Counseling a suicidal adolescent with hidden trauma from abuse

Adolescent Suicide

Consultation with the client took place at the mental health agency in an urban Midwest town. The demographics of the area comprise 50% white people, 33% Black, 10% Hispanic, with the rest being a mix of other races, such as Indian, Mexican and Chinese. Of this demographic, about 55% are women and 45% men. The mental agency serves all age groups and demographic orientations without exception and without prejudice. The agency also serves those with severe mental problems as well as persons visiting the agency as outpatients or only for occasional consultations.

Counselor Background

After completing her studies at an American University, the counselor completed one year of practical training before entering the counseling field. After entry, she spent seven years counseling patients with a variety of mental problems. These patients came from all age, income, and demographic groups.

The counselor also has specific experience with juveniles via her work with adolescents in juvenile detention centers, via children's services, and in mental health agencies. The problems faced by these young people were diverse in nature, and the counselor has a wide range of experience in working with them. This provides her with sufficient professional background to work with the specific client in question for this case study.

III. Client Overview

The client is female, 15 years of age, and is currently in the 10th grade. She is a gifted student, but tried to commit suicide by cutting her pulses. The attempt was unsuccessful, and she was referred for counseling to help her work through the issues that led to the suicide attempt.

She began using alcohol and cocaine at the age of thirteen, and has been through many counseling sessions to deal with her self-destructive habits. Although she has revealed many personal issues, there was one that she kept hidden throughout all these sessions. She only revealed after her suicide attempt that her father sexually abused her for many years. In retrospect, it appears that previous counseling attempts failed because of this hidden trauma.

IV. Goals & Strategies

The first goal is to address the suicidal ideations displayed by the girl. To form an overview of the issue, the client will be encouraged to talk about her suicide attempt. Via a number of questions, the client's feelings regarding her attempt will be investigated. How does she feel about failing in the effort? Why does she feel that it would be better if she were dead? Are there any people she feels would be hurt by her suicide? What about the family members other than her father? The counselor will also attempt to understand whether the client truly wanted to commit suicide, or whether it was a request for help with the problems she is facing, at the root of which lies the abuse, or indeed, whether it was a combination of both.

The next step is to investigate the circumstances in the client's home life. The client will be questioned regarding her family members, and how she feels about each. Was her mother aware of the abuse? Did she try to confide in her other family members regarding the abuse? Were any of her siblings abused that she knows of?

Finally, the abuse itself will be addressed. The client will be encouraged, again via questions, to be completely honest about her feelings and about the events surrounding the abuse. It is suspected that guilt forms a substantial part of the problem. How significant a part did the abuse play in her suicide attempt? What kept her from revealing the abuse, and why did she reveal it now?

The revealed feelings will be used as a springboard to help the client begin the healing process. She will be led to believe in her own innocence, and provided with the building blocks to regain her strength of spirit without the help of alcohol or drugs. If necessary, she will be offered help via rehabilitation centers to deal with the alcohol and drug issues. It is important to help her understand that the alcohol and drugs are merely symptomatic of the deeper-lying issues that are related to the abuse, and that they can only be addressed once the root problem is eradicated.

VI. Results

The results can be viewed as very positive, although only time will tell whether they were completely successful. The client is in counseling for her drug and substance abuse, and is to enter a rehabilitation clinic in the near future. She is currently living with her family, from which the father is absent. Family members are to be included in later counseling sessions.

The family views the results as positive, as the client has made no further attempts on her own life. Drug and alcohol abuse is still a problem. Other professionals however also view this outcome as positive, because the client is aware of her problem, and has declared herself willing to enter a rehabilitation facility. The community can view the result as positive, because the client has finally been able to honestly relate to her feelings regarding the abuse. As such, the client can empower not only herself, but also other members of the community to be honest about abuse issues and to seek help, and finally healing.

VII. Personal Reflection

What worked well with the client was to be continuously gentle with questioning, but also encouraging answers via silence rather than further questions or clarifications. The discomfort caused by silence was experienced as more intense than the discomfort of the questions themselves. What would not work well is confronting the client directly with the core issue from the beginning. A better approach is to begin with gentle, leading questions that address the issue very subtly. This approach will also be used with similar clients in the future.