What Therapists Learn About Crisis, Trauma, and Suicide Risk: 15 Questions From My Counseling Training

When people think about therapy, they often picture a conversation between a therapist and client. But behind that conversation is a considerable amount of training in areas such as crisis intervention, trauma, suicide assessment, ethics, confidentiality, communication, and safety.

During my clinical mental health counseling training, I created the following multiple-choice questions as part of my coursework in crisis intervention and conflict resolution. They cover topics ranging from how we cope with stress and what distinguishes an everyday challenge from a psychological crisis to therapist boundaries, vicarious trauma, HIPAA, suicide risk, and the communication skills counselors use during difficult conversations.

I decided to share them here because they offer a glimpse into some of the thinking that occurs behind the scenes in psychotherapy. A therapist may appear to simply be listening, asking questions, or reflecting back what you have said, but good counseling often involves simultaneously considering safety, coping resources, risk factors, emotional responses, cultural differences, ethical responsibilities, and the strength of the therapeutic relationship.

You can treat the questions below as a short psychology quiz, read through the explanations, or simply use them to learn more about how counselors are trained to respond when clients are experiencing stress, trauma, or crisis.

Question 1: Normative vs. Nonnormative Stressors

Can you distinguish an expected life stressor from an unexpected event that may trigger a crisis?

Question 1. (Source: Chapter 1, p. 7, Section on "Elements of Stress and Crisis Theory'') The following are examples of nonnormative stressors, except:

A. Being sexually abused by a family member (Incorrect. Experiencing sexual abuse is a traumatic experience, and probably especially so when the perpetrator is a family member. Given the severity and non-developmental normality of sexual abuse, being sexually abused is not a normative stressor.)

B. Struggling with school assignments (Correct. While working through school assignments can be stress-inducing, the struggle with completing assignments is developmentally typical. It’s normal for most students to experience hardship when it comes to schoolwork, and as such it’s the only normative stressor on this item list.)

C. Experiencing a tornado that devastates a town (Incorrect. Even though tornadoes are a natural phenomenon of the world, it’s abnormal to experience a devastating one. While some areas of the world may be more prone to tornadoes, i.e. Tornado Alley, this fact does not dismiss the catastrophic and often untimely nature of tornadoes. Therefore, tornadoes, especially when they cause damage to a town, are nonnormative stressors.)

D. Grieving the loss of a close friend who committed suicide (Incorrect. Grieving alone may be considered a normative stressor since we live in the world for a finite period of time. But death from suicide is a different story. Death by suicide is a nonnormative stressor since suicide is not a normal stage of development and can be a tragic way to die — both for those who kill themselves and the surviving family and friends.)

E. Getting struck by a drunk driver while crossing the street (Incorrect. Being struck as a pedestrian is calamitous, unexpected, and developmentally atypical. Most people will not be struck by a car at some point in their life, and it’s not characteristic of any stage of development. These factors make being hit by a car a nonnormative stressor.)

Correct Answer: B

General Feedback: Being able to differentiate between normative and nonnormative stressors is key for a future counselor. Since normative stressors are foreseen from a developmental perspective, they may be easier to address in therapy, and may not result in crisis. Non-normative stressors, on the other hand, can catalyze crisis and throw an individual into disequilibrium. After non-normative stressors, someone may experience complex grief, Acute Stress Disorder, Post Traumatic Stress Disorder, and more. This typically isn’t seen in developmental stressors, such as taking a new job, kindling a new romantic relationship, or moving.

Question 2: The Role of Psychiatrists in Mental Health Care

What distinguishes psychiatrists from many other mental health professionals?

Question 2. (Source: Chapter 1, p. 19-21, Section on "Roles and Collaboration Between Mental Health Workers During Crisis") While there are many converging factors among all mental health workers, only psychiatrists:

A. Can prescribe medications to clients without additional training or licensure (Correct. While some psychologists are able to prescribe in certain states, as a general rule of thumb, only psychiatrists can prescribe medications. Connecting with psychiatrists and referring patients to them may be invaluable to counselors, psychologists, social workers, and paraprofessionals, since only psychiatrists have the authority to prescribe medications).

