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WASHINGTON – An effective approach to suicide prevention engages the patient in a therapeutic relationship that starts with the patient’s narrative, Katherine A. Comtois, PhD, said at the American Association of Suicidality annual conference.
“The narrative should be the first touch” with the patient, advised Dr. Comtois, professor of psychiatry at the University of Washington, Seattle. “Start the narrative and form a connection, and then get to the other stuff.” She also recommended that therapists place themselves next to the patient, “court” the patient, be persistent, give positive reinforcement, and “give it all you’ve got.”
She endorsed the Aeschi model for suicide prevention, the treatment approaches recommended in The Way Forward, published in 2014 by the National Action Alliance for Suicide Prevention, and application of dialectical behavior therapy.
Dr. Comtois subdivided therapeutic interventions into two broad categories: management and treatment.
Management uses interventions aimed at modifying risk factors and reducing risks that relate to suicide, such as connectedness, treatment of the diagnosis, means safety, and safety planning; external factors that affect suicide risk. Although a collaborative approach between the therapist and patient is ideal for achieving management goals, it is not mandatory.
Treatment involves interventions that get at the internal factors that intrinsically drive a patient to suicide and aims to resolve the risk they pose. By necessity, treatment is a collaborative process. Ideally over time, the collaboration allows the patients gain confidence and take responsibility for self-managing their internal suicide risks.
She stressed the importance of a therapist orienting a patient to the management style to expect, “so what you do is not a surprise.” The therapist should listen to the patient’s goals, and carefully review expectations and a step-by-step plan. If the patient identifies potential problems and limitations, Dr. Comtois suggested commiserating with the patient about difficulties but not justifying them. For example, reviewing with patients how likely you will be to answer their phone call, what would likely happen during and as a result of a call, and offer the patients your advice on what to do if you can’t answer their call.
Dr. Comtois acknowledged that some clinicians fear managing and treating a suicidal patient, and advised “getting past your fear to help the client find a path forward. If you can get past your fear” the intervention often boils down to “clinical common sense: Things you would know how to handle if suicide weren’t involved.” If clinicians feel they can’t help, she suggested learning new skills to make assistance possible, or referring the patient to someone else who could help. “Negligence is not making a wrong decision; it’s doing nothing. Liability risk is often a huge fear,” but if the clinician at least makes a consult, that reduces the risk of potential negligence. She warned against referring suicidal patients to a hospital emergency department. “In this day and age, the emergency department is not a source of treatment; it’s a gatekeeper.”
While published evidence documents the efficacy of dialectical behavior therapy and case management for preventing suicide and self-harm biological treatments, including antidepressants, lithium, and other psychopharmacology have not been effective, she said.
Dr. Comtois had no disclosures.
WASHINGTON – An effective approach to suicide prevention engages the patient in a therapeutic relationship that starts with the patient’s narrative, Katherine A. Comtois, PhD, said at the American Association of Suicidality annual conference.
“The narrative should be the first touch” with the patient, advised Dr. Comtois, professor of psychiatry at the University of Washington, Seattle. “Start the narrative and form a connection, and then get to the other stuff.” She also recommended that therapists place themselves next to the patient, “court” the patient, be persistent, give positive reinforcement, and “give it all you’ve got.”
She endorsed the Aeschi model for suicide prevention, the treatment approaches recommended in The Way Forward, published in 2014 by the National Action Alliance for Suicide Prevention, and application of dialectical behavior therapy.
Dr. Comtois subdivided therapeutic interventions into two broad categories: management and treatment.
Management uses interventions aimed at modifying risk factors and reducing risks that relate to suicide, such as connectedness, treatment of the diagnosis, means safety, and safety planning; external factors that affect suicide risk. Although a collaborative approach between the therapist and patient is ideal for achieving management goals, it is not mandatory.
Treatment involves interventions that get at the internal factors that intrinsically drive a patient to suicide and aims to resolve the risk they pose. By necessity, treatment is a collaborative process. Ideally over time, the collaboration allows the patients gain confidence and take responsibility for self-managing their internal suicide risks.
