ACT Emergency Procedures & Response 2 — Questions and Answers
Question 1: During an ACT session, a client discloses they have a specific plan to end their life tonight. What is the therapist's FIRST priority?
- Explore the psychological flexibility underlying the suicidal urge
- Ensure the client's immediate physical safety and assess access to means (Correct answer)
- Complete a values clarification exercise to reconnect the client with life
- Schedule a follow-up session for the next morning
Correct answer: Ensure the client's immediate physical safety and assess access to means
Immediate safety and means restriction take precedence over therapeutic techniques when there is imminent suicide risk.
Question 2: An ACT practitioner receives a call from a client's family member stating the client has not been seen in 48 hours after expressing hopelessness. The appropriate response is to:
- Advise the family to wait another 24 hours before acting
- Refer the family to the client's primary care physician only
- Conduct a wellness check by contacting emergency services if the client cannot be reached (Correct answer)
- Document the call and address it at the next scheduled session
Correct answer: Conduct a wellness check by contacting emergency services if the client cannot be reached
When a client is unreachable and risk indicators are present, initiating a welfare check via emergency services is the appropriate duty-of-care response.
Question 3: Which element is MOST critical to include in a collaborative safety plan developed within an ACT framework?
- A list of the client's core irrational beliefs to challenge
- Specific coping strategies, support contacts, and steps to reduce access to lethal means (Correct answer)
- A written commitment never to feel suicidal urges again
- Homework assignments focused on behavioral activation
Correct answer: Specific coping strategies, support contacts, and steps to reduce access to lethal means
Effective safety plans include warning signs, coping strategies, social supports, professional contacts, and means restriction.
Question 4: A client in an ACT session becomes acutely dissociative and unresponsive to verbal prompts. The practitioner should:
- Continue the mindfulness exercise to help the client ground naturally
- Use grounding techniques (e.g., 5-4-3-2-1) and if unresponsive, call emergency services (Correct answer)
- End the session and reschedule for when the client is more regulated
- Administer PRN medication kept on site
Correct answer: Use grounding techniques (e.g., 5-4-3-2-1) and if unresponsive, call emergency services
Acute dissociation unresponsive to grounding may indicate a medical emergency requiring professional emergency intervention.
Question 5: Under HIPAA's emergency exception, a therapist MAY disclose protected health information without client consent when:
- A curious family member requests session notes
- Disclosure is necessary to prevent serious and imminent threat to the client or others (Correct answer)
- Another clinician requests records for billing purposes
- The client's employer requests confirmation of treatment attendance
Correct answer: Disclosure is necessary to prevent serious and imminent threat to the client or others
HIPAA permits disclosure to prevent serious and imminent threat to health or safety under its safety exception.
Question 6: In ACT-informed crisis intervention, the concept of 'defusion' is applied to suicidal ideation by helping the client:
- Suppress and avoid the thoughts of suicide entirely
- Observe suicidal thoughts as mental events rather than literal commands requiring action (Correct answer)
- Debate the logic behind suicidal thinking until it is disproven
- Replace suicidal thoughts with positive affirmations
Correct answer: Observe suicidal thoughts as mental events rather than literal commands requiring action
Cognitive defusion in ACT teaches clients to notice thoughts without fusing with them or treating them as directives for action.
Question 7: A client threatens to physically harm a specific named third party. The Tarasoff duty to protect most commonly requires the therapist to:
- Maintain strict confidentiality and only address the issue therapeutically
- Warn the potential victim and/or notify law enforcement (Correct answer)
- Refer the client to a higher level of care only
- Document the threat and monitor over several sessions before acting
Correct answer: Warn the potential victim and/or notify law enforcement
The Tarasoff ruling established a duty to warn an identifiable potential victim and/or notify law enforcement when a credible threat exists.
ACT Emergency Procedures & Response 2
During an ACT session, a client discloses they have a specific plan to end their life tonight.
What is the therapist's FIRST priority?