Three Assessments for Suicide Prevention

This post offers three brief examples of assessments (non-standardized, norm-based, and standardized) for evaluating those at risk of suicide as well as determining factors that may play a role in reducing suicidal intentions.  The construct being measured, therefore, is suicide ideation and intention. In 2013 the average suicide rate in the United States was 113 people per day (Whiston, 2017, p. 153).   A community health assessment for Buncombe County, North Carolina in 2015 concluded that suicide in Buncombe county is rising and as of 2015 the suicide rate was higher than the North Carolina Rates (Buncombe County Community Health Assessment, 2015, p. 20).

With regards to suicide prevention, taking time to engage a client in a conversation about where he or she is at with regards to their propensity and trajectory towards suicidal thoughts may include the non-standardized assessment of discussing the mnemonic device represented in the the following phrase: IS PATH WARM.  Each letter of the phrase represents a guide for counselors in determining the potential risk of a client, please refer to figure 1.1 (Whiston, 2017, p. 154).

Screen Shot 2018-03-13 at 1.49.01 PM.png Whiston (2017) indicates that if the mnemonic assessment reveals there is risk for suicide for the client, the next step is to determine whether the client has a plan to carry out the his or her suicide.

The non-standardized approach of using the mnemonic IS PATH WARM assessment is helpful in providing a guide for the counselor in his or her discussions with a client so as to map out the direction their client seems to be heading with regards to suicide.  This may be considered the ground work or foundation by which other follow-up assessments may add to.  Though non-standardized and consequently subjective, this conversational approach to learning more about what the client is thinking may help build client-counselor trust and establish the client counselor relationship prior to bringing in more normative and standardized assessments.

With regards to a norm-based assessment for determining suicide potential in a client the Suicide Probability Scale provides a 36-item instrument the helps the counselors measure the risk of suicide.  “The scale includes sub scales that assess hopelessness, suicidal ideation, negative self-evaluation, and hostility” (Whiston, 2017, p. 157).  In order to utilize this scale, the counselor must have Masters related to-the-field degree.

An additional and more frequently used standardized assessment for determining suicide is the Beck Depression Inventory-II , which is an assessment focused on depression. “Ponterotto, Pace, and Kavan (1989) identified 73 different measures of depression that researchers or mental health practitioners use” (Whiston, 2017, p.159).  This is assessment may be a preferred standardized assessment as its focus concentrates around depression and it only take the client around 5 minutes to complete, allowing time for the client and counselor to discuss the results almost immediately.  To utilize this assessment also requires the clinician to meet certain educational standards and or certification requirements.

In conclusion, suicide prevention is something that needs awareness in both public and professional arenas in order that the symptoms of suicide do not go unnoticed and are given prompt attention by a professional counselor.

For further reading on the subject of suicide prevention I recommend:

References: 

Buncombe County. (2015). WNC Healthy Impact. Buncombe County Community Health Assessment. Buncombe County: Buncombe County Health & Human Services.

Brown, Jarrod & Salvatore, Tony. (2017). Raising Awareness of Suicide Risk. Counseling Today. Retrieved from http://ct.counseling.org

Whiston, Susan, C. (2017). Principles and Applications of Assessment in Counseling. Fifth Edition.  Australia: Cengage Learning.

Postmodern and Social Constructionist Implications for Christians Who Are Counselors

Postmodern and Social Constructionist Implications for Christians Who Are Counselors

Introduction

A trending topic in research journals over the last twenty years has been the various implications of postmodern thought on psychology and counseling (Biever, Cashion, Franklin, 1998).  Inherent in these journal articles are a variety of views pertaining to the practical analysis of social construction, an off-shoot of postmodernism creating implications for both counselors and social scientists.  A foreseeable problem when engaging in such discussions or reading academic papers on postmodernism is the convoluted language and often confusing jargon that seems to limit the discussion to the ‘isms’ and prevent it from moving towards the praxis of counseling methodology.  The purpose of this paper is to create a synthesis between the philosophical foundations of postmodernism, its psychological counterpart—social constructionism, then analyze a way forward for for Christians who are also counselors.

