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dontknow

counsellor

3 posts in this topic

this is another past question

g.p counsellor or counsellor on your team contacts you to say someone they are seeing for counselling has threatened suicide if the counsellor stops seeing them

what would you advice the counsellor?

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1. Get a new job.....hah hah

2. Seriously.. I'd go into risk management mode.

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Issues: risk of harm to patient, possible risk of harm to councellor

Gather background info: speak to councellor, find out how long been seeing for, current issues, reason for first referral, what diagnosis is likely/known, what threat was made when and where. Where is the patient now?

Speak to GP, background psych contact?

Get psych notes if available

Speak to other MDT members that may be involved.

Arrange to see the patient possibly with the councellor, explain has been referred due to concerns about self harm. Explore context of threats and try to understand reasons behind it. Screen for psychiatric disorder and personality difficulties. Ask about previous self harm.

Mental state to exclude psychosis, depression.

Diff dx: no mental illness, depressive disorder, acute stress reaction, adjustment disorder, personality disorder esp dependent, borderline, histrionic. Abandonment fears.

Management: exclude and treat mental illness if there. If down to personality issues then may need to advise change of councellor, ensuring adequate supervision for future councellors, reassure councellor that they would not be responsible for suicide. Explain to patient that they need to take responsibility for their actions and that this type of distressing behaviour is inappropriate. May be unsuitable for future councelling, may be more appropriate for psychodynamic psychotherapy. If serious concerns about suicide then may need to admit, otherwise use CPN to monitor, involve social work department if there are social stressor precipitating the crisis.

Should be about it.

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