Problem: Client: Jamie R., a 22-year-old biracial (Black/White) woman, presents to a community mental health clinic after being referred by her university's counseling center. She is in her senior year of college and majoring in psychology. Presenting Concerns: Jamie reports "feeling numb most of the time" and says that cutting helps her "feel something." She has been engaging in nonsuicidal self-injury (NSSI)-making shallow cuts on her upper thighs-on and off since age 15. She denies intent to die when cutting, describing it as a way to cope with intense emotional distress and shame. Over the past three months, Jamie has increased her alcohol use, drinking 4-6 drinks per night, 3-4 times per week. She sometimes drinks alone and has blacked out twice. Friends have expressed concern about her "partying" and isolating afterward. Two weeks ago, Jamie sent a text to a friend that read: "I don't see the point in any of this. It'd be easier if I just didn't wake up." • Her friend called campus police, leading to an involuntary overnight hospital stay. Jamie told the hospital staff she "didn't mean it that way" and was discharged with a referral for outpatient therapy.
Assessment:
1. How would you distinguish between nonsuicidal self-injury and suicidal behavior in Jamie's case? Need Assignment Help?
2. What questions would you ask to assess suicidal intent, plan, and means?
3. What role does alcohol use play in her risk profile?
Formulation:
1. How might Jamie's substance use interact with her self-injury and suicidal ideation?
2. Consider how trauma, grief, and family history influence her coping strategies.
Intervention:
1. What evidence-based approaches could be used to address NSSI and co-occurring substance use (e.g., DBT, CBT, MI)?
2. How would you collaboratively develop a safety plan that addresses both NSSI and suicide risk?
Cultural & Systemic Considerations:
1. How might Jamie's biracial identity, gender, and college environment shape her experience of distress and help-seeking?
2. What systemic or institutional supports (campus counseling, peer support, substance use programs) could be mobilized?