Case Study
Patient Demographic: Initial Intake: Age: 58 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Married Counseling Setting: Private Practice Type of Counseling: Individual
Mental Status Exam: The client reports that in the past six months she has lost 40 pounds, which leaves her looking thinner than seems appropriate for her 5’8” frame. Her hair is combed and neat, but looks thin and lacks a healthy shine. Her clothes, while clean, appear rumpled as if they have been slept in. She is cooperative and engaged, but moves slowly and pauses in her speech, causing you to wonder if she is lost in thought or if speaking is too painful. She reports she has difficulty falling asleep at night and never feels like she has any energy, though she does go to work each day.  She denies any suicidal thoughts but states she feels sad all the time and “can’t wait to see him again.” She admits she blames herself for not keeping him home that evening, which would have prevented his death.
Presenting Problem: You are a counselor in a private practice setting.  You receive a telephone call from an attorney that would like to refer their client, who is engaged in a civil suit, to you for counseling treatment. The attorney provides you with a detailed description of a traumatic event, death of her son, and expresses concerns about the client’s well-being. The attorney requests that you work with their client and be prepared to testify in court when the case goes to trial.
Other Contexts: Family History:
During the intake session, the client reports that her youngest son was killed in a car accident eighteen months ago, which was caused by an impaired driver.  Her son was the youngest of her five children and while she said she loves them all equally, she reported that her children have always said their youngest brother was her favorite.

Question: What is the best explanation for how the counselor distinguishes between clients with suicidal ideations related to depression and clients who have thoughts of death and dying due to grief?
(A): Clients with depression and suicidal ideations will often have history of suicide attempts in their past; whereas clients who have thoughts of death or dying have no history of previous suicidal attempts.
(B): Clients with depression and suicidal ideations very rarely tell anyone about their thoughts of suicide; whereas clients who think about death due to bereavement very often feel comfortable talking to others about wishing that their life was over.
(C): Clients with depression and suicidal ideations isolate themselves from others; whereas clients who have thoughts of death and dying due to grief seek the company of others even though they are sad.
(D): Clients with depression and suicidal ideation focus on their own feelings of worthlessness, guilt, or inability to cope; whereas clients with thoughts of death and dying due to grief usually focus on the deceased person.

Correct Answer: Clients with depression and suicidal ideation focus on their own feelings of worthlessness, guilt, or inability to cope; whereas clients with thoughts of death and dying due to grief usually focus on the deceased person.
Explanation: Focusing on one's thoughts of death or dying is the best indicator of depression versus bereavement or grief. Alternatively, both clients with depression and clients who are grieving may talk to others about their active or passive suicidal thoughts, may or may not have a history of suicide attempt, or may or may not isolate themselves from others. Therefore, the correct answer is (A)
Competency: counseling skills and interventions