B. Can diagnose and treat mental health conditions (Incorrect. Diagnosing and treating mental health conditions isn’t limited to the domain of psychiatry. Rather, it’s a shared duty and practice of counselors, psychologists and even social workers. While prescription drugs may not be prescribed as means of treatment, other modalities of treatment are enacted via therapy. Clinical assessment and diagnosis is also the responsibility of counselors, psychologists, and clinical social workers, in addition to psychiatrists).

C. Work in hospital settings (Incorrect. While psychiatrists commonly work in a hospital setting, many have the option of operating in a private practice, or working in an outpatient setting. Counselors, psychologists, and social workers also have the option to work in a hospital setting, which means this type of workplace is not exclusive to psychiatrists.)

D. Manage resources to help facilitate stabilization (Incorrect. All mental health professionals manage resources to assist in the stabilization of clients. This could mean making sure the client attends appointments and has access to prescription drugs, and it can also mean obtaining internal resources from within, such as self-efficacy, healthy self-esteem, bonadaptation, and resiliency.)

Correct Answer: A

General Feedback: Psychiatrists are an important component of keeping our community healthy. Psychiatrists are trained from a biomedical model, which positions them to effectively and reliably prescribe drugs to those who may need them. If psychologists (without prescription privileges), counselors, social workers and even paraprofessionals suspect pharmaceutical interventions may be needed (such as in the case of a psychotic or schizophrenia patient), then referring to a psychiatrist, or suggesting the client visit, would be a proactive action.

Question 3: How Do We Cope With Stress?

Can you identify the major ways people respond cognitively and behaviorally to stress?

Question 3. (Source: Chapter 1, p. 14-15, Section on "Coping") Coping is a response to stress via behavioral or cognitive actions. Within coping, there are three broad categories which include all of the following except:

A. Problem-focused coping (Incorrect. Problem-focused coping is considered a broad category of responding to stress. This stress response type is characterized by defining the problem at hand, creating potentially viable solutions and weighing their pros and cons, selecting a solution, and then following through with action. While this option may appear to be proactive, it’s important to remember coping can be successful or unsuccessful, adaptive, or maladaptive, including problem-focused coping).

B. Spirituality-focus coping (Correct. While spirituality can be a source of refuge and strength for many, it is not cited as one of the three responses to stress).

C. Emotion-focused coping (Incorrect. Emotion focused coping is, indeed, a legitimate means to respond to stress and is one of the three coping types. Emotion-focused coping aims to reduce the affective arousal of the stressor so that its emotional bearing may be tolerated. Perhaps counterintuitively, emotionally-focused coping relies on cognitive processes to reframe stressors, and potentially even distance yourself emotionally from said stressors)

D. Avoidant coping (Incorrect. Avoidant coping is another type of a response to stress. It can be perceived as being a subtype of emotion-focused coping and relies on distraction or diversions. Unfortunately, avoidance-focused coping is the most likely to lead to diminished well-being and is the least likely of the three options to result in effective adaptation.)

Correct Answer: B

General Feedback: The three broad categories of coping include avoidant coping, emotion-focused coping, and problem focused coping. As mentioned, it’s important to note that these are just attempts to deal with stress, and do not guarantee success, nor are they always adaptive. While spirituality-focused coping doesn’t exist within this existing construct, some people may use spirituality through the other three channels of coping. For example, someone bogged down by stress may choose a problem-focused coping strategy that involves meditating (which would likely be adaptive). In another example, one may pray the “Hail Mary '' when troubling flashbacks of a car accident arise, rather than dealing with the problem head-on.

Question 4: Safety and Screening in Counseling

What information might a counselor consider when screening someone before beginning treatment?

Question 4. (Source: Chapter 2, p. 32, Section on "Physical Safety'') Screening clients is an important step in ensuring your safety as a counselor. This is especially true if you work independently in private practice, or work in an isolated setting. Which of the following includes all of the phone screening best practices:

A. Inquire about the client’s medical and psychological history (including medications), and about their reason behind seeking counseling. Pay attention to off-putting comments. Do not ask about their legal history. (Incorrect. While the former components of this response, including asking about the client’s medical and psychological history, and their reason behind seeking psychotherapeutic services, are right, it’s incorrect to not ask about their legal history. Asking about a client’s legal history can help you determine whether or not the client has had past incidences of violence; past violence correlates with future violence. Knowing a client’s legal history can help protect you).

