I love the title of J. Christopher Fowler’s article that was published in the current issue (vol 49, issue 1) of Psychotherapy, “Suicide Risk Assessment in Clinical Practice: Pragmatic Guidelines for Imperfect Assessments.” This practice review is thorough and wise. Fowler strikes just the balance between encouraging completeness and responsibility, and acknowledging the limits inherent in [...]
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Helping at-risk patients who rarely show up
January 4, 2011
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From early on in my quest to understand the unique challenges mental health professionals face in working with patients at risk for suicide, I’ve wondered aloud about the things that make us the most nervous. I’m still working my way through a list of questions I posted based on my notes from a series of [...]
Read moreClinical reflections on Army’s approach in interactive suicide prevention video
October 22, 2008
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A colleague pointed me to a Washington Post article describing an interactive suicide prevention video the Army has produced and will make mandatory for all soldiers. I experimented with the online demo of Beyond the Front, which shows scenes from the life two soldiers and allows the viewer to make choices that either lead toward [...]
Read moreClinician response to violation of the “social contract”
February 7, 2007
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I had a stimulating conversation with a senior colleague in the CSPS yesterday. One part of the conversation centered around what happens for us, as clinicians, when the patient does not fulfill his/her end of the “social contract” that is implied when someone goes to a mental health professional. The assumed contract is that the [...]
Read moreClinician anxiety–what’s it about?
February 1, 2007
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When the “S” word comes up, many clinicians feel on edge. I’m sure that more than one factor (and different factors for different people) that contributes to the anxiety, but they are different enough that it affects how we would target training. Here are some possibilities: Uncomfortable with the pain and despair of another. Squemish [...]
Read moreRisk and patient choice
January 25, 2007
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It’s hard enough to assess for suicidal risk, interview, reach a formulation, and develop a plan that matches the risk level. But what do you do when the client does not agree to the plan? It is difficult to manage one’s emotions, and difficult to know how to proceed. This is especially true when the [...]
Read more“How bad has it gotten?”
January 9, 2007
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When I teach about clinical interviewing, I often recommend this phrase (or some variation) as an entry point to questions about suicidal ideation. This accomplishes a couple of things: 1. Frames the discussion about suicidal ideation as one that is exploring the person’s subjective experience and suffering, avoiding the impression of ticking through the required [...]
Read morePost from AAS/SPRC Workshop-Thoughts about staying therapeutic
January 4, 2007
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I’m in Ohio this week at a “train the trainer” workshop developed by the American Association for Suicidology (AAS) and the Suicide Prevention Resource Center (SPRC). The workshop is called “Assessing and Managing Suicide Risk: Core competencies for mental health professionals.” The training has been excellent so far. The material focuses a lot on the [...]
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