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Douglas Flemons,Leonard M. Gralnik

Relational Suicide Assessment: Risks, Resources, and Possibilities for Safety

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A relational approach to evaluating your suicidal clients.

Given the isolating nature of suicidal ideation and actions, it’s all too easy for clinicians conducting a suicide assessment to find themselves developing tunnel vision, becoming overly focused on the client’s individual risk factors. Although critically important to explore, these risks and the danger they pose can’t be fully appreciated without considering them in relation to the person’s resources for safely negotiating a pathway through his or her desperation. And, in turn, these intrapersonal risks and resources must be understood in context—in relation to the interpersonal risks and resources contributed by the client’s significant others.
In this book, Drs. Douglas Flemons and Leonard M. Gralnik, a family therapist and a psychiatrist, team up to provide a comprehensive relational approach to suicide assessment. The authors offer a Risk and Resource Interview Guide as a means of organizing assessment conversations with suicidal clients. Drawing on an extensive research literature, as well as their combined 50+ years of clinical experience, the authors distill relevant topics of inquiry arrayed within four domains of suicidal experience: disruptions and demands, suffering, troubling behaviors, and desperation.

Knowing what questions to ask a suicidal client is essential, but it is just as important to know how to ask questions and how to join through empathic statements. Beyond this, clinicians need to know how to make safety decisions, how to construct safety plans, and what to include in case note documentation. In the final chapter, an annotated transcript serves to tie together the ideas and methods offered throughout the book.

Relational Suicide Assessment provides the theoretical grounding, empirical data, and practical tools necessary for clinicians to feel prepared and confident when engaging in this most anxiety-provoking of clinical responsibilities.
Dit boek is momenteel niet beschikbaar
411 afgedrukte pagina’s
Oorspronkelijke uitgave
2013
Jaar van uitgave
2013
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    Identify significant others who could assist in implementing relevant details of the safety plan.
    II. Work out how to prevent and/or restrict access to means for making a suicide attempt.
    III. Explore reasonable alternatives to troubling behaviors for coping with distress.
    IV. Identify safe havens the client could, if necessary, access for a limited time.
    V. Consider the possibility of the client’s taking a leave of absence from work and/or school.
    VI. Determine if the client would consider initiating, resuming, or continuing psychotherapeutic and/or medical treatment.
    VII. Generate a list of personal resources the client could contact if necessary.
    VIII. Identify emergency resources the client could access if necessary.
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    . Coming to a Safety Decision
    According to the American Psychiatric Association (2003), “the estimation of suicide risk, at the culmination of the suicide assessment, is the quintessential clinical judgment” (p. 24). From our perspective, clinical judgment is quintessentially a decision about the client’s safety that takes shape, often gradually and seldom linearly, over the course of a suicide assessment, informed by an empathic grasp of the client’s intra- and interpersonal risks and resources. In order to come to a decision about the client’s potential for staying safe over the coming days, you must continually juxtapose different sources of information throughout the session:
    • Your empathic grasp of the client’s intrapersonal and interpersonal risks and resources.
    • Your perceptions of the client’s engagement with you in the assessment process, including his or her response to your empathic comments, to your questions, to your therapeutic suggestions (both direct and implicit), and to the development and possible implementation of the safety plan (see Step 3, below).
    • Your insider (empathic) and outsider (professional) sense of whether the safety plan feels safe.
    For reasons outlined earlier, we don’t believe it makes sense to try to metaphorically “weigh” or quantify these data as a means for decision-making. Instead, we again turn to qualitative researchers for inspiration. They analyze their data by juxtaposing information from various sources, allowing understanding to “emerge” from the ongoing comparisons. There is an appreciation in this process not only of analytical (outsider or professional) understanding, but
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    Some of the more commonly accepted risk factors include hopelessness10; previous threats and attempts11; mood and emotional problems and instability, including depression,12 bipolar disorder,13 posttraumatic stress disorder (PTSD),14 panic,15 and anxiety16; self-harming behaviors17; intensive psychiatric involvement18 and psychiatric hospitalization19; substance abuse20; psychotic symptoms (including hallucinations and delusions)21; a family history of suicide attempts22; neuropsychological dysfunction23; access to firearms24; recent losses25; sleep disturbances, including nightmares26; a history of physical and/or sexual abuse27; sexual orientation28; chronic pain29 and medical conditions30; unwanted pregnancy31; and stress related to school,32 work,33 and legal entanglements.34
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