B. Ask about the client’s medical history and psychological history. Asking about the client’s reason behind seeking counseling may tarnish the therapeutic alliance, and may push the client away. (Incorrect. Since this is just a screening call, you are not acting as the potential client’s therapist, so there is no therapeutic relationship to speak of. There may be rapport building, on the other hand, but that’s unlikely to be blemished by inquiring about the client’s reasons for seeking out professional mental help. In fact, it may strengthen your rapport).

C. Ask about the client’s reason as to why they’re seeking counseling. Asking about their medical and psychological history is unethical and potentially illegal in some jurisdictions. (Incorrect. Asking about the client’s reason behind seeking therapy is a great practice to abide by when conducting screening calls. This answer is incorrect since it states that asking about the client’s medical and psychological history is unethical and potentially illegal; this is not true. While there are legal systems in place, such as those outlined by HIPPA, to protect patient data, it is not illegal to inquire about someone’s medical history.)

D. Inquire about the client’s medical and psychological history (including medications), about their reason behind seeking counseling, and their legal history. Pay attention to off-putting comments. (Correct. This answer contains all the components of an effective screening phone call that’s designed to filter out risky or violent clients. It’s savvy to ask an individual who’s interested in counseling therapy with you about their medical, legal, and psychological history, and their intentions, and to be on the lookout for unsettling comments.)

Correct Answer: D

General Feedback: While some areas of crisis intervention call for objective approaches, such as interventions in suicidal clients, others involve listening to your own gut. Screening phone calls are a time to tap into your intuition. If a client makes a comment that doesn’t sit well with you, such as by asking about what you’re wearing, or noting that you work all alone in the evenings, then it’s probably a good idea to avoid seeing this client in person. When inquiring about a client’s past, be sure to pay attention to past details regarding self-harm and violence.

Question 5: Why Therapist Boundaries Matter

What do healthy professional boundaries between therapists and clients look like?

Question 5. (Source: Chapter 2, p. 34-35, Section on "Physical Safety") Setting boundaries is an essential part of a counselor’s career. The following are recommended boundary-setting practices, except:

A. Set firm boundaries, especially in writing (Incorrect. As a counselor, it’s important to establish crystal clear boundaries with clients. While verbal boundaries are efficacious means of establishing boundaries, it’s best to expressly articulate boundaries via writing to avoid any confusion).

B. Giving the client your personal phone number and address, only for emergencies (Correct. This is not a recommended boundary-setting practice, and in fact, may set a therapist up for being stalked or receiving unwanted calls outside of standard working times. Proving your personal contact information is not recommended).

C. Engage in no contact with clients between sessions (Incorrect. Not engaging with clients is important for many reasons; by not being constantly available to clients, they are able to implement learnings from counseling sessions in the real world without assistance. And not only, by extending sessions, or talking to therapists outside of counseling, the client may assume a false impression that you’re interested in establishing a platonic or romantic relationship.)

D. No family pictures in the office and no personal objects (Incorrect. While adding personal touches to a workspace can seem like a great way to express yourself, it can also open the door to clients discovering important information about you that you may want to keep private. While your kids may be adorable, and you may have been married to your partner for over a decade, it’s best to keep personal items and photos outside of the professional setting.)

Correct Answer: B

General Feedback: As a therapist, boundaries are of the utmost importance. Clients may misinterpret a lack of boundaries as an invitation to become friends, or even to attempt to romanticize the counseling relationship. By setting firm boundaries in writing, avoiding the sharing of personal contact information, confining the counseling relationship within the allotted session, and avoiding personal objects in the therapy practice, you’re setting yourself in alignment with boundary-setting best practices. While boundary setting may seem trivial, they can help therapists avoid being stalked.

