Alan: (I am assuming this is the first session I have met him).

1. Introduce self, explain process of referral; explain therapy

2. Empathize with Alan regarding stress
3. Collaboratively form plan for the session. Guiding initial assessment by using a step-by-step
assessment of suicide, e.g. “It seems that you have an enormous amount of stress on your
shoulders.” “It seems like there are a lot of things interfering with your studies and work.” “In
some situations you've even felt hopeless.” “People under those circumstances can often feel
desperate to solve their problems.” “Have you even thought about suicide as a way out of the
pain that you're in?” (Mirroring his language.)
Once information is gathered regarding whether he is acutely suicidal, I would assess warning signs for
suicide risk. I would assess nature of ideations and his lethality. I would suggest that suicide is a focus
of ongoing treatment and/or I would suggest that suicide is an urgent matter that has to be addressed
today, depending on his level of risk. Using CAMS (Collaborative Assessment and Management of
Suicide) and the Suicide Status Form is one of the tools I might use to engage him therapeutically.*
4. Early in the session, I would try to formulate treatment plan with Alan (e.g. following treatment
plan). I would use solution focusing to formulate goal. E.g. “What would your life look like if
three months from now, it seems this treatment has been effective for you?”
5. Psychoeducation regarding stress and its normality under circumstances, depression, and
panic/anxiety attacks. I would explain that it appears that he had a panic attack when he came
to class late. Expressed interest in assisting him to develop skills in coping with panic attacks.
6. I would empathize and normalize emotions that could come up, e.g. emotions regarding the
distance from his family, his alienation from Seattle, his lack of social support, and worries
about work. Along with these emotions, there may be deeper emotions and beliefs about
himself as fitting in/not fitting in with his social scene, his identity as a college student and as
an African American man. I would suggest finding ways of coping with emotions through
behaviors and reflecting on the meanings of these emotions.
7. In the last 10 minutes, I would ask him how this session has helped, if there is anything that
stands out to him as being important to remember, and if there is anything that is missing that
we forgot to address. I would summarize the session by repeating what we have discussed and
reinforcing the options on the crisis plan, giving him a copy of the crisis plan. I would suggest
a treatment schedule.

*Suicide assessment: If he is showing any level of suicide risk, I'd suggest using a standardized
instrument such as the Columbia Suicide Severity Rating Scale (C-SSRS) or the CAMS Suicide Status
Form (SSF-4). Does he have a plan? How intense/frequent/lasting are his ideations? Does he see them
as comforting or as disturbing and unwanted thoughts? Does he think of suicide as a way out or as a
way to communicate? Does he have any means? Any prior attempts? Etc.
Is the schoolwork or work a key variable in his suicidal thoughts? (ie. If he does poorly in his grades
does it mean that he will be come acutely suicidal? If he is fired from work would he become acutely
suicidal?) What are his triggers for suicidal thoughts? E.g. his grades: does his self esteem or belief in
himself depend on good grades, and do bad marks trigger suicidal ideations?

Alan:
Diagnosis: 1. Acute stress disorder, generalized anxiety disorder (constant worrying, restless, difficulty
concentrating, trouble sleeping, muscle tension, sweating, irritability)
Rule out: Major depression. Ask questions that assess depression sx. Has he lost interest in activities?
Has he felt hopeless? Has he been Differential diagnosis process regarding bipolar and unipolar
depression.
Areas of need/challenges:
All of these are relevant as they arise in the session. In the information that is provided on the case
study, I would suggest for both of them:
1. Mental health / behavioral symptoms: Suicidal ideations, self care/daily functioning
(perfectionism, worry, beliefs, cognitions/schemas, strategies to use when anxious or having
suicidal thoughts; panic attacks)
2. Self care –
Identifying areas where self care can be improved; e.g. perfectionism; work schedule. I would seek to
identify strengths of his, including areas of skill that has brought him to college.
3. Social: Strengthen social supports by identifying behaviors that he can engage in to improve
social connection. E.g. clubs or activities that restore interpersonal support that can lower
stress. Perhaps he has worries about his social skills and the therapeutic relationship could be a
place where he could develop those skills.
4. Medical: Interventions would depend on his medical status.
5. Risk: see above re: suicide risk.
6. Substance use: None reported, but may use SBIRT or other tool to assess
7. Educational/vocational: Identify areas of concern (performance; perfectionism; specific goals;
behavioral tasks related to goals)
8. Family: Relations with family that contribute to well being, or lack of well being. Identifying
responsibilities to care for others and how this contributes to stress. Identifying ways of
communicating self care needs as well as continuing to maintain responsibilities.
9. Culture: Find out what he values and expects from an ideal life. What values has he been
raised with and how these values have been challenged by his current environment?

Initial service plan: ALAN

NEED: Mental health / behavioral symptoms. Suicidal ideations.
1. Continue to assess risk every session through PHQ-9. Formulate crisis plan collaboratively
with him and consider crisis planning a continually updated document.
2. Strengths: 1. Therapeutic alliance, he knows he needs to address his mental health symptoms,
and knows there is a problem that he wants to work on. 2. He has developed some ways of
encouraging himself positively. 3. Supportive family. 4. Academic skills.
3. Goals: 1. Cope with feelings of subjective distress causing suicidal thoughts. 2. Cope with
suicidal thoughts when they come up.
4. Objectives: Use cognitive interventions including practicing self-compassion, mindfulness
meditation, physical exercise, keep diary card, chain analysis, etc (whatever the client and
therapist agree together as an intervention). In case of suicidal ideations: Use
cognitive/behavioral interventions including distraction, calling family, calling therapist, calling
crisis line or suicide hotline (also identify specific strategies that Alan knows he can use).
NEED: Self care/daily functioning
1. Strength: Client has a strong work ethic and is self-critical/able to self-reflect.
2. Goal: Manage stress and anxiety in a way that reduces his subjective distress.
3. Objectives: 1) Establish a schedule that is sustainable. 2) Identify and practice specific self
care routines that he can use on a regular basis, using specific ideas developed in therapy. 3)
Cope with problems that come up (e.g. exams and work conflicts) by using specific
interventions and coping skills developed in therapy.