Christians who are counselors have a particular need to be aware of these trending and rather popular philosophical models because they have implications for how one perceives the purpose and role of the counselor in the client-counselor relationship.  Additionally, this paper will explore the benefits and disadvantages of postmodernism and it will explore various ways in which a Christian counselor may come to appreciate, at least in part, some of the values of postmodernism. Firstly, the current postmodern landscape needs to be described within the context of its beginnings, then an analysis of its recent developments for Christian counselors will be explored.

The Birth of Postmodernism and Social Constructionist Perspectives  

Postmodernism is a byproduct of modernism, a worldview that exhibits certain presuppositional beliefs such as human beings have the capacity through reason to discern what is true, regardless of one’s perception of that truth.  This kind of truth is known as universal truth or objective truth.  These universal or fixed truths in the world are considered knowable regardless of the geographic region one lives.  Postmodernism, a reaction over and against these presuppositional truths rejects that truth is knowable through reason.  To propose this is possible is evidence of having been “indoctrinated into the modernist assumptions of Western culture” (Hanson, 2015, p. 356).

Since postmodernism rejects that truth is knowable through reason, it also rejects that reality can be adequately understood by the mind. “Instead of knowing the truth about reality, postmodernism suggests that we interpret reality….Postmodernism asserts that there are multiple realities, realities that depend upon the stories being told in a particular society” (Blanton, 2008, p. 74).  Within this framework, the social constructionist system for contextualized meaning and “truth” are found solely within relationships, which has brought about new approaches in counseling techniques such as solution-focused therapy and narrative therapy (Hansen, 2015).  Narrative therapy focuses on meanings found in relationship, particularly in the story or stories human beings co-create in relationship with others.  Meaning, therefore is discovered through experience in the social interactions with others. “Thus, social constructionists see numerous competing viewpoints of the world rather than one true view” (Biever, Cashion, Franklin, 1998, p. 169).

Analysis of Postmodern and Social Constructionist Epistemology 

When postmodernism rejected the individualism and rationalism of modernism it however kept intact the modern view of naturalism, which limits knowledge to co-created stories between human beings engaging one-another through speaking—in sharing language. “Rorty (1989), a postmodern thinker, says that only humans speak. However, what if there are higher forces that desire to speak to people? The fact that the divine is not allowed to be part of a person’s social context in postmodern thought is a problem” (Blanton, 2008, p.76).  The epistemic foundation of postmodernism is the same as that of the modernism with regards to the elimination of the divine with regards to social interaction, co-created stories, and humanity’s story as a whole.  Purpose, meaning, and significance do not have larger transcendent or super-natural meaning within either modernism or postmodernism.  Social constructionists therefore are freed from the burden of trying to discern what is true in any given situation, so long as an individual’s “truth” promotes their well being and mental health.  For the Christian who is a counselor, the inevitable conclusion is that universal truth as a standard or for discerning right from wrong no longer exists in postmodern thought.  “Postmodernism seems to accurately describe the contemporary cultural context, but also points toward a disturbing relativism. If everything is ideological, then presumably nothing and everything can be “true” at the same time. None of this seems to be acceptable” (Watson, 2011, p. 309).

Modernism and postmodernism are contentious in their approaches to find a solution to the pitfalls of objectivity.  Even science itself seems to have failed with this regard.  For example, runaway slaves were diagnosed with drapetomania and women who desired an education and career were occasionally told by their psychiatrists that they had ‘penis envy’ (Hansen, 2015).   This would suggest that even science is fallible, or at least until future scientific revelations are made.  However, the greater epistemic concern here is the question of objectivity.  Who or what is objective?  Modernism says human beings are capable of finding objective truth through reason.  Postmodernism rejects objectivity altogether as unnecessary factor in the creation of meaning.  “While passionately criticizing Christianity, Nietzsche also rejected the claim that science could ever be fully “objective.” Science instead, he argued, invariably reflects perspectives motivated by diverse “subjective” interests” (Watson, 2011, p. 310).  If human beings cannot be trusted to arrive at objective truth without imposing their “subjective” interests (a problem for modernism) and if objective truth does not exist at all (a problem for postmodernism), then who is to say what one perceives or experiences at all can be trusted to be an accurate reflection of reality?

