Crisis - D. Reflection

Describe the emotional state of the student(s). 

• I had been seeing SA off and on throughout the first part of the semester so I knew her fairly well by this point. On this particular day SA was very quiet and subdued. She wasn’t crying, shaking, or even visibly upset, but she was hovering around, so I asked if she needed to talk and she said yes. We were talking and she asked about AL and where she was. I told her that I could not violate AL’s confidentiality by telling SA what was going on, but that AL was safe. SA said “I think she’s in a mental hospital. I’ve been wondering if I need to go to one too.” While her statement wasn’t necessarily surprising, I wanted to make sure that she knew exactly what she was talking about and that this wasn’t just a copycat behavior.  

What tools did you use to assess the presenting issue? 

• After talking for a while, I asked SA if she was ok answering some questions. We were at an impasse where she didn’t want me to talk to her parents, but at the same time I really needed to make that phone call home. I told her how about we follow the directions on this and I’ll just follow the directions on how we handle things. She agreed so I administered the Columbia screener. The results of this indicated that SA was at a low to moderate risk of suicide. We talked through what exactly that meant and then proceeded to fill out a safety plan for SA.

How did the student(s) change as a result of your intervention?

• As we worked through the safety plan SA seemed to relax and presented signs of feeling much better. I made a copy of it for her and sealed it in an envelope for her to keep. I told her that I would have to make a phone call home to her mom, and while SA wasn’t super happy with me she understood what had to happen. Overall she was nervous when she left my office since I had said that I had to call home and talk to mom, but otherwise was in a pretty stable state. 
  

What worked? 

• Administering the Columbia and filling out the safety plan worked very well. The Columbia allowed me to reflect all of the blame for the home phone call on the “rules.” This reduced the resentment that SA would feel towards me for violating her confidentiality. The Safety Plan did it’s job by allowing SA to see all of the support that she had available to her. It allowed for her to relax and de-escalate back to her normal state.

What would you do differently next time? 

• I called home to mom and asked if she’d be willing to come in and meet me about the conversation I had with SA. Much to my surprise and shock, mom said that she couldn’t come in that day and asked if I could talk to her therapist instead. I shared with mom that I our conversation had dealt with suicide ideation, and that I preferred to talk with her, but could talk to SA’s therapist first if she wanted. Mom indicated that she would prefer that, so I secured permission for SA to drive herself and siblings home, and contacted her therapist. I feel like I should have done something differently here, either insisted that mom come in and talk with me or forced a follow-up or something. I was just in so much shock from mom’s refusal to meet that I was at a loss for words. I know now I am much more prepared to handle a variety of reactions from parents, so hopefully next time I am not caught off guard when parents don’t react the way I predict that they will. 
  

How has this crisis impacted you?

• Long story short, this topic is really really important to me. My wife has experienced suicidal ideation at several points of her life. I know this has impacted my family and knowing how difficult it is to handle, I want to be able to help students and parents navigate these dangerous waters. This particular instance messed with my head for a long time. While I knew I did everything I needed to and filled my obligations to her family, I was reeling when her mom deferred to SA’s therapist. I struggled with the thoughts that a parent wouldn’t address this topic with their own child. I knew I would move heaven and earth to help my own son if he was dealing with these feelings, and the realization that not every parent would do that hit me like a ton of bricks. I also had to deal with the aftermath of breaking a student’s confidentiality and the resentment that can build up because of that. I had to work very hard to earn SA’s trust back and it took a quite a while before she was willing to talk with me in a therapy setting again. All in all this was a major learning experience for me this year and was probably one of the most difficult situations I’ve had to deal with. Not because of the topic, but because of the parent reaction.