Question 6: Vicarious Trauma and Therapist Well-Being

How can therapists protect their own well-being while regularly helping people through trauma and crisis?

Question 6. (Source: Chapter 2, p. 40-41, Section on "Vicarious Trauma") Working with clients experiencing cruises or who have experienced traumatic events can be emotionally taxing, and lead to a phenomenon known as “vicarious trauma”. The following are ethical ways to mitigate vicarious trauma, except for one:

A. Avoid working with clients who have a history of trauma (Correct. While it may be convenient to avoid clients with a history of trauma, first, it’s probably unavoidable since many of us have experienced traumatic events. Also, developing an aversion toward clients with trauma is probably maladaptive. Instead, limiting the number of trauma clients, rather than avoiding working with them altogether, is a more ethical approach)

B. Limiting the number of trauma clients you see and/or your caseload (Incorrect. This is an adaptive strategy to mitigate the effects of vicarious trauma. While you shouldn’t aim to completely cut out clients experiencing crisis or trauma, aiming to reduce your caseload and the number of trauma clients you see can be a great way to mitigate this issue).

C. Seeking peer supervision to debrief and gain advice (Incorrect. Seeking supervision is an adaptive strategy when it comes to dealing with vicarious trauma. A more experienced therapist can provide you with tools to overcome challenges you may face when working with clients with trauma. )

D. Personal coping via leisure, creative endeavors, etc. (Incorrect. This is an adaptive strategy to cope with the vicarious stress that can be experienced when working with trauma clients. Disconnecting and engaging in your favorite activities, such as biking, hiking, or gardening, and pursuing creative projects, can help mitigate the risk of vicarious trauma..)

E. Using spirituality to facilitate connection to meaning (Incorrect. Using spirituality can be a powerful tool to buffer the effects of vicarious trauma. Through spirituality, you may tap into a connection to a force or spiritual framework that transcends the mundane and adds meaning to the work you do.)

Correct Answer: A

General Feedback: While vicarious trauma is a real risk for counselors, therapists, and other helping professionals, there are a variety of ways to mitigate the potential negative consequences of listening to traumatic stories and aiding clients to work through crises. By limiting your caseload or limiting the number of trauma clients you see, seeking supervision, engaging in leisure activities, and leveraging spirituality, you are greatly reducing your risk of experiencing vicarious trauma.

Question 7: HIPAA, Privacy, and Emergencies

How does patient confidentiality work when a mental health emergency occurs?

Question 7. (Source: Chapter 3, p. 49-51, Section on "Health Insurance Portability & Accountability Act") HIPAA, or the Health Insurance Portability & Accountability Act (1996) is intended to protect patients’ privacy and sensitive data. However, HIPAA is NOT intended to:

A. Protect the patient's health information of minors (Incorrect. HIPAA protects all individuals, including minors. Since HIPAA encompasses minors and their health information, this answer is incorrect).

B. Interfere during emergencies, but in cases that involve minors (Incorrect. While it’s true that HIPAA does not intend to interfere during emergencies, it’s untrue that this rule only applies to minors. HIPAA rules can be violated during emergencies, provided healthcare workers exercise their best judgment).

C. Interfere during emergencies, meaning during a crisis, patient information can be shared freely with anyone. (Incorrect. Patient information can be shared during a crisis, but not to anyone and everyone. The patient information that’s to be shared should be limited, and only pertain to the case at hand. This rule does not grant the right to openly share patient data.)

D. Interfere during emergencies, meaning patient information can be released given healthcare workers exercise their best judgment (Correct. HIPAA places stringent regulations on the storing, management and communication of patient data. However, it’s designed to be flexible and permeable during crises. When an emergency arises, medical professionals can share pertinent healthcare information about patients to others involved in a situation, such as police officers, judges, and social workers.)

Correct Answer: D

General Feedback: Sharing patient data without their consent is a tricky area to navigate. In general, patient data can only be shared during times of emergency, i.e. to prevent harm to the patient or to others who may be harmed by the patient. Ultimately, while the area of sharing patient data is gray, those involved with communicating patient data are expected to act with their best judgment. This means patient healthcare information cannot be shared openly and freely.