The social constructionist response to this, is to point out the inevitability of multiple realities.  These multiple realities with relation to the pursuit of truth changes the dynamic of counseling.  For example, it alters the counselor and supervisor relationship.  “A social constructionist perspective then, would view supervision not as a definitive model, a quest for objective truth about clients or the finding of appropriate, corrective interventions, but as the cocreation and development of new meanings through conversation” (Philip, 2007, p. 52).  This approach is a direct challenge to approaching counseling with empirical studies for the sake of adopting techniques or tools that are objectively verifiable and backed by evidence (Philip, 2007).

By What Standard?  

The very essence of Christian faith begins with the foundational belief that there is a God who has the ability to transcend cultural norms, enter into reality and directly influence nature and human beings in accordance with his own will.  Consequently, Christians philosophically and theologically find their ethical roots in the moral compass of who God is and in the various ways in which this God communicates his desires and thoughts.    This means that for Christianity, God is understood as being Truth itself, the ultimate standard by which all ‘other’ reality is measured, experienced, and perceived.  Thus to reject this objective Truth, is to the Christian a rejection of God.  Or, to put it another way, to say that human beings have the ability to judge for themselves what is right and wrong independent of any other body of truth outside of themselves is to inaugurate an age where human beings are elevated to the role of gods and goddesses.  Pure naturalism and pure materialism cannot even conceive of a God who intervenes in the lives of human beings–it’s the stuff of fantasy.  “The materialistic model of both modernism and postmodernism assumes that the real world is the world of time, space, and matter” (Blanton, 2008, p. 78).  Any extra-curricular activity on the part of a divine being simply cannot be recognized as such.

 A Way Forward for Christian Counselors

Christians who are counselors have an opportunity to genuinely empathize with their clients since Christians believe in a meta-narrative that includes morality that is independent from any legal system of any particular nation or any morality contrived by humanity.  The Christian approach to morality comes from a Christian meta-narrative. Dockery (2001) defines meta-narrative as: “An interpretive structure which gives meaning to reality and common experience” (p. 132).  Christians believe that God constructed a meta-narrative, which is shared through the Bible (divine revelation) in order that he may be in relationship with his creation.  However to believe in the Christian meta-narrative is to believe that truth exists–since the author of the meta-narrative is God–and God is Truth itself.

Blanton (2008) argues that the problem with denying truth altogether, is that God is truth-itself.  To silence truth, is to silence God, which is to silence the Word of God.  The point being is that because God is a relational God, his truth is personal.  “Truth is not simply discovered by reason, as modernism argued. Not only is truth created in language, as postmodernism postulates” (p. 79).  Following this line of thinking, if Truth is personal then morality also becomes personal, as its precepts are are refection of a God who ushered them into existence.

Watson (2001) describes a contemporary response by Christians who are engaging in the postmodern debate: “Erickson (2001) writes, for example, “We must work toward a postpostmodernism, not simply ignoring the phenomenon of postmodernism, and reverting back to a prepostmodernism, but also not halting with postmodernism” (p. 309).”

Christians who are also counselors can reflect their recognition of Truth (or, God) in their community by:

  1. Reflecting the benevolence of the God to others
  2. Taking responsibility when they say or do things that are wrong
  3. Forgiving others of the wrongs done to them
  4. Living out of the joy that comes from the freedom found in the gospel
  5. Passionately pursuing life with a fervor of learning from others
  6. Compassionately caring for others as Jesus emulated in his ministry
  7. Demonstrating empathy for those whom are wounded in body, mind, and spirit
  8. Loving others in they that Jesus loved others–serving, listening, and helping
  9. Delighting in the beauty of creation
  10. Avoiding the pitfalls of philosophical arguments that see to reject the ontological foundation and basis of Christianity.

