it should be done so to benefit Mark. Thus he should be told that as a while Caucasian male he is superior to other people around him. He has a good status, a house, a car and many of the things that he certainly likes in life. While now he indeed has a major problem in his life he is no different from other people who lose their loved ones and friends yet still need to continue their living and struggling.
As one can see the role of culture, gender and race is to reframe the situation and make Mark understand that he has all the greatest opportunities just in front of him. We need to move Mark out of the state of disequilibrium and stress into the state where he would feel the most comfortable while at the same time developing some plans for his future life.
Overview of the social problem and facts known about it
Speaking about some social problems I would like to note that there exists little to none for Mark in his way to overcome stress, depression and suicidal thoughts. Since in the intervention stage we will discuss different ways of improving the life of Mark, the social problems might be the practices that are socially unacceptable for Mark. Overall, I did not envisage any social problems that prevented me from engaging in the process of stress intervention. I have to note though that I personally felt somewhat uneasy in the first 10 minutes, as I had to speak to a man who is much older and more experienced than me. Still, understating my good cause and importance of my assistance to Mark, I continued to communicate with the client and ultimately managed to resolve his problems.
Description of an assessment phase with the client
Thorough assessment as well as understanding of lethality and dangerousness and immediate psychosocial needs of Mark is instrumental before the intervention. Assessment is the first stage of effective intervention and treatment of people who are in crisis like Mark. The background information about Mark had been expressed earlier in the essay.
Since the critical part of any assessment with depressed and suicidal people like Mark is the assessment of lethality and the level of danger assessment, I defined the level of lethality of Mark as average assuming that while thinking about suicide once in a while, Mark would not commit it since when asked he had no plan as to how commit the suicide more efficiently and quickly.
Ethical issues in counseling involve the anonymity and secrecy regarding the patients. In order to advise the patients properly, it is vital to “know as much as possible about the patients meaning that the doctor oftentimes possesses sensitive information about the client” (Biddle et al, 2000). The ethics here is to keep the information about the client confidential. Furthermore, just like in any medical profession, it is necessary for doctors ‘not to harm’ the patient. So whenever, the doctor believes that a customer needs more than counseling he/she should direct the patient to the proper doctor or institution.
The types of interventions employed with the client
As for the intervention stage, I used different types of intervention aimed at different problems and stressors that contribute to Mark’s current condition. Speaking about psychoanalytic approach, one needs to remember that it is also called “talking therapy” (Skelton 1996). This therapy strives to analyze and find the roots and causes of behavior, feelings and problems. The person starts to express his/her unconscious mind and the relationship of that part of the mind to the conscious mind. This therapy is derived from the Freudian model that makes extensive use of free association, person’s dreams, transference, let alone other strategies used to explore the client’s mind. Usually, the client lies down on the sofa, while the therapist would take notes and engage in an interpretation of dreams and thoughts. The key of this theory is unconscious motivation. During this type of intervention, Mark would start to cry while lying on the sofa recalling certain events from his past life which I tried to get over with.
Gestalt therapy approach to counseling, on the other hand uses the ideal conditions of “here and now” and the relationship between the client and the outside world as developed by F.Perls and P.Goodman (Erens et al, 2001). Gestalt model had developed as a combinatory model that comprises existential, dialogical, and phenomenological approaches to counseling. This model promotes awareness of the patient rather than a denial. During this intervention phase, Mark, instead of avoiding the problems, pain or feelings was advised to emerge into them and thus engage in self-healing. Gestalt therapy promotes the concept of being in present. Mark was advised to stop imagining, unnecessary thinking, and experience the unpleasant things. He was advised to take full responsibility of one’s actions, accept no ‘should’, ‘must’ from anyone but oneself.
Another approach to intervention I would like to note in this essay was person-centered approach as founded by Carl Rogers. This approach resembles the Adlerian counseling approach because of the ‘becoming’ concept that in both approaches states that people are always moving towards their self-actualization. People like Mark are believed to have the needed tools to reach the desired potential, yet it takes different time for different people. People are born with a potential, yet typically during the life they lose connection with the reality. People are usually alienated from real selves and that can oftentimes become the cause of what one might think as mental illness. The approach states that “there is no such thing as mental illness” (Shephard 1997). Person-centered approach is believed to be the most optimistic approach among all since it states that every person at any time is able to connect to true self and reach the needed potential. The person-centered approach in my opinion was also extremely successful as it allowed Mark to start believing in his own powers and think about how to use these powers in the future to lead a peaceful life.
