资源取向安全计划制定

资源取向安全计划制定

在首次咨询中，针对高自杀风险但无急性精神病性发作、具备基本现实检验能力且对支持系统存有模糊信任基础的来访者，结构化协同制定包含紧急联系人、情绪调节策略、安全场所三要素的安全计划，并获得其关于‘不伤害自己’的明确口头承诺。

Prompt

以共情和无条件积极关注为基调，用非评判性语言引导来访者共同生成可操作的安全计划：① 明确紧急联系人（含外部热线）并确认其可达性；② 用正向提问激活来访者既往有效的自我安抚经验（如听音乐、吃美食）；③ 共同识别物理上与心理上均感安全的场所（如图书馆、低楼层教室）；最后清晰陈述安全要求，并邀请来访者就‘不伤害自己’作出明确口头承诺。

Objective

危机稳定化

Applicable Signals

• 表达无助感或存在感稀薄
• 提及具体自杀想法但无实施计划
• 对支持系统存有模糊信任基础
• Client names specific places where they feel safer (e.g., 'library', 'ground-floor classroom')
• Client links safety to social presence ('where there are people')
• Client shows momentary engagement with alternatives to self-harm

Contraindications

• 来访者处于急性精神病性发作状态
• 拒绝签署或口头承诺安全协议
• 缺乏基本现实检验能力
• Client is actively psychotic or disoriented
• Client refuses collaboration on safety planning
• No verifiable emergency contacts or accessible support systems exist

Intervention Moves

• 正向提问
• 共情性重述
• 选择性聚焦（避开病理性归因，锚定可控行动）
• 具身化引导（如‘想到那个安全场所时，身体哪部分最先放松？’）
• Resource elicitation (‘What places or people help you feel less alone?’)
• Affirming naming of safety (‘You already know what helps — let’s build from that.’)
• Concrete co-documentation (writing plan together, using client’s words)

Workflow Steps

• 评估当下自杀意念强度、计划性、既往行为史及保护性因素
• 介绍安全计划目的：‘不是限制你，而是帮你多一个可用的支持工具’
• 协同填写三项内容：① 紧急联系人（含24小时心理援助热线）；② 个人有效的情绪缓冲行为（用正向提问激活：‘上次心情变好时，你做了什么？’）；③ 安全场所（强调‘人多’‘易离开’‘有熟悉感’等特征）
• 清晰陈述安全约定：‘在咨询期间，请承诺不做出伤害自己的行为；如有不可控冲动，请立即联系咨询师、家人或辅导员’
• 邀请来访者用自己语言复述承诺，并确认其理解与意愿
• Elicit client-named safe places and conditions using open, non-leading questions.
• Validate and reflect the function of each cue (e.g., ‘So being around others helps your nervous system settle — that’s real and usable.’).
• Co-list four plan components using client’s language; avoid clinical jargon.
• Confirm storage method and accessibility (e.g., ‘Would a photo in your phone work? Or a printed copy in your notebook?’).
• End with verbal confirmation: ‘If things get overwhelming this week, which part of this plan will be easiest to try first?’

Constraints

• 必须在首次咨询中完成
• 需确保来访者理解每项内容而非仅被动应答
• 不得将安全计划替代危机转介或医疗干预
• Must be completed within first session of acute risk presentation
• Cannot proceed without at least one client-identified safe location or person
• No hypothetical or future-oriented items (e.g., ‘I’ll call my mom someday’) — only present-tense, actionable items

Cautions

• 避免使用‘保证’‘发誓’等施压性措辞；聚焦‘尝试联系’‘先做一件小事’等低门槛行动承诺
• 若来访者对某项内容犹豫，须暂停推进、探索顾虑，不可跳过或代偿
• Avoid framing safety as ‘staying alive’ abstractly; anchor instead in felt experience (e.g., ‘less alone’, ‘calmer breathing’).
• Do not omit or minimize client’s stated reasons for distress while focusing on resources.
• If client names a place that is objectively unsafe (e.g., rooftop), collaboratively explore why it feels safe and identify a proximal alternative with similar qualities.

Output Contract

• 三方确认的安全计划文本（含联系人、自我安抚策略、安全场所）及来访者‘不伤害自己’的明确口头承诺
• A client-accessible, co-constructed safety plan document (physical or digital) containing four validated components: (1) emergency contacts, (2) crisis hotline numbers, (3) client-identified emotion-regulation actions, (4) client-named safe locations — all expressed in client’s own words and confirmed for immediate usability.

Example Therapist Responses

Example 1

• Client/Input: 咨询师：小Y，考虑到你目前的情绪状态和自杀风险，我们今天需要制定一个安全计划，以确保你能够得到及时有效的帮助和支持。你觉得怎么样？
• Therapist/Output: 小Y：好的，我试试。
• Notes: 来访者初步接受，进入协作制定阶段

Example 2

• Client/Input: Client says: 'I only feel okay in the library — it’s quiet but there are people nearby.'
• Therapist/Output: Plan includes: 'Library (ground floor, near front desk) — go there when overwhelmed; sit for 10 min, watch people walk by.'
• Notes: Uses client’s sensory description and embeds micro-behavior.

Example 3

• Client/Input: Client says: 'My roommate checks on me sometimes — I can text her “I’m shaky”.'
• Therapist/Output: Plan includes: 'Text roommate: “I’m shaky” → she comes over or stays on call for 15 min.'
• Notes: Turns relational resource into time-bound, low-barrier action.

Files

• references/evidence.md
• references/evidence_manifest.json

Triggers

• 来访者报告当前有自杀意念
• 无即时自伤行为但风险评级为中高
• 药物治疗已启动且依从性良好
• Client expresses active suicidal ideation with intent or plan
• Client identifies environmental cues linked to safety (e.g., 'people-rich spaces')
• Client demonstrates capacity to name even minimal protective factors

Examples

Example 1

Input:

咨询师：小Y，考虑到你目前的情绪状态和自杀风险，我们今天需要制定一个安全计划，以确保你能够得到及时有效的帮助和支持。你觉得怎么样？

Output:

小Y：好的，我试试。

Notes:

来访者初步接受，进入协作制定阶段

Example 2

Input:

Client says: 'I only feel okay in the library — it’s quiet but there are people nearby.'

Output:

Plan includes: 'Library (ground floor, near front desk) — go there when overwhelmed; sit for 10 min, watch people walk by.'

Notes:

Uses client’s sensory description and embeds micro-behavior.

Example 3

Input:

Client says: 'My roommate checks on me sometimes — I can text her “I’m shaky”.'

Output:

Plan includes: 'Text roommate: “I’m shaky” → she comes over or stays on call for 15 min.'

Notes:

Turns relational resource into time-bound, low-barrier action.