Question 8: Understanding Malpractice

What has to occur for professional malpractice to be established?

Question 8. (Source: Chapter 3, p. 60, Section on "Negligence and Malpractice") Malpractice is a serious concern that counselors face when they deviate from best practices. To prove practice, the “4 Ds” must be present. What are they?

A. Decrepitude, Duty, Direct, Damages (Incorrect. While duty, direct, and damages are correct, decrepitude is not. While in some aspects the word decrepitude may be similar to dereliction (e.g. dereliction can lead to a state of decrepitude), it’s not the word used in the 4 Ds acronym, and is therefore incorrect).

B. Dereliction, Duty, Direct, Damages (Correct. This is the correct answer that accurately depicts the four D words that involve malpractice. For malpractice to be present, there must be a breach of care that directly causes harm to a patient. All four of these conditions must be met for the definition of malpractice to be fulfilled).

C. Dereliction, Dare, Direct, Damages. (Incorrect. While dereliction, direct, and damages are correct, dare is incorrect. Dereliction involves a breach, and direct means the breach of care directly impacts the patient/victim. Meanwhile, damages imply the victim has been harmed in some way.)

D. Dereliction, Duty, Direct, Derangement (Incorrect. While dereliction, duty, and direct are correct, derangement is a non-fitting word that does not form part of the 4 Ds. For malpractice to be present, all 4 conditions of the 4 Ds must occur, including dereliction, duty, direct, and damages.)

Correct Answer: B

General Feedback: Malpractice can be scary for both a practitioner and a patient or victim to experience. In order to prevent malpractice from occurring, it’s important to understand its definition. The 4 Ds help us to better understand malpractice and the four conditions that must occur to satisfy the definition of malpractice. First, there must have been a breach (dereliction) of care (as in the duty to care). Next, the breach of care must have directly impacted a client and resulted in damages.

Question 9: Ending Therapy and Crisis Counseling

What should happen when a course of crisis counseling comes to an end?

Question 9. (Source: Chapter 3, p. 63, Section on "Termination in Crisis Intervention'') When concluding crisis counseling, there are several best practices involved. To prevent the risk of malpractice, and to end on positive terms with your clients, which termination summary steps must be followed?

A. Have the client sign a form that states they’d like to terminate services. (Incorrect. Ending the therapeutic relationship with a signed form is unnecessary. When terminating crisis counseling services, instead of having the client fill out a form, it’s best for the clinician to create notes that cover the reason, summary of progress, diagnostic impression, follow up plan and other).

B. Simply end the session. There’s no need to create a termination summary. (Incorrect. Not jotting down a termination summary can put both you and the client at risk. The termination summary includes important information such as the diagnostic impressions, which can potentially be used in potential future legal proceedings, as well as a follow up plan. By neglecting this information you might be putting both yourself and the client at risk).

C. Outline the reason for termination, summary of progress, final diagnostic impression, follow up plan, and other pertinent info (Correct. Ending the therapeutic session the right way is important, not only from a human-to-human standpoint, but also from a practical, legal standpoint. By adopting the writing of termination summaries, you’re mitigating risk for yourself, and positioning the client to be better served should they resume counseling with you or another clinician)

D. Outline the reason for termination, summary of progress, final diagnostic impression, follow up plan (Incorrect. While this answer option contains many of the important ingredients of a termination summary, it lacks one final step: Other important information. There, you might include specific incidents that occurred, such as legal proceedings the client was involved in, relevant contact information, and more.)

E. Outline the reason for termination carefully in your notes (Incorrect. While it’s true you should outline the reason for termination in your notes, it’s important to fill in the other gaps as well, including information on the final diagnostic impression, the summary of progress, the follow up plan, and other important information is just as important.)

General Feedback: Ending counseling sessions the right way is key, not only for you, but also the client. By including termination summaries in the process of ending counseling sessions, you’re helping to mitigate malpractice risk on your end, and on the clients end, you’re helping them achieve adequate future care with plenty of contextual notes that will help the future counselor working with that client (even if that future person is you!)

Correct Answer: C

Question 10: Eye Contact in Therapy

What can eye contact communicate during a counseling session, and why does culture matter?

