AAS Clinical Practice & Treatment Planning 2 — Questions and Answers
Question 1: A client with borderline personality disorder presents with chronic suicidal ideation and a recent superficial cut. What is the most appropriate first step in treatment planning?
- Immediate inpatient hospitalization
- Conduct a thorough risk assessment differentiating chronic from acute risk (Correct answer)
- Increase session frequency to daily
- Contact emergency services immediately
Correct answer: Conduct a thorough risk assessment differentiating chronic from acute risk
Distinguishing chronic baseline suicidality from acute elevations is essential before deciding on the level of care for BPD clients.
Question 2: Which therapeutic modality has the strongest evidence base for reducing suicidal behavior in individuals with borderline personality disorder?
- Cognitive Processing Therapy (CPT)
- Dialectical Behavior Therapy (DBT) (Correct answer)
- Eye Movement Desensitization and Reprocessing (EMDR)
- Motivational Interviewing (MI)
Correct answer: Dialectical Behavior Therapy (DBT)
DBT was specifically developed for BPD and has robust randomized controlled trial evidence for reducing suicidal acts and self-harm.
Question 3: During a safety planning session, a clinician asks the client to list reasons for living. This technique draws primarily from which theoretical framework?
- Psychodynamic theory
- Cognitive-behavioral theory and means restriction counseling
- Existential therapy
- Motivational interviewing and hope-based approaches (Correct answer)
Correct answer: Motivational interviewing and hope-based approaches
Eliciting reasons for living is a core motivational and hope-based technique that taps into the client's own ambivalence about dying.
Question 4: A safety plan differs from a no-suicide contract primarily because it:
- Requires a witness signature to be valid
- Is collaborative, actionable, and focuses on coping steps rather than a promise not to act (Correct answer)
- Is only used in inpatient settings
- Must be approved by a psychiatrist before implementation
Correct answer: Is collaborative, actionable, and focuses on coping steps rather than a promise not to act
Safety plans are collaborative, step-by-step coping tools; no-suicide contracts are promises that lack evidence of effectiveness and can create false security.
Question 5: When treating a suicidal client who is also experiencing active psychosis, which intervention priority is MOST appropriate?
- Focus exclusively on psychotherapy before any pharmacological intervention
- Address psychotic symptoms medically while concurrently assessing suicide risk (Correct answer)
- Discharge once psychosis remits regardless of suicidal ideation
- Avoid discussing suicidal thoughts to prevent suggestion
Correct answer: Address psychotic symptoms medically while concurrently assessing suicide risk
Psychosis significantly elevates suicide risk, so stabilizing psychotic symptoms medically while continuously monitoring suicidality is the safest approach.
Question 6: A clinician is counseling a veteran who endorses passive suicidal ideation but no plan. Which factor would MOST elevate clinical concern?
- The client reports mild insomnia
- The client recently gave away a prized military firearm (Correct answer)
- The client missed one therapy appointment
- The client expressed frustration with VA wait times
Correct answer: The client recently gave away a prized military firearm
Giving away valued possessions is a behavioral warning sign that suggests preparatory behavior for suicide.
Question 7: The 'means restriction counseling' component of a safety plan involves:
- Teaching clients to restrict negative thoughts
- Collaborating with clients and support persons to reduce access to lethal means (Correct answer)
- Limiting the number of crisis calls a client can make
- Restricting the client's access to social media
Correct answer: Collaborating with clients and support persons to reduce access to lethal means
Means restriction counseling reduces access to firearms, medications, and other lethal means to create a time buffer during a suicidal crisis.
AAS Clinical Practice & Treatment Planning 2
A client with borderline personality disorder presents with chronic suicidal ideation and a recent superficial cut.
What is the most appropriate first step in treatment planning?