She stressed the importance of a therapist orienting a patient to the management style to expect, “so what you do is not a surprise.” The therapist should listen to the patient’s goals, and carefully review expectations and a step-by-step plan. If the patient identifies potential problems and limitations, Dr. Comtois suggested commiserating with the patient about difficulties but not justifying them. For example, reviewing with patients how likely you will be to answer their phone call, what would likely happen during and as a result of a call, and offer the patients your advice on what to do if you can’t answer their call.
Dr. Comtois acknowledged that some clinicians fear managing and treating a suicidal patient, and advised “getting past your fear to help the client find a path forward. If you can get past your fear” the intervention often boils down to “clinical common sense: Things you would know how to handle if suicide weren’t involved.” If clinicians feel they can’t help, she suggested learning new skills to make assistance possible, or referring the patient to someone else who could help. “Negligence is not making a wrong decision; it’s doing nothing. Liability risk is often a huge fear,” but if the clinician at least makes a consult, that reduces the risk of potential negligence. She warned against referring suicidal patients to a hospital emergency department. “In this day and age, the emergency department is not a source of treatment; it’s a gatekeeper.”
While published evidence documents the efficacy of dialectical behavior therapy and case management for preventing suicide and self-harm biological treatments, including antidepressants, lithium, and other psychopharmacology have not been effective, she said.
Dr. Comtois had no disclosures.
WASHINGTON – An effective approach to suicide prevention engages the patient in a therapeutic relationship that starts with the patient’s narrative, Katherine A. Comtois, PhD, said at the American Association of Suicidality annual conference.
“The narrative should be the first touch” with the patient, advised Dr. Comtois, professor of psychiatry at the University of Washington, Seattle. “Start the narrative and form a connection, and then get to the other stuff.” She also recommended that therapists place themselves next to the patient, “court” the patient, be persistent, give positive reinforcement, and “give it all you’ve got.”
She endorsed the Aeschi model for suicide prevention, the treatment approaches recommended in The Way Forward, published in 2014 by the National Action Alliance for Suicide Prevention, and application of dialectical behavior therapy.
Dr. Comtois subdivided therapeutic interventions into two broad categories: management and treatment.
Management uses interventions aimed at modifying risk factors and reducing risks that relate to suicide, such as connectedness, treatment of the diagnosis, means safety, and safety planning; external factors that affect suicide risk. Although a collaborative approach between the therapist and patient is ideal for achieving management goals, it is not mandatory.
Treatment involves interventions that get at the internal factors that intrinsically drive a patient to suicide and aims to resolve the risk they pose. By necessity, treatment is a collaborative process. Ideally over time, the collaboration allows the patients gain confidence and take responsibility for self-managing their internal suicide risks.
She stressed the importance of a therapist orienting a patient to the management style to expect, “so what you do is not a surprise.” The therapist should listen to the patient’s goals, and carefully review expectations and a step-by-step plan. If the patient identifies potential problems and limitations, Dr. Comtois suggested commiserating with the patient about difficulties but not justifying them. For example, reviewing with patients how likely you will be to answer their phone call, what would likely happen during and as a result of a call, and offer the patients your advice on what to do if you can’t answer their call.
Dr. Comtois acknowledged that some clinicians fear managing and treating a suicidal patient, and advised “getting past your fear to help the client find a path forward. If you can get past your fear” the intervention often boils down to “clinical common sense: Things you would know how to handle if suicide weren’t involved.” If clinicians feel they can’t help, she suggested learning new skills to make assistance possible, or referring the patient to someone else who could help. “Negligence is not making a wrong decision; it’s doing nothing. Liability risk is often a huge fear,” but if the clinician at least makes a consult, that reduces the risk of potential negligence. She warned against referring suicidal patients to a hospital emergency department. “In this day and age, the emergency department is not a source of treatment; it’s a gatekeeper.”
While published evidence documents the efficacy of dialectical behavior therapy and case management for preventing suicide and self-harm biological treatments, including antidepressants, lithium, and other psychopharmacology have not been effective, she said.
Dr. Comtois had no disclosures.