| Threat of violence against another. While in group, a male client expressed strong feelings of anger toward another man involved with the client's ex-wife. The client stated that he had a gun and wanted to kill the other man. |
| Counselor response. The counselor removed the client from the group and engaged him in a discussion about his feelings and remarks. The counselor expressed concern about the client's well-being and assessed whether he understood the seriousness of his statements. The client's anger began to subside, and the counselor had him sign a “no violence” contract. |
| For several days thereafter, the counselor telephoned or spoke in person with the client to assess his feelings and thoughts. The client stated he would “never do anything like that” and had regretted his outburst. |
| Threat of suicide. A female client telephoned her counselor and said she was tired of struggling with her addictions and other problems and was thinking about killing herself. |
| Counselor response. The counselor assessed the immediacy of the threat by reviewing the case record to determine whether there had been any previous attempts at suicide and asking the client whether she had a specific plan and the means to carry out the plan. If the counselor were still concerned, he or she would have consulted immediately with the supervisor or program director to develop and document a plan to inform the police, relatives, and the client's doctor and scheduled an immediate one-on-one session. Because these criteria were not met, the counselor, with the agreement of the client, scheduled an individual therapy session. During the session the counselor and client negotiated a “no suicide” contract that included a commitment by the client to see a psychiatrist for evaluation as soon as possible. |
| The counselor recorded the incident in the case record and discussed it further with the supervisor. |
From: Chapter 7. Clinical Issues, Challenges, and Strategies in Intensive Outpatient Treatment
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