Question 10. (Source: Chapter 4, p. 68-69, Section on "Essential Crisis Intervention Microskills'') This crisis intervention microskill conveys interest, confidence and involvement in a story, and is culturally dependent (e.g. European Americans interpret this behavior as expressing interest). It’s best to occasionally break it up, and avoiding it might indicate a protective defense mechanism. The microskill described is:

A. Attending (Incorrect. Attending is the most important alliance-building strategy between a client and a counselor, but unfortunately, it’s not what’s being described here in this prompt. What’s being described is eye contact. Other key things to know about attending is that it involves non-verbal gestures, presentation and body language to communicate interest and understanding).

B. Eye contact (Correct. Eye contact is important in the therapeutic relationship. For many people, particularly European Americans, an appropriate level of eye contact is interpreted favorably; it expresses interest and care for the other person. However, not all cultures engage in eye contact. Asians, for example, tend to make less use of eye contact in general).

C. Silence (Incorrect. While silence is an important crisis intervention microskill, it’s not what’s being mentioned in the prompt. Introducing silence can be a great way to counteract the effects of asking a barrage of questions, however, many counselors feel awkward using silence, especially at the beginning of their careers.)

D. Basic listening (Incorrect. While listening is an important crisis intervention microskill, what’s being described in the given prompt is eye contact, not listening. Listening helps you to obtain a summary of what’s being said, to extract the key facts, and then to glean the important emotions being expressed.)

Correct Answer: B

General Feedback: Making eye contact with clients is important in a therapeutic relationship. For most clients, feeling like they’re being seen and heard is key; utilizing eye contact can be a great way to express interest in what your clients have to say. But a word of warning: too much eye contact can ruin rapport since it can be interpreted as being too intense, or even creepy. Instead, the clinician should take care in striking a balance between too much eye contact and too little.

Question 11: Asking Better Questions in Therapy

Why might the way a therapist phrases a question affect how deeply a client is able to explore an issue?

Question 11. (Source: Chapter 4, p. 72-80, Section on "The Basic Listening Sequence") Asking questions that inhibit intellectualization and defensiveness is key for a counselor. The following are good examples of questions or reflective statements that enable the client to dig deeper, except which of the following:

A. You mentioned your drinking affects your relationship with your wife. Walk me through this. (Incorrect. This is an example of a reflective statement that is generally good in a therapeutic relationship. Rather than interrogating the client, the therapist makes a statement. Tone and other non-verbal communication variables will help the counselor execute this statement effectively).

B. You stated your actions are affecting your family life. What can I do to help you improve your relationship with your family? (Incorrect. This is an example of a good question since it’s open and avoids the use of “why” which can lead to intellectualization and potentially shutting the client off).

C. Why do you act in ways that ruin your family life? (Correct. This, in general, is a “bad” question to ask as a therapist. Using questions that lead with why can lead to the client to intellectualizing their problem, rather than understanding it at an emotional level. “Why” questions can also lead to clients feeling put on the spot).

D. From what you’ve said, it seems you acknowledge how your substance use is affecting your relationships (Incorrect. This is an example of a reflective, summarizing statement made by the therapist, and is generally regarded as good. The therapist gathers input from the client, and then reflects back on what’s said, expressing the therapist’s attentiveness and interest in the client)

Correct Answer: C

General Feedback: Asking the right questions can deepen the therapeutic relationship and catalyze the client’s own inner exploration. It’s important to avoid using “why” questions since they can make the client feel put on the spot, and they may lead to intellectualization. Instead, open-ended questions should be asked in a non-threatening way that fosters introspection in the client. Alternatively, statements can be made by the counselor that encourage the client to speak; these must be stated with warmth and gentleness to avoid compromising the therapeutic relationship.

Question 12: Why Therapists Summarize What You Say

Why might your therapist occasionally pause and summarize what you have been discussing?

