Clinical Manual for the Assessment and Treatment of Suicidal Patients

Since the first edition of Clinical Manual for Assessment and Treatment of Suicidal Patients was published in 2005, advances have been made that increase our understanding of suicidal and self-destructive behavior. Although clinicians cannot unerringly predict which patients will die by suicide, they can focus more successfully on early identification of suicidal behavior and effective intervention, and this new edition of the clinical manual thoroughly explores not only assessment of suicidality but what comes after an at-risk patient has been identified. The authors argue that treating specific psychiatric disorders is not enough to prevent suicide, and they offer clinicians the necessary information and strategies to bridge that gap. The authors' main premise is that suicide is a dangerous and short-term problem-solving behavior designed to regulate or eliminate intense emotional pain -- a quick fix where a long-term effective solution is needed -- and this understanding is the underpinning of the assessment and treatment strategies the authors recommend. The content of this new edition has been thoroughly reviewed and revised, and substantive changes have been made to specific chapters to ensure that the book represents the most current thinking and research, while retaining the strengths of the previous edition. • The chapter on assessment has been revised to put the fundamental components of effective treatment in a clinical, case-oriented context and includes an easy-to-use assessment protocol that allows clinicians to determine where individual patients stand on seven dimensions (cognitive rigidity, problem-solving deficits, heightened mental pain, emotionally avoidant coping style, interpersonal deficits, self-control deficits, and environmental stress and social support deficits).• The many issues involved in the use of psychotropic medications in suicidal patients are addressed in a new chapter, which includes information on the relevant classes of drugs (such as antidepressants and antianxiety agents) and the issues that may arise with their use, including side effects, degree of lethality, and tendency to aggravate suicidality on introduction and withdrawal of the medication. • The chapter on special populations has been expanded to include adolescents, elders, and patients with co-occurring substance abuse or psychosis. Because of additional vulnerabilities, treating these groups may call for the use of added or special techniques to ensure the best therapeutic outcomes.• Primary care physicians are the first point of contact for many patients, and they may require additional preparation in order to assess and respond to those experiencing suicidal thoughts. The chapter "Suicidal Patients in Primary Care" explores strategies for screening, recognizing, and assessing risk; treating the initial crisis; and developing a crisis management plan.• "Tips for Success" appear at intervals, and "The Essentials" are included at the end of each chapter, highlighting the most important concepts. In addition, there are scores of helpful charts and exercises. Practical, accessible, and reader-friendly, the Clinical Manual for Assessment and Treatment of Suicidal Patients is not an academic book but rather is one designed to become an indispensable part of clinicians' working libraries. Cover Half Title Title Page Copyright Contents About the Authors Preface 1 Dimensions of Suicidal Behavior Lived Experiences With Suicidality Can Suicide Be Predicted? The Role of Psychiatric Disorders The Role of Personality Characteristics The Role of Environmental Factors The Role of Genetics The Role of Biochemistry The Role of Medical Illness Conclusion 2 The Clinician’s Emotions, Values, Legal Exposure, and Ethics: Global Issues in the Treatment of Suicidal Patients Understanding Your Emotional Responses to Suicidal Behavior Morals- and Values-Based Stances on Suicide More Self-Examinations Legal and Risk Management Issues Ethical Issues in the Treatment of Suicidal Patients Ethical Guidelines for the Treatment of Suicidal Patients 3 A Basic Model of Suicidal Behavior: A Learning-Based Problem-Solving Approach The Role of Mental Pain The Patient’s Relationship to Suffering The Role of Avoidance-Based Coping The Role of Learning and Reinforcement The Role of Short-Term Versus Long-Term Consequences Final Comments 4 Assessment and Case Conceptualization: Fundamental Components of Effective Treatment Prediction (and Prevention) of Suicide: Clinical Lore Versus Clinical Research Risk Prediction Systems: Beware of Smoke and Mirrors A New Approach to Assessing Suicidal Behavior Using Assessment to Reframe Suicidal Behavior Using Self-Monitoring to Study Suicidal Behavior Using Self-Monitoring to Decrease Reactivity Building a Collaborative Set Using Self-Report Measures Case Conceptualization