Since we were on the train for about 10 hours over the last 2 days, I was able to finally finish a book I have been reading for work called, The Practical Art of Suicide Assessment by Shawn Christopher Shea, MD. This is an excellent book recommended by my mentor here in China. She had been a counselor in Illinois, and brought all of her Master’s course-level books with her to China. And I get to read them!
I will be writing a series of blogs about what I have learned through my reading. I’m not really expecting anyone to read this… it’s more for me to get my thoughts out, and my blog keeps me accountable to actually write it out. However, in my biased opinion, I think these ideas and techniques are useful for all types of ministry, not just for the person in a counseling role.
Here is what I will be writing about.
1. Six Simple Validity Counseling Tools
2. Other Practical Techniques (Used specifically with suicidal people)
3. Safe and Effective Decision making within a counseling session
Six Simple Validity Counseling Tools
Behavioral incident: (Asking for the Facts)
When a counselor asks for a patient’s opinion, the patient has an opportunity to distort the truth, due to embarrassment, rationalizations, and resistance among other things. However, if the counselor asks for only facts or exact thoughts, he or she is much more apt to get truthful information from the patient. “It is best for counselors to make their own judgments based on the details of the story itself as opposed to the client’s interpretations of the details” (Shea 128). This technique is most used with issues such as sexual abuse, substance abuse, domestic violence, antisocial behavior, and suicide.
Examples: What did your father say then?, Did you put the razor blade up to your wrist?, When you say that you threw a fit, what exactly did you do?
Beware: Use sparingly, if all the details are not necessary, because it can be very time consuming.
Shame attenuation: (Gives an excuse to talk about a subject)
This technique “enhances the counselor’s ability to noninvasively inquire about behaviors that many patients would be hesitant to discuss because of the shame and guilt attached” (Shea 129). The counselor must ask a question that allows a sense of acceptance and positive regard, in order to receive a truthful answer about a shameful behavior. For instance, instead of asking, “Do you lie often?” a counselor could say, “You had told me your father was abusive, which sounds like a horrible experience. I’m wondering if you ever found it necessary for you to lie to him in order to protect yourself.” If a positive answer is given, the counselor could continue with a behavior incident question, “Do you find that you still lie often?” or “Are there other times that you find yourself lying to protect yourself.”
Examples: With all the tremendous financial stresses you’ve encountered recently, have you found that you felt a need to steal just to get food on the table?, With the immense stressors going on in your, have you ever thought about suicide?
Beware: This technique is not meant to condone or endorse inappropriate behavior, but rather it is a “genuine attempt to understand the rationalizations that shape how a patient perceives his or her reality” (Shea 131).
Gentle assumption:
Similar to the last technique, the gentle assumption is “designed to increase the likelihood that sensitive material will be discussed more openly” (Shea 131). The counselor assumes that a given behavior is occurring, rather than asking if it is occurring. If the patient is put-off by the assumption, a buffer can be added, such as, “if at all.”
Examples: How often have you been pulled over by the police for a DWI?, What other ways have you thought about killing yourself? How often have you found yourself in a fist-fight, if at all?
Beware: Gentle assumptions should not be used with patient’s who want to please their counselors, since they could potentially answer in the way they feel that ought to answer, rather than with the truth. This technique should also not be used with children, as they are easily confused or persuaded, especially in the case of sexual abuse.
Symptom amplification: (Looking for a specific number)
At times, patients will downplay the frequency of a specific behavior. When using symptom amplification, the counselor should set a high number to the behavior, which will likely cause the patient to give a truthful number in response. The importance of this technique lies in the fact that it does not create a confrontation, but rather allows the patient to still use the defense mechanism of minimization.
Examples: How many fist-fights have you had in your whole life…twenty-five, forty, fifty?, How many times have you struck your wife…twenty times, thirty times?
Beware: Don’t be absurd. This can cause a counselor to look foolish or naïve.
Denial of the specific:
This technique will jar the memory of a patient, and makes it more difficult to falsely deny a specific question, as opposed to a general question. These questions are basically behavior incident questions, however that’d be asked in a series in order to gain more specific information.
Examples: If discussing suicide ask questions like: Have you ever thought about jumping off of a bridge or building?, Have you ever thought about hanging yourself?
If discussing drugs ask: Have you ever tried cocaine? Have you ever used crystal meth? Have you ever dropped acid?
Beware: Do not overload the patient with question after question. Allow them time to process and answer each question individually.
Normalization: (Allows the patient to feel supported and not alone)
Many times, it helps patients who are anxious or embarrassed to know that others have gone through similar experiences or have dealt with similar destructive behaviors. Normalizing the issue can give the patient a sense of freedom and support that will keep them from denial or shame.
Examples: Sometimes, when people get really angry, they say things that they later regret. Has this ever happened to you?, Sometimes, when people are really worried about their weight, they will do things to make sure they won’t gain weight, such as vomiting. Have you ever tried that?
Beware: This can be a counteractive technique with patients who are eager to please or who often exaggerate their situation.
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