Treating Suicidal Behavior An Effective, Time-Limited Approach

by Rudd, M. David; Joiner, Thomas E.; Rajab, M. Hasan

• ISBN13: 9781572306141
• ISBN10: 1572306149
• Format: Hardcover
• Copyright: 2000-11-14
• Publisher: The Guilford Press

Summary

Structured yet flexible, this empirically supported approach to treating suicide behavior is specifically tailored to today's managed care environments. Outlined are intervention techniques that focus on symptom management, restructuring the patient's suicidal belief system and building key skills such as interpersonal assertiveness and problem solving.

Author Biography

M. David Rudd, PhD, ABPP, is Professor of Psychology and Director of Clinical Training at Baylor University. He also maintains a part-time private practice. Dr. Rudd received his doctorate from the University of Texas at Austin and completed postdoctoral training at the Beck Institute in Philadelphia. He is the author of over 60 articles and book chapters.

Thomas Joiner, PhD, is Professor of Psychology and Director of the Psychology Clinic at Florida State University. He completed his doctoral training at the University of Texas at Austin. Dr. Joiner has authored over 100 articles and book chapters in the areas of depression, eating disorders, and suicidality.

M. Hasan Rajab, PhD, is Associate Professor in the Department of Psychiatry and Behavioral Science at Texas A&M Health Science Center. Dr. Rajab completed his doctoral training in biostatistics at Texas A&M University. He is the author of several articles addressing a range of issues in methodology and biostatistics.