and Treatment Formulation 5 Outpatient Interventions With Suicidal Patients: Promoting Acceptance and Value-Based Problem Solving Overview of Basic Principles Letting Go of Polarities The Role of Suicidal Behavior in Therapy Initial Contact: Treatment Starts in the First Minute The Early Phase of Treatment Changing Reactions to Trigger Situations Focusing on Workability Encouraging Behavioral Experiments Avoiding Clinical Pitfalls Considering Session Logistics and Course of Treatment Goals of Continuing Treatment Terminating Treatment: Building for the Future Conclusion 6 Suicidal Behavior and Use of Psychotropic Medications Medications and the Suicidal Patient Case Management in Microcosm: The Prescribing Physician–Therapist–Patient Triangle 7 The Repetitiously Suicidal Patient: An Intervention Approach for High-Risk Patients Suicide, Attempted Suicide, and Parasuicide A Functional Contextual Perspective on Multiproblem Patients Working With the Multiproblem Patient Clinical Strategies for Working With Multiproblem Patients Clinical Management of Suicidal Crises 8 Managing Suicidal Emergencies: Using Crisis to Create Positive Change Working Through Suicidal Crises: Five Principles Strategies for Working Through Escalating Suicidal Behavior Using Suicidal Crises to Promote Growth An Important Agreement: Who Will Do What in the Heat of the Moment? Developing a Coping Card Staying the Course: Principles for Helping a Patient Grow in the Midst of Suicidal Crisis Case Management: Crisis Intervention at the System Level Making Productive Use of Hospital and Residential Treatment Options Seeking Respite: Practicing Responsibility and Self-Control Funneling: Someone Has to Be in Charge Qualities of the Effective Case Manager 9 Hospitals and Suicidal Behavior: A Complex Relationship Does Hospitalization Prevent Suicide? Does Hospitalization Work as a Treatment of Suicidality? What Are the Unintended Side Effects of Hospitalization for Suicide? Is This Place a Treatment Facility or a Prison? When Hospitalization Goes Sour Will I Get Sued if I Do Not Hospitalize? When Should a Patient Be Hospitalized? Clinical Targets for an Effective Short-Term Hospital Stay Model Integrated Treatment and Crisis Response System Keep All the Doors Open 10 Suicidality and Special Populations Addictive Behaviors and Suicide: The Patient Who Is Left Out in the Cold The Special Case of Psychosis Working With Suicidal Children and Adolescents The Forgotten Many: Suicidal Behavior in the Elderly 11 Suicidal Patients in Primary Care: Responding to the Challenge The Best Option: Integrate Behavioral Health Services on Site Prepare to Deal With This on Your Own Implementing a Quick, Effective Screening and Assessment Protocol for Suicidality The Role of Diagnostic Screening Developing the Management Plan Intervention Strategies for Treating the Initial Crisis If Ongoing Management Is in the Cards Conclusion Appendix A: Philosophies About Suicide I. Suicide Is Wrong II. Suicide Is Sometimes Permissible III. Suicide Is Not a Moral or Ethical Issue IV. Suicide Is a Positive Response to Certain Conditions V. Suicide Has Intrinsic Positive Value Appendix B: Consequences of Suicidal Behavior Questionnaire Part 1 Part 2 Part 3 Appendix C: Reasons for Living Inventory Survival and Coping Beliefs Responsibility to Family Child-Related Concerns Fear of Suicide Fear of Social Disapproval Moral Objections Appendix D: Malpractice Management Assessment Appendix E: Suicidal Thinking and Behaviors Questionnaire Index Back Cover Since the first edition of Clinical Manual for Assessment and Treatment of Suicidal Patients was published in 2005, advances have been made that increase our understanding of suicidal and self-destructive behavior. Although clinicians cannot unerringly predict which patients will die by suicide, they can focus more successfully on early identification of suicidal behavior and effective intervention, and this new edition of the clinical manual thoroughly explores not only assessment of suicidality but what comes after an at-risk patient has been identified. The authors argue that treating specific psychiatric disorders is not enough to prevent suicide, and they offer clinicians the necessary information and strategies to bridge that gap. The authors' main premise is that suicide is a dangerous and short-term problem-solving behavior designed to regulate or eliminate intense emotional pain — a quick fix where a long-term effective solution is needed — and this understanding is the underpinning of the assessment and treatment strategies the authors recommend. The content of this new edition has been thoroughly reviewed and revised, and substantive changes have been made to specific chapters to ensure that the book represents the most current thinking and research, while retaining the strengths of the previous edition. • The chapter on assessment has been revised to put the fundamental components of effective treatment in a clinical, case-oriented context and includes an easy-to-use assessment protocol that allows clinicians to determine where individual patients stand on seven dimensions (cognitive rigidity, problem-solving deficits, heightened mental pain, emotionally avoidant coping style, interpersonal deficits, self-control deficits, and environmental stress and social support deficits).