The counselor-person approach represents a rather lengthy therapy since it is the therapist who provides all the needed conditions for the patient to grow. Namely, “one provides the clients with genuineness, understanding, empathy, and positive regard” (Spirduso 1995). The therapist needs to be transparent, open and willing to communicate to positively impact the client. To effectively use this kind of healing and intervention, I had to see the world through client’s eyes and accept him the way he was. Ultimately, this approach allows the client to move to self-actualization that will further the personal growth. In other words, the counselor like me in this situation leads by example with the patient learning directly from the counselor rather than from one’s own personal reasoning.
The last approach I will note in this essay is called existential counseling. This approach strives to examine the Mark’s unfulfilled needs and existing potential to issues and then, help Mark direct oneself towards the achievement of his needs and potential. The approach assumes that every client has some needs that she/he desires to meet, still they do not always pursue everything that they desire and need realizing their full potential. God or some higher deity thus becomes the source of energy and inspiration. This approach recommends people to become god-centered rather than self-centered.
I should also draw the reader’s attention to the fact that professional counseling means applying combination of existent human development, rehabilitation and psychosocial and psychotherapeutic principles. A person can be called professional counselor once he/she has been licensed as a professional by the professional counselor section of the examining board.
In conclusion, I would like to note that approaches I used on Mark to allow him return to the psychological and mental equilibrium are numerous and different from each other. These approaches are based on different theories developed by world-renowned psychologists yet all focus on helping a person to reach their potential and personally overcome the problem that they might have or think they have. Each approach targets different perceptions in the client and takes different amount of time. I used all of the aforementioned approaches for personal practice purpose and to assure that they synergistically produce an extremely powerful effect on Mark and allow him to return to the normal functioning while forget about suicide and depression.
References Alessi, C.A., Yoon EJ, Schnelle, J.F., Al-Samarrai, N.R., Cruise, P.A. (1999). A randomized trial of combined physical activity and environmental intervention in nursing home residents: do sleep and agitation improve? Journal of the American Geriatric Society, 47 (7), 784-91. Biddle, S, Fox K, Boutcher, S. 2000. Physical activity and mental health: A national consensus. London: Routledge. The book speaks about different exercises physical and mental aimed at improving the health of individuals. Blumenthal, J.A. (1999). Effects of exercise training on older patients with major depression. Archives of Internal Medicine, 15, 2349-56. Depression is a major problem for adults and the elderly. How to treat it effectively and lead a new healthy life is shown in the book. Butler, RN, Davis R, Lewis, C.B., Nelson, M.E., Strauss E. (1998). Physical fitness: benefits of exercise for the older patient. Geriatrics; 53: 49-52, 61-62. Different mental disorders and obsessive thoughts of older patients are expressed in the book. Colditz, G.A., Cannuscio, C.C., Frazier, A.L. (1997). Physical activity and reduced risk of colon cancer: implications for prevention. Cancer causes and control, 8 (4), 649-67. This masterpiece comments on how to live a long and healthy life free from cancer, depression and suicidal thoughts. Erens, B, Primatesta P, Prior G. (2001). Health Survey for England; The health of minority ethnic groups (1999). London, The Stationery Office. This magazine speaks about how the lifestyle and health of different races and ethnic groups differs. Shephard, R.J. (1997). Aging, Physical Activity and Health. Champaign, Illinois: Human Kinetics. One learns not only what problems (physical and mental) a person will have as getting old but also how to overcome them. Skelton, D.A., McLaughlin, A. (1996). Training functional ability in old age. Physiotherapy, 82 (3), 159-67. One learns about how to lead a healthy and active life with positive thinking and flexibly body. Spirduso, W. (1995). Physical dimensions of aging. Champaign, Illinois: Human Kinetics. This masterpiece speaks about existing mental and physical aspects of getting old. The doctor learns how to make a patient healthy.
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