Table of Contents

I. ESTABLISHING A FOUNDATION FOR TREATMENT
What Do We Really Know about Treating Suicidality?: A Critical Review of the Literature	3	(12)
The Available Literature: A Limited Database	4	(2)
A Critical Review of Intervention Studies: Do Simple Procedural Changes Make a Difference?	6	(2)
Implications for Clinical Practice	8	(1)
A Critical Review of Treatment Studies: An Emerging Trend for Cognitive-Behavioral Therapy	8	(3)
Implications for Clinical Practice	11	(1)
The Therapeutic Relationship in Treating Suicidality: Attachment, Hope, and Survival	12	(1)
Implications for Clinical Practice	13	(1)
Unanswered Questions: The Challenge Awaits Us	14	(1)
A Cognitive-Behavioral Model of Suicidality	15	(29)
Existing Theoretical Models of Suicidal Behavior: A Brief Overview	15	(2)
Static and Dynamic Variables Predicting Suicidality	17	(1)
Application of Theory and Empirical Findings in Treatment: The Problem of Limited Clinical Relevance	18	(2)
Basic Assumptions of Cognitive Theory and Therapy: Implications for Suicidality	20	(3)
The Essential Requirements for a Cognitive-Behavioral Model of Integrating Empirical Findings and Ensuring Clinical Relevance	23	(1)
The Suicidal Mode as a Cognitive-Behavioral Model of Suicidality: An Elaboration and Specific Application of Beck's Theory of Modes and Psychopathology	24	(3)
Defining the Suicidal Mode: Characteristics of the Various Systems	27	(6)
Completing the Suicidal Mode: Individual Case Conceptualization	33	(7)
Implications of the Suicidal Mode for the Organization, Content, and Process of Treatment	40	(1)
Theoretical Flexibility of the Suicidal Mode for Psychotherapy Integration	41	(1)
The Therapeutic Relationship in Cognitive-Behavioral Therapy: Three Fundamental Assumptions	42	(2)
An Overview of the Treatment Process	44	(35)
Completing the Clinical Picture: Understanding Severity, Chronicity, and Diagnostic Complexity	45	(1)
Identifying Treatment Components	46	(3)
An Overview of the Goals for Each Treatment Component	49	(1)
An Overview of the Steps in Treatment Planning	50	(2)
Understanding the Treatment Process: Treatment Components and Corresponding Levels	52	(1)
Defining the Component Levels	53	(2)
Symptom Management Component	55	(3)
Cycling through Components and Levels	58	(2)
The Role of Medications	60	(1)
Skill-Building Component	61	(1)
Personality Development Component	62	(1)
Variation in Therapist Role	63	(1)
A Clinical Example of Acute Suicidality: The Case of Mr. E	64	(2)
Monitoring the Treatment Process	66	(1)
Process Tasks and Markers	66	(4)
Provocations and Resistance in the Therapeutic Relationship: How a Clear Organizational Framework Helps	70	(1)
Quantifying Change: How to Measure and Monitor Change in Treatment	70	(1)
Treatment Withdrawal and Noncompliance	71	(1)
Ensuring Treatment Fidelity	72	(1)
Termination: When, Why, and How	73	(1)
Interpersonal Process Groups and Booster Sessions	73	(1)
The Role of the treatment Team	74	(1)
The Need for Long-Term Care in a Time-Limited World	75	(4)
II. ASSESSMENT AND TREATMENT
Treatment Course and Session-by-Session Guidelines	79	(21)
The Beginning of Treatment: Sessions 1--4	81	(13)
Sessions 5--10: Symptom Management, Cognitive Restructuring, Reducing and Eliminating Suicidal Behaviors	94	(2)
Sessions 10--19: Emphasis on Skill Building	96	(2)
Sessions 19--20: A Shift toward Personality Development and Longer-Term Treatment	98	(2)
The Evaluation Process and the Initial Interviews	100	(26)
Risk Assessment Goals: The Importance of Establishing a Baseline for Ongoing Monitoring	104	(1)
Treatment Conceptualization and Consent: Setting the Stage	105	(12)
The Use and Role of Psychometric Testing	117	(4)
Establishing the Therapeutic Relationship	121	(5)
Assessing Suicide Risk	126	(22)
Distinguishing between Risk Assessment and Prediction: Defining the Nature of Clinical Responsibilities	127	(1)
The Importance of Precise Terminology: Saying What We Know and Knowing What We Say	128	(3)
Essential Components of a Clinical Risk Assessment Interview	131	(4)
Tips on Eliciting Information on Intent and Self-Control	135	(1)
Risk Categories: Baseline, Acute, Chronic High Risk, and Chronic High Risk with Acute Exacerbation	136	(2)
Rating Severity: A Continuum of Suicidality	138	(3)
Clinical Documentation and the Process of Risk: The Concept of Risk Monitoring	141	(2)
The Role of Chronicity and Time in Risk Assessment	143	(1)
Clinical Decision Making, Management, and Treatment	143	(2)
Ongoing Monitoring of Treatment Outcome and Evaluation	145	(2)
The Persistence of Suicidal Thoughts: A Potentially Misleading Marker of Treatment Outcome	147	(1)
Crisis Intervention and Initial Symptom Management	148	(22)
Key Tasks of Crisis Intervention	149	(4)
Ensuring the Patient's Safety	153	(1)
Self-Monitoring during Crises	154	(1)
Teaching the Patient to Rate Discomfort: A Self-Monitoring Task	154	(4)
Completing the Suicidal Thought Record	158	(1)
Depicting the Suicidal Cycle: The Suicidal Mode in Action	159	(1)
Using Mood Graphs	160	(2)
Improving Distress Tolerance and Reducing Impulsivity: The Importance of Emphasizing That Bad Feelings Do Not Last Forever	162	(1)
Targeting Source Hopelessness: A Different Kind of Problem Solving	163	(2)
Symptom Matching: Improving Level of Functioning over the Short Term	165	(1)
The Importance of Structure: Providing a Crisis Response Plan	166	(4)
Reducing and Eliminating Suicide-Related Behaviors	170	(28)
Identifying Behavioral Targets in Treatment: Understanding the Suicidal Mode	170	(3)
Distinguishing between Suicidal Acts and Instrumental Behaviors	173	(2)
Dealing with Mixed Messages	175	(1)
Identifying the Suicidal Cycle	176	(2)
The Process of Behavioral Change: Reducing and Eliminating Suicidal Behavior	178	(5)
Inhibiting the Suicidal Cycle during Crisis States: Late-Cycle Intervention	183	(1)
Substitute Behaviors and Purposeful Hypervigilance: Early-Cycle Intervention	184	(2)
Shaping Behavior: A Process of Gradual Change	186	(1)
Exposure-Based Strategies: Role Playing, Cue Exposure, and Behavioral Rehearsal	187	(1)
Contingency Management and Treatment Success	187	(2)
Targeting Treatment Disruptions	189	(2)
Provocation(s): The Currency of Interpersonal Relatedness in Suicidality	191	(3)
Handling Provocation in Treatment	194	(3)
The Evolution of Hope and the Elimination of Suicidal Behavior: A Few Concluding Words	197	(1)
Cognitive Restructuring: Changing the Suicidal Belief System and Building a Philosophy for Living	198	(28)
Private Meaning and the Suicidal Belief System: The Role of Automatic Thoughts and Intermediate and Core Beliefs	198	(5)
A Straightforward Strategy for Cognitive Change	203	(5)
Dealing with Poor Motivation and Treatment Noncompliance	208	(1)
Building a Philosophy for Living: Change and Acceptance as New Rules	209	(2)
Prevailing, Facilitating, and Compensatory Modes in Chronic Suicidality: Developing Adaptive Modes and Acknowledging Personal Qualities and Characteristics	211	(1)
The Therapeutic Belief System: Therapy-Specific Beliefs	212	(6)
Outlining the Therapeutic Belief System	218	(4)
The Therapeutic Belief System of the Therapist Treating Suicidality: Monitoring Thoughts, Feelings, and Behaviors in Treatment	222	(2)
Evaluating the Relationship: Patience, Determination, and Consistency	224	(2)
Skill Building: Developing Adaptive Modes and Ensuring Lasting Change	226	(25)
Conceptualizing Skill Deficits in Cognitive-Behavioral Therapy for Suicidality	226	(2)
Targeting Skill Deficits	228	(6)
A Model for Problem Solving: Learning to Identify, Evaluate, and Pursue Alternatives to Suicide	234	(3)
Emotion Regulation Ability: The Art of Feeling Better When Suicidal	237	(2)
Self-Monitoring	239	(2)
Distress Tolerance	241	(1)
Interpersonal Skills: Learning to Be Assertive, Attentive, and Responsive	242	(1)
Anger Management: Early Identification, Appropriate Expression, and the Importance of Empathy, Acceptance, and Forgiveness	243	(4)
Skill Building and Personality Change: One and the Same?	247	(1)
Changing Interpersonal Process: Integrating Group Treatment	247	(4)
References	251	(10)
Index	261