Question 12. (Source: Chapter 4, p. 81-82, Section on "Summarizing") There are several instances that a counselor should summarize what the client has just said. These situations include:

A. When a client is rambling, when a client introduces several unrelated ideas, when it's necessary to provide direction in the interview, when you’re ready to transition phases of the interview, and when summarizing a prior interview to open the current session. (Correct. There are many instances in which summarization is appropriate. When the client has deviated too far off topic, when they’re rambling, when it’s necessary to add structure to an interview, and when it’s time transition; these are important times to utilize summaries to help both you and the client stay on-track of what;s being said)

B. When you’re having trouble following what the client has stated. Summaries cna be a great way to seek clarification of what the client has verbalized. (Incorrect. While it’s true summaries are important when you’re having difficulty following what the client has stated, there are other important instances in which a counselor should summarize).

C. When you’re ready to transition phases of the interview, and when summarizing a prior interview to open the current session. (Incorrect. While these two instances are important places for a counselor to summarize the sentiments and content of what a client has said, there are other situations where it’d be appropriate for a crisis counselor to summarize. Only Answer A includes all of those appropriate situations.)

D. Just at the beginning and end of each session. Summarizing otherwise is pointless, and wastes both your time and the client’s. (Incorrect. While summarizing information from a previous session can be a great way to open a new counseling session, and summarizing at the end of a session can help to add structure and aid in the client's revisiting of what they have said, ultimately there are other instances that a counselor could summarize.)

Correct Answer: A

General Feedback: Summarizing is a key way for counselors to keep track of what the client has said, ensuring there haven’t been any miscommunications. Summarizing is also a great tool to reflect back the client's sentiments, to ensure they’re accurate. There are many situations when a counselor should summarize what a client has said, including when a client is going on and on, when a silence has introduced several different ideas, when direction is needed, when transitioning, and when opening a new counseling session. In summary, summaries are an important tool for counselors to yield in the right situations.

Question 13: Protective Factors Against Suicide

What factors can help protect someone who is experiencing suicidal thoughts?

Question 13. (Source: Chapter 5, p. 98, Section on "Assessment: Level of Risk: Low, Moderate or High") Buffers are key in mitigating suicide risk. Buffers include all of the following, except one:

A. Ambivalence toward living (Incorrect. Ambivalence toward living means the client is indifferent toward living, or that they may want to partly live or partly die. This is considered a buffer since there’s an expression of neutral sentiment toward living.)

B. Ambivalence toward death (Correct. Ambivalence toward death is identified as a chronic risk factor for suicide. This may manifest in therapy sessions with the client asking questions such as, “what’s the point?” The client may also have more passive suicidal feelings, rather than over. Ambivalence, toward death, is feeling neutral toward death and is an attitude that places a client at risk).

C. Social support system (Incorrect. Social support includes family members, community members, friends and other social support services, which includes counselors. Social support systems help to buffer the individual experiencing a crisis from committing suicide)

D. A sense of purpose (Incorrect. A sense of purpose has been identified as a buffer, or a protective mechanism, that shields the individual experiencing suicidal ideation from actually executing their plan. A sense of purpose is linked with diminished suicide risk, and probably prevents suicide ideation in the first place.)

E. Therapeutic alliance (Incorrect. A therapeutic alliance, also defined as engagement with the helper, is a buffer against suicide. Keeping the therapeutic relationship in mind should be a priority for a therapist counseling a suicidal or at risk client)

Correct Answer: B

General Feedback: While there are many risk factors associated with suicide, there are also plenty of buffers that help protect an individual from following through with their suicidal plan. Some of the buffers include ambivalence toward living, developing and maintaining a support system, finding a sense of purpose in life, and establishing a therapeutic alliance with a mental health professional. Suicide can eb a daunting topic, but knowing the buffers can help establish more effective care for those who are experiencing suicidal thoughts.

Question 14: Identifying Suicide Risk

How are mental health professionals trained to remember and recognize possible suicide risk factors?

Question 14. (Source: Chapter 5, p. 99, Section on "Method of Assessment: Interview, Written instruments and Multiple Types") Several mnemonic devices help crisis counselors, as well as the general public, to remember the risk factors for suicide. The following are all legitimate mnemonic devices, except:

A. IS PATH WARM (Incorrect. IS PATH WARM is, in fact, an acronym used to identify suicide risk. It means Ideation - Substances - Purpose - Anxiety - Trapped - Hopelessness - Withdrawal - Anger - Reckless - Mood. The acronym is comprehensive, identifying emotional states such as hopelessness and anxiety, and also identifies attitudes, such as a lack of purpose.)