• The many issues involved in the use of psychotropic medications in suicidal patients are addressed in a new chapter, which includes information on the relevant classes of drugs (such as antidepressants and antianxiety agents) and the issues that may arise with their use, including side effects, degree of lethality, and tendency to aggravate suicidality on introduction and withdrawal of the medication. • The chapter on special populations has been expanded to include adolescents, elders, and patients with co-occurring substance abuse or psychosis. Because of additional vulnerabilities, treating these groups may call for the use of added or special techniques to ensure the best therapeutic outcomes.• Primary care physicians are the first point of contact for many patients, and they may require additional preparation in order to assess and respond to those experiencing suicidal thoughts. The chapter "Suicidal Patients in Primary Care" explores strategies for screening, recognizing, and assessing risk; treating the initial crisis; and developing a crisis management plan.• "Tips for Success" appear at intervals, and "The Essentials" are included at the end of each chapter, highlighting the most important concepts. In addition, there are scores of helpful charts and exercises. Practical, accessible, and reader-friendly, the Clinical Manual for Assessment and Treatment of Suicidal Patients is not an academic book but rather is one designed to become an indispensable part of clinicians' working libraries. Since the first edition of Clinical Manual for Assessment and Treatment of Suicidal Patients was published in 2005, advances have been made that increase our understanding of suicidal and self-destructive behavior. Although clinicians cannot unerringly predict which patients will die by suicide, they can focus more successfully on early identification of suicidal behavior and effective intervention, and this new edition of the clinical manual thoroughly explores not only assessment of suicidality but what comes after an at-risk patient has been identified. The authors argue that treating specific psychiatric disorders is not enough to prevent suicide, and they offer clinicians the necessary information and strategies to bridge that gap. The authors' main premise is that suicide is a dangerous and short-term problem-solving behavior designed to regulate or eliminate intense emotional pain -- a quick fix where a long-term effective solution is needed -- and this understanding is the underpinning of the assessment and treatment strategies the authors recommend. Table of Contents: Dimensions of suicidal behavior The clinician's emotions, values, legal exposure, and ethics : global issues in the treatment of suicidal patients A basic model of suicidal behavior : a problem-solving model of suicidal behavior Assessment and case conceptualization : fundamental components of effective treatment Outpatient interventions with suicidal patients : caring for suicidal patients outside of the hospital Suicidal behavior and use of psychotropic medications The repetitiously suicidal patient : evaluation, intervention and crisis response Managing suicidal emergencies : using crisis to create positive change Hospitals and suicidal behavior : a complex relationship Suicidality and special populations Suicidal patients in primary care : responding to the challenge Dimensions Of Suicidal Behavior -- The Clinician's Emotions, Values, Legal Exposure, And Ethics : Global Issues In The Treatment Of Suicidal Patients -- A Basic Model Of Suicidal Behavior : A Problem-solving Model Of Suicidal Behavior -- Assessment And Case Conceptualization : Fundamental Components Of Effective Treatment -- Outpatient Interventions With Suicidal Patients : Caring For Suicidal Patients Outside Of The Hospital -- Suicidal Behavior And Use Of Psychotropic Medications -- The Repetitiously Suicidal Patient : Evaluation, Intervention And Crisis Response -- Managing Suicidal Emergencies : Using Crisis To Create Positive Change -- Hospitals And Suicidal Behavior : A Complex Relationship -- Suicidality And Special Populations -- Suicidal Patients In Primary Care : Responding To The Challenge. John A. Chiles, Kirk D. Strosahl, Laura Weiss Roberts. Challenging the underlying assumption that suicidal behavior can be predicted and controlled, the authors conceptualize suicidality as problem-solving behavior to which an individual resorts when other options seem to have failed.