Clinical Manual for the Assessment and Treatment of Suicidal Patients

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
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