B. NO HOPE (Inorrect.NO HOPE is an acronym that means the following: No meaning, Overt change in clinical presentation, Hostile environment, Out of hospital recently, Predisposing personality factors, Excuses for dying. NO HOPE seems to be a more effective acronym for mental health workers dealing with an acute or high-risk client, as evidenced by its inclusion of recent hospitalization and clinical presentation).

C. PLAID (Incorrect. PLAID means: Prior attempts, Lethality, Access to means, Intent, Drugs/alcohol. This definition maps out the most important suicide risk, including whether the client has tempted before, whether they have means, how severe their intention is, and whether substance abuse is involved (which increases risk).)

D. SCAR (Correct. SCAR is not a recognized suicide risk mnemonic device. However, if we were to make one up, we could say: Substance abuse, Competence, Attempted previously, and Risky behavior. While this isn’t a widely recognized or established acronym, it works in identifying suicide risk factors in session with clients.)

E. MAP (Incorrect. MAP, which stands for Mental state (thinking), Affective state (emotions), and Psychological state (circumstances), is a recognized suicide risk acronym. It’s higher level and broad, encompassing many emotional states, mental states, and contexts)

Correct Answer: D

General Feedback: There are a variety of acronyms to help you identify suicide risk in clients you’re counseling. Since suicide is one of the most stressful types of cases to work with, and places a counselor at a higher risk of malpractice, it’s important to enter situations involving suicide with great care, armed with knowledge. While there are many different acronyms, a lot of them overlap on the following themes: substance abuse, risky behavior/personality traits, means, previous attempts, and context.

Question 15: Assessing Threats of Violence

What characteristics can make a threat appear more serious or potentially imminent?

Question 15. (Source: Chapter 5, p. 117, Section on "Threat Level Assessment") The FBI’s National Center for the Analysis of Violent Crime has outlined three levels of threat when it comes to potential violence: low, medium, and high. Which of the following describes a high level of threat:

A. More direct and concrete with some thought as to how it would be carried out. General indication of a place and time. No strong indication that the threatener has taken preparatory steps (Incorrect. While this threat level is to be taken seriously, it describes a moderate level of threat. In general, moderate levels of threat involve some planning and feasibility, but are generally unrealistic and are not as elaborately planned as high-risk threats).

B. Threat is direct, specific, and plausible. The threat suggests concrete steps have been taken toward carrying it out (e.g. the person has practiced and acquired a gun, or has the victim under surveillance) (Correct. High-risk threats should be taken very seriously, as they’re clearly defined, and plausible and the threatener has acquired means. High threats generally mean an attack is imminent, and preventive measures should be enacted).

C. Vague, indirect threat. The information obtained in the threat is inconsistent and the threat lacks realism. The content suggests a person is unlikely to carry out the act (Incorrect. While this type of threat is considered a low-level threat, it should be evaluated carefully in case the situation escalates or the threatener acquires means to carry out their vague plan. In general, low-level threats are unrealistic and poorly defined.)

D. Threat is direct, specific, but implausible. The threatener indicates a place and time, but the content suggests the threat is unlikely to occur. (Incorrect. While this answer contains some components of high-threat situations, i.e. the threat is direct and specific, since the threat is implausible, the threat does not qualify as being high level.)

Correct Answer: B

General Feedback: Dealing with threats as a counselor can be intimidating, and even scary. It’s important to identify the threat level to better understand the scope of the problem, and obtain a rough outline of the imminence of the threat. In general, the more concrete and detailed the plan, as well as the more realistic, the more likely it is to be carried out. Conversely, plans that lack realism and are more loosely defined are considered low-level threats.

References

Jackson-Cherry, L. R., & Erford, B. T. (2014). Crisis Assessment, Intervention, and Prevention. Pearson Higher Ed.

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