History taking is a pivotal part of any therapy or counselling process. The more complete a history one can get the better as the possible paths the client may go in the future can be anticipated and treatment can be designed to deal with those.
One obvious problem with history taking is you can not take a history if the client does not have one. That is, a client who is 17 years old has much less history then a 37 year old. This can be a significant disadvantage when working with the younger client. In my book Working with Suicidal Individuals, I discuss depression including what to look for when assessing the history of a client who reports experiencing depression.
To assist with this I constructed a graph depicting the key components in taking a history of the depressed person. This graph is presented below:
Most depression is cyclical as shown in the diagram with the mood changing over time from a normal level to a depressed level and back. As shown in the diagram one can move from a normal mood range down into the range of dsythymia. In this phase the depressive symptoms are at a moderate degree. Historically this has also been known as neurotic depression. This is seen as less severe than the next level down which is called a major depression. Sometimes this is called 'clinical depression' where the individual is significantly incapacitated and is very depressed. Also at this level one can have a condition known as psychotic depression. This is where the individual has the symptoms of major depression plus some psychotic symptoms.
In taking a history of the depressed person one need to look at four aspects of the depressive cycle W, X, Y and Z. Firstly one is wanting to assess the length of the non depressed periods (W) and the lengths of the depressive episodes (X). How many have there been and how long were they? Also were there any precipitating factors such as marital problems or financial difficulties that lead to the depressive episodes. These can then be charted on a graph as is shown in diagram.
One also needs to assess the quality of the depressive episodes by making an assessment of the 'Y' component. Here one assesses how depressed the person becomes, how the person has felt in past episodes. As mentioned before the system being presented here distinguishes between normal mood, dysthymia or neurotic depression, major depression and psychotic depression.
Finally in the diagram one needs to make an assessment of 'Z' in the depressive cycle. Suicide risk may increase as the person improves particularly from a major depression or a psychotic depression. In these depressive states the person is so depressed they can become incapacitated. They are so depressed that they literally do not have the energy to think seriously of suicide or certainly making any definite planning. As the depressed state lifts, along with that comes an increase in energy which may bring about an increased ability to act on any self destructive wishes, as they improve one may need to be more vigilant as they reach the “Z” part of the depressive cycle.
If one can get reasonable quality information on these four aspects of the depressive cycle then one has a good understanding of the depressive history of the client.
Graffiti
I have been subject to far too many suicides. That is to say I have known someone, been related to someone, found someone, or been privy to someones attempt in some way shape or form to kill themselves. I appreciate much of what you have to say and thank you for sharing. Suicide is the most selfish act someone can commit, but for those left behind the questions are very personal. Something that helps me along is remembering this loss of life had nothing to do with me. Nothing to do with the parents. Nothing to do with the friends. Many people live very similar lives to complete success... it was the weakness in that person we held so dear manifesting itself in the worst opportune time. Suicide awareness is always "monday-morning-quarterbacking".
ReplyDeleteHello Thee Kidd,
ReplyDeleteOften when I run workshops on working with the suicidal I ask people to report their reactions to suicide. I usually get a whole variety with one of them being that it can be viewed as a selfish act as you have indicated. Others report it is sad, some even say it is an act of bravery and some say they understand as it is everyones right to choose when to die.
I suppose we are all different in how we view the world.
Graffiti
Have you been thinking about death or suicide more than usual,
ReplyDeleteor have you tried to commit suicide. Surwit notes also that:
"The change is nearly as large as you would expect to see from some diabetes-control drugs".
Deficiencies in vitamins, minerals, and amino acids
can cause a lack of serotonin and norepinephrine, the primary
chemicals involved in mood regulation (Elkins 26).
My blog ; postnatal depression