Where's the Family?

I was just looking at the post counts on my categories and seeing few posts I have (only 2) family therapy category.   I think that reflects the state of the field right now, as well as my own internal conceptual development which is not yet entirely integrated.  Two things for sure:

1.  Almost everything I've read in the clinical suicide assessment literature assumes a one-on-one context.   Family therapy is usually not mentioned.  Families are sometimes mentioned, usually as potential sources of information when things get really risky, but without much attention to how to do that.

2. Family therapists tend to get pretty individualistic when they teach or write about suicide prevention.   This tendency was unmistakable in a recent Family Therapy Magazine, a publication of AAMFT that is distributed free to all members.   The July/Aug 2006 issues was titled "Suicide in the Family."   Yet if you look at the articles there is almost no content related to family therapy.  In fact, if you removed the cover and took out a couple of intro paragraphs, the articles would be indistinguishable as a family therapy publication.   Remarkable.

I think this state of affairs reflects that fact that it's not easy to bring the two together in practice.   How, when and of whom do you ask about suicidality in a room full of family members of different ages?  How do you bring up a topic that is hard enough to bring up with one person in front of you?   How much history about self-harm do you gather in front of children?  I don't think anyone has really spelled out how to translate the relatively linear risk assessment principles to skillful systems work. If there is work in this area, I'd be interested to learn more about it.That said, I think it's hard and we don't have good models, but it is not impossible.  I see our trainees doing it exceptionally well.   It is demanding, but do it well because they are talented and devoted--and because we emphasize it, in part, because of my developing expertise in the area.  But I don't think any of us yet has a clearly-enough articulated model to present as the standard of care.

I feel obligated to add here, that there are some equally hard questions that a family therapist could ask an individual therapist too.  Like...how can you possibly get a complete risk assessment picture without talking with family members, seeing the patient interact with them, understanding the family pathology and strengths?  How do you monitor warning signs without inside players?   I've lately been reading extensive case reports of people who died by suicide.  In each of the cases I read, it would have been impossible to understand the risk picture without extensive information from family members.  Many of those truly at risk of killing themselves just do not disclose enough and the right kind of information.

This is an area in much need of development.