I'll be speaking in Lewiston Idaho next week at the St. Joseph's Region Medical Center's annual Rural Mental Health Symposium. I know from IP addresses that we have readers in the Northwest. If any are in the Lewiston area, please come.
Emotion Regulation Difficulties, Youth– Adult Relationships, and Suicide Attempts Among High School Students in Underserved Communities
My colleagues and I conducted a study examining associations between self-reported suicide attempts, emotion regulation difficulties, and trusted youth–adult relationships among 7,978 high-school students. The results have been pre-published online in the Journal of Youth and Adolescence. Our findings point to adolescent emotion regulation and relationships with trusted adults as complementary targets for suicide prevention that merit further intervention studies. We argue that reaching these targets in a broad population of adolescents will require new delivery systems and “option rich” (OR) intervention designs. Print publication will follow later this year.
Suicidal High School Students’ Help-Seeking and Their Attitudes and Perceptions of Social Environment
Clinicians, school personnel, parents and other adults share at least one thing in common: none of us can read minds. The only way we're going to know if an adolescent is considering suicide is if they tell us. My colleagues and I conducted a study examining some key correlates of help-seeking among adolescents who had seriously considered suicide. The results have been published in the Journal of Youth and Adolescence.
I have made some notes about issues that were raised by clinicians, and plan to blog my thoughts about these in coming months as I get pockets of time to reflect on my travels. As I have stated before, I think it's important for educational initiatives to map closely onto the real-life concerns of clinicians, rather than simply reflecting content that experts deem important. Here are a few concerns and questions that I hope to think more about when I have time:/
- When it comes to hospitalizing isn't it always best to "err on the side of caution?"
- Why are we focusing on suicide so much when the people we work with have so many other problems?
- Why are we focusing on suicide when it's so rare and most people who die by suicide weren't in treatment when they die?
- How do we handle individuals at risk who are only marginally involved in treatment-they miss more appointments than they make, but still come enough that they remain on our caseloads?
- Does doing a better job with risk for suicide always mean more work and writing?
- Is there anyone for whom it is not indicated to ask about suicidal thoughts?
- How often should we do a risk assessment?
- What kinds of lawsuits have and have not been successful against clinicians in cases of completed suicide?
- Even if we do everything right, can suicide really be prevented?
Along the lines of that last question, several clinicians shared moving stories about ways in which suicide has touched their lives, personally and professionally. It is always so sad to hear about these deaths, and so encouraging to hear that some of the ideas I brought for discussion felt relevant to these experiences.
A big thanks to the professionals at OMH, St. Lawrence, and Pilgrim who supported and hosted me during these trips. And to the clinicians at both facilities who made these trainings so stimulating and enjoyable.
Some of the members of the Wynne Center for Family Research board read my blog post from yesterday about my presentation to the Board. When I saw them today their response was quite positive--lots of comments (and humor) about it. This brings me back to some of my initial posts about blogging in a professional setting (see Blogging out in the open in a clinical setting and How clinicians learn: Web 2.0 Opportunities?). I'm now at the point of being pretty open about it where I work, and I continue to see it as a useful way for developing ideas, connecting with others with similar interests, and disseminating information to and dialogue with front-line clinicians and trainees.
I presented at the Wynne Center for Family Research (WCFR) board meeting today. I presented about our clinical services and about my work in suicide risk assessment, including how it grew out of experiences with suicidal patients in couples and families. The Center board and the faculty of the WCFR were present.
Barbara Fiese, Ph.D., Syracuse University
Nadine Kaslow, Ph.D., Emory University
William Pinsof, Ph.D., Northwestern University
Harry Reis, Ph.D., University of Rochester (Liaison)
Frederick S. Wamboldt, M.D., National Jewish Medical Center
Karen Weihs, M.D., University of Arizona
Given the stature and brilliance of this audience, I was both nervous and eager to get their feedback about our clinical service and about the work that has grown out of it. Here are my notes, and some reflections, from the discussion that followed my presentation:
-- One board member shared an experience she had many years ago working with a prominent family therapist as her supervisor. She recounted the following experience:
She worked with the family of an adolescent who had attempted suicide. She wanted to do a suicide risk assessment as part of her session with the family. Her supervisor, at first, discouraged her because it wasn't "systemic." She persisted and ultimately prevailed by offering to do a suicide assessment for each person present (not just the child) and to invite others present to provide input on the others' assessment! The supervisor allowed this as sufficiently systemic.
Reflection: This is a fascinating story that highlights the tension inherent in melding an activity that has traditionally been part of an individualistic medical model with a family systems view of people, their problems, and their strengths. I think few family therapy supervisors nowadays would advise against suicide risk assessment. Suicide risk assessment is taught (with a range of how much) in every family therapy training program. But I'm not sure if we've developed a lot further in terms of the actual how-to. My impression is that most of the time, there continues to be a one-dimensional linear approach to training suicide assessment that implicitly assumes individual therapy and interviewing.
-- Other thoughts: One key to resolving the potential tension is to think about suicide as residing in a family system. This view goes beyond thinking about family members a "collateral informants", which is how family involvement is often described in the suicide literature. Instead, we need to develop conceptual AND CLINICAL models for assessing risk through the lens of interactions, relationships, roles, and family myths. For example, how does the hopeless that registers in the individual grow out of family roles and interactions...or from a strength-based approach how might shifts in the family give greater hope to the individual experiencing suicidality. It is not that this is never talked about, it's just that the focus on individual psychopathology and personality often overshadows this dimension--and perhaps more so than with other behaviors we assess and intervene with because the act of suicide is ultimately unilateral and done when alone.
-- One member asked about me "sharing" what I'm working on. This is an important question to me on several levels:
- Blog. This blog is one mechanism I'm using to share thoughts and discoveries.
- Planned publications. I am on the cusp of conducting an evaluation of my risk assessment workshop and plan to publish the results. I am also working on another publication in which I'm collaborating with two faculty members of the Deaf-Wellness Center.
- Career Direction. If what I'm doing turns out to be helpful to clinicians and to families, I want to share it widely. That brings up interesting questions about how I spend my time professionally. Given the range of my interests (in terms of content (peds primary care, suicide) and professional activities (teaching, writing, clinical work), it is hard to know the right direction. A career in research is appealing in ways it hasn't been in the past. This is probably a dilemma many of my readers (especially those in academia) are familiar with. I'll be focusing on discerning this over the next year or so.
-- After I talked about this blog, a board member recommended using it as a way of helping to disseminate science to general audience. I have done this a little (such as here), but could probably do more.
-- A board member suggested that, in light of how heavy it is to focus on suicide (an adverse outcome), it would be advisable for our clinical service to also gather stories and data about positive outcomes of family therapy. This is a perceptive and appreciated comment because prevention of a bad outcome does have a peculiar emotional tone for an individual or group. I named this blog "Commitment to living" in part to cast this work in a positive direction. This comment is a good reminder to do that kind of thing in many ways also at a system level.
All of that in 30 minutes! I appreciated the opportunity to consult with such bright and experienced senior experts in our field.