Moving Beyond Defensive Practice with the Suicidal Person

SpeakUp ReachOut is the suicide prevention coalition of Eagle County.  Our mission is to prevent suicide in Eagle County through training, awareness and HOPE!

SpeakUp ReachOut

This presentation explores moving beyond the fear-based practices clinicians often turn to with suicidal clients.

Presented by Dr. Stacey Freedenthal, PhD, LCSW. This event is virtual and free to clinicians or professionals for Continuing Education credits. AbstractMany therapists and other professionals understandably dread losing a client to suicide. This fear can lead to “defensive practice,” in which clinicians interrogate clients about their suicidal thoughts, pursue emergency care prematurely, involve the police, or take other actions to protect themselves legally and emotionally. This presentation will cover methods for conducting a therapeutic risk assessment, avoiding coercion and control, collaborating with the client around staying safe and more generally meeting the client’s needs for understanding. The presentation will conclude with guidance for clinicians on managing suicide-related fears.Learning ObjectivesIn this 2-hour workshop, participants will learn to:<ul><li>Examine the ways that fears of client suicide can impede their empathy and effectiveness.</li><li>Identify defensive, fear-based practices with clients who have suicidal thoughts</li><li>Describe client-centered care for people with suicidal thoughts.</li><li>Distinguish between a risk assessment and a therapeutic risk assessment.</li><li>Work collaboratively with a client at risk for suicide.</li><li>Manage fears of client suicide.</li></ul>AgendaThe presentation will cover these topics:Professionals’ fears of client suicide<ul><li>“Suicide anxiety”</li><li>Facts about client suicide</li><li>Healthy vs. unhealthy fear</li></ul>Defensive practice <ul><li>Definition of defensive practice</li><li>Examples of defensive practice with suicidal clients</li></ul><ol><li>Avoiding asking directly about suicide</li><li>Interrogating the client about suicidal thoughts</li><li>Using coercion, control, and persuasion to try to reduce the person’s suicide risk</li><li>Requiring a no-suicide contract or promise</li><li>Referring the client to an emergency room or psychiatric hospital to allay the clinician’s anxiety</li></ol>Client-centered practice<ul><li>Risk assessment vs. therapeutic risk assessment</li></ul><ul><li>Examples of client-centered practice with suicidal clients</li></ul><ol><li>Directly asking about suicidal thoughts</li><li>Using a narrative approach</li><li>Validating and exploring the wish to die</li><li>Collaboratively developing a safety plan</li><li>Avoiding emergency services or hospitalization whenever possible</li></ol>Education as an antidote to fear<ul><li>Effective techniques</li><li>Evidence-based therapies</li></ul>Other tips for managing fearPresenter BioStacey Freedenthal, PhD, LCSW, authored the book Helping the Suicidal Person: Tips and Techniques for Professionals, and created the website Speaking of Suicide. She’s an associate professor at the University of Denver Graduate School of Social Work, as well as a psychotherapist and consultant in private practice. Her clinical practice specializes in helping people who are experiencing suicidal thoughts or suicide bereavement, and her research and scholarship likewise focus on suicide-related concerns. Dr. Freedenthal earned a master’s degree in social work from the University of Texas and a doctorate in social work at Washington University in St. Louis.CitationsBlades, C. A., et al. (2018). The benefits and risks of asking research participants about suicide: A meta-analysis of the impact of exposure to suicide-related content.. Clinical Psychology Review, 64, 1-12. Bryan, C. J., &amp; Rudd, M. D. (2018). Brief cognitive-behavioral therapy for suicide prevention. New York: Guilford Publications.DeCou, C. R., &amp; Schumann, M. E. (2018). On the iatrogenic risk of assessing suicidality: A meta‐analysis. Suicide and Life‐Threatening Behavior, 48(5), 531-543.Freedenthal, S. (2007). Challenges in assessing intent to die: Can suicide attempters be trusted? Omega: The Journal of Death and Dying, 55(1), 57-70. Freedenthal, S. (2018). Helping the suicidal person: Tips and techniques for professionals. New York: Routledge.Isometsä et al. (1995). The last appointment before suicide: Is suicide intent communicated? American Journal of Psychiatry, 152(6), 919-922. Jacobson, J. M. et al. (2004). Prevalence of and reactions to fatal and nonfatal suicidal behavior: A national study of mental health social workers. Omega: The Journal of Death and Dying, 49, 237-248. Jahn, D. R., et al. (2016). The influence of training and experience on mental health practitioners’ comfort working with suicidal individuals. Professional Psychology: Research and Practice, 47(2), 130. Jobes, D. A. (2016). Managing suicidal risk: A collaborative approach (2nd ed.). Guilford Publications.Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press.Linehan, M. M. (2014). DBT skills training handouts and worksheets (2nd ed.). New York: Guilford.Linehan, M. M. et al. (2015). Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: A randomized clinical trial and component analysis. JAMA Psychiatry, 72(5), 475-482. McGillivray, L., Rheinberger, D., Wang, J., Burnett, A., &amp; Torok, M. (2022). Non-disclosing youth: A cross sectional study to understand why young people do not disclose suicidal thoughts to their mental health professional. BMC Psychiatry, 22(1), 1-11. Michel, K., &amp; Valach, L. (2011). The narrative interview and the suicidal patient. In K. Michel &amp; D.A. Jobes (Eds.), Building a therapeutic alliance with the suicidal patient (pp. 63-80). Washington, DC: American Psychological Association.Morrison, L. L., &amp; Downey, D. L. (2000). Racial differences in self-disclosure of suicidal ideation and reasons for living: Implications for training. Cultural Diversity and Ethnic Minority Psychology, 6(4), 374-386.Mullen, R. et al. (2008). Defensive practice in mental health. The New Zealand Medical Journal, 121, 85-91.Needleman, L. D. (2006). Case conceptualization in preventing and responding to therapeutic difficulties. In R. L. Leahy (Ed.). Roadblocks in cognitive-behavioral therapy. New York: Guilford Press.Paris, J. (2007). Half in love with death: Managing the chronically suicidal patient. New York: Routledge.Roush, J. F., Brown, S. L., Jahn, D. R., Mitchell, S. M., Taylor, N. J., Quinnett, P., &amp; Ries, R. (2018). Mental health professionals&#x27; suicide risk assessment and management practices. Crisis, 39(1), 55-64. Sanders, S., Jacobson, J., &amp; Ting, L. (2005). Reactions of mental health social workers following a client suicide completion: A qualitative investigation. Omega: The Journal of Death and Dying, 51(3), 197-216.Stene-Larsen, K., &amp; Reneflot, A. (2019). Contact with primary and mental health care prior to suicide: A systematic review of the literature from 2000 to 2017. Scandinavian Journal of Public Health, 47(1), 9-17. doi:10.1177/1403494817746274Wenzel, A., Brown, G. K., &amp; Beck, A. T. (2009). Cognitive therapy for suicidal patients: Scientific and clinical applications. Washington, DC: American Psychological Association.“This program includes 2.0 CE. The University of Denver, Graduate School of Professional Psychology (GSPP) is approved by the American Psychological Association to sponsor continuing education for psychologists. GSPP maintains responsibility for this program and its content.”I understand that by registering for this event, my email address will be added to the SpeakUp ReachOut email distribution list, if not already included. I may opt out of email communications at any time.

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Moving Beyond Defensive Practice with the Suicidal Person

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