Conclusion

Christians who are counselors can benefit from the social constructionist’s emphasis on community and its effects on human beings as well as the postmodern emphases on relationships and their impact on the way human beings perceive the world.  Christianity has within its meta-narrative these two values as core representations of what it means to be in relationship with God and his creation.  Additionally, Christians can find value on the emphasis of story in Narrative therapy, as it illustrates what Christianity describes as a consistent and common feature in humanity—sinful behavior that affects all people in all places.  Obviously, the counselor is restricted by the ACA Code of Ethics from imposing his or her own values on the client, however the Christian counselor is well equipped with tools for engaging clients who are suffering, hurting, and or wounded particularly by their own choices or the choices of others.

Christians who are counselors have the ability to enter counseling without judgement of the client’s choices because he or she knows that all have humanity has sinned (Romans 3:23) and consequently all of humanity is in need of salvation.  This produces humility, compassion, and love for others.  The Christian who is a counselor is able to use silent prayer before and after counseling for his or her clients.  This provides an opportunity to trust the work of the Holy Spirit.  The pressure or desire to measure the progress of the counseling process eases, as the Christian who is a counselor, places his or her efforts in the guiding work of the Holy Spirit.  The Christian who is a counselor is not surprised or confounded by other religious perspectives because he or she knows that human beings are spiritual beings created to worship, filled with desires and have the capacity to sin (Romans 1:21; 2 Timothy 4:3-4).  Lastly, the Christian who is a counselor is able to cast aside his or her own “agenda” for counseling because he or she knows that God is the ultimate counselor and is able to fully engage humanity without the “help” of human beings.  The Christian meta-narrative offers the best, most concrete approach for authenticity in the counseling relationship because it is in Christianity one recognizes there is no longer a need to hide behind a self-created identity grounded in materialistic or naturalistic values of self-promotion.  Christianity offers a new hope, a new creation, and new identity to those of believe in Jesus Christ (Ephesians 1-2).  As a result the Christian who is a counselor is equipped to fully engage the problems of humanity with an understanding and self-less approach unrivaled by its secular counter-approaches.  Consequently, the ultimate pedagogy for the Christian who is a counselor, is an attitude of a servant.  Counseling is not about the counselor but the client and the client is best served by an attentive counselor who is able to serve the client by giving his or her time to the client in order to build a counseling relationship grounded in trust.

All of these tools are examples of ways Christians who are counselors may live out their faith without imposing their values on the client, yet at the same time remain true to the Christian meta-narrative, the Gospel, and the God who has acted in time and space to offer salvation to mankind.

References

Biever, J. L., de, l. F., Cashion, L., & Franklin, C. (1998). The social construction of gender: A comparison of feminist and postmodern approaches. Counselling Psychology Quarterly, 11(2), 163-179.

Blanton, P. G. (2008). Integrating postmodern and christian contemplative thought: Building a theoretical framework. Journal of Psychology and Christianity, 27(1), 73-84.

Dockery, David S. The Challenge Of Postmodernism. 1st ed. Grand Rapids, Mich.: Baker Academic, 2001. Print.

Hansen, J. T. (2015). The relevance of postmodernism to counselors and counseling practice. Journal of Mental Health Counseling, 37(4), 355-363.

Philp, K., Guy, G., & Lowe, R. (2007). SOCIAL CONSTRUCTIONIST SUPERVISION OR SUPERVISION AS SOCIAL CONSTRUCTION? SOME DILEMMAS. Journal of Systemic Therapies, 26(1), 51-62.

Watson, P. J. (2011). Whose psychology? which rationality? christian psychology within an ideological surround after postmodernism. Journal of Psychology and Christianity, 30(4), 307-316.