CRISIS MANAGEMENT DURING "LIVE" SUPERVISION: CLINICAL AND INSTRUCTIONAL MATTERS

Journal of Marital and Family Therapy, Jul 2005 by Charl�s, Laurie L, Ticheli-Kallikas, Michele, Tyner, Kelly, Barber-Stephens, Brandi

During the break, I pointed out to the therapists the phrases the client had made. Both therapists had noticed the comments, but had chosen not to address them. I told them we had to focus the rest of the session on the client's comments and do a suicide assessment. BBS and KT seemed hesitant and pointed out that they thought they had done that. I walked them through a typical lethality assessment and suggested questions for them to ask: What had the client imagined doing? What had she attempted doing? What had kept her from succeeding thus far? BBS and KT seemed receptive to my suggestions and went back in the room.

Back in the room, MTK began to explore with the client how she had avoided hurting herself in the past: "Who do you think of? What stops you [from hurting yourself]? Susan responded, "My mother." As a team we were all aware that the client's mother was deceased, and I was concerned that she had only her deceased mother as a resource.

BBS asked Susan, of all the things she had thought of doing, (which included taking pills and cutting her wrists), "What are you more likely to do?" Susan then said, very softly, "Slit my wrists. . . . I'm tired. I've got nothing left to give." Finally, after a long silence in which I was grateful that both BBS and MTK participated, Susan said, barely audible, "I'd like a little bit of help." She also said, quietly, "I don't know who I am." At this point, the client was despondent, barely completing her sentences. This seemed to throw the therapists a bit of a curve; the more despondent the client got, the less the therapists asked her questions about what that was like. I remember thinking (and telling the trainees behind the mirror) that perhaps Susan may sense that the therapists are afraid or do not want to ask her such painful questions. Thus, Susan may try to "help them out," by not being more forthcoming.

By that point in the session, we knew that Susan went to sit on the bathroom floor to think about cutting her wrists. We did not know much more than that. BBS and KT seemed hesitant to go further. As a supervisor, I wanted BBS and MTK to "get on the bathroom floor" with the client metaphorically, and find out what it was like for her there. What was happening at those times? More importantly, what had kept her from doing anything thus far? Why had she remained attempt free? I called into the room and encouraged the therapists to have this conversation with Susan and to try to elicit some information from her about what kept her going even in those moments. I remember thinking that if BBS and MTK were fearful; I should reflect calm and confidence in making my suggestions. In this way, I tried to convey that it was okay to ask these questions, and that they could deal with the answers.

In the next part of the session, we learned that the client's aunt had attempted to commit suicide by slitting her wrists. We discovered that Susan did not feel she had anyone to talk to that could or would really listen to her needs. We also learned why she had been so afraid to talk to anyone; she thought her children would get taken away by Child Protective Services (CPS). She did not see any wisdom in telling anyone else what she had told BBS and MTK.