Case Study Questions

Jason is a 17-year-old high school senior who informed one of his friends that he was having suicidal thoughts. Jason’s friend informed the school counselor, who met with Jason to conduct a clinical interview and suicide risk assessment using the CAMS model. Jason was comfortable during the interview and reported he was relieved to be talking with the counselor about his suicidal thoughts, which he reported had occurred since he was in middle school and had been steadily increasing recently, particularly after breaking up with his longtime girlfriend. The assessment results suggested that Jason was experiencing some depression and having suicidal thoughts, but he denied making any previous suicide attempts. He also reported that he had “a lot to live for” but that his breakup with his girlfriend had put him “over the edge.” Jason also informed the counselor that there were no guns in his house and that he had never used a gun. He indicated he had no specific suicide plan and his suicidal ideation was occurring frequently but irregularly (i.e., a few times a week). He informed the counselor, “I don’t want to die; I just want to feel better, and I don’t know how to do that.”
Based on the clinical interview, the counselor determined that Jason was not at high risk for suicide but that he should be carefully monitored and be provided with resources to get him help for his depression and suicidal ideation. Following the interview, Jason’s parents were contacted and came to the school to pick up him. Although he was not taken to the emergency room, Jason committed to getting treatment for his problems and stated he was “motivated to feel better.” The counselor gave Jason and his parents the phone numbers for two crisis hotlines—a national one and another based in their community. The counselor also provided Jason’s parents with the name of a DBT therapist in the community, and an appointment was made to meet with the therapist the next day.
Jason met weekly with his therapist for a 3-month period, during which there were also frequent group therapy components and meetings with his parents. Through acceptance and mindfulness techniques discussed in therapy sessions and extensively practiced outside of it, Jason learned several skills that helped reduce his depression and his suicidal thoughts. These skills included how to change the relationship he had with his thoughts by detaching himself from them or, in his therapist’s words, “not taking all your thoughts seriously; simply regarding them as temporary and passing.” Jason was also encouraged to form greater connections with people, even when he felt like withdrawing, and soon reported he had a new girlfriend.
After 3 months of treatment, Jason no longer reported feeling depressed or having any suicidal ideation. At this point, the DBT therapist continued to meet with Jason for several more weeks (on a biweekly basis) to monitor his progress, but after 5 months, therapy was terminated. Jason continued to periodically “check in” with his school counselor after his DBT treatment ended, but neither Jason nor his parents nor his friends reported any ongoing concerns. Jason reported to the school counselor that he was optimistic about his future and was looking forward to attending an area college.
  1. Kazdin and Blase (2011) discuss “rebooting” psychotherapy practice and research so that it incorporates more of an emphasis on prevention and public health approaches to psychological service delivery. What are the implications for this recommendation for counselors and psychotherapists, particularly as applied to suicide prevention?
  2. Although more adolescent and young adult females engage in suicidal ideation and attempt suicide as compared with males, many more males actually die by suicide. What can be done to reduce the rate of suicide among adolescent and young adult males, and what role should counselors and therapists have in that process?
  3. Both cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) have growing support as evidence-based treatments for suicidal behavior. What are the unique strengths of each approach for working with potentially suicidal adolescents and young adults? Which approach might be better for a particular client, and how would you make that decision?
  4. Sexual minority adolescents and young adults appear to be at higher risk for suicidal behavior as compared with their heterosexual peers. What are the some unique challenges about working with sexual minority youth who are suicidal?
  5. Similar to other people with mental health problems, adolescents and young adults who have a history of suicidal behavior may have been stigmatized and/or marginalized by their peers. How can we better promote social justice for people who exhibit, or are at risk for developing, suicidal behavior?