Prior to joining this site, I have found a great deal of literature on suicide prevention work with adolescents in both individual and group formats. I am familiar with ACT and DBT and I'm curious about research specifically on suicide prevention for adults. The CBT-SP model (individual and supplementary group) seems modifiable to suit adults, so I wonder if there is some reason I'm not getting that keeps us from implementing CBT-SP on a wider scale. Many troubled adults feel very "held" by structure. Regardless, the issues that must be dealt with are likely to be harrowing, and group support and experiential insight could be exponentially effective for post-crisis individuals. Aside from cohesion, mindfulness and grounding, what would you do with such a group? How can you work with the group to take hope out of the dissociative realm and make positive or rational thinking feel more real?
Corrina, As I have previously referenced in writing up a needs analysis for people presenting to emergency suicidal, the study I have found most instructive in working with suicidal people - 'outpatient (postcrisis)' is as follows:
Rudd, Joiner, Jobes, and King (1999) made a number of practice recommendation based on an extensive review. They note the two following points:
● For acute crisis case of suicidality (particularly in the presence of an Axis I disorder), provide a relatively short-term psychotherapy that is directive and crisis focused, emphasizing problem solving and skill building as core interventions.
● For chronic cases of suicidality (particularly in the presence of an Axis II disorder), provide a relatively long-term psychotherapy in which relationship issues, interpersonal communication, and self-image issues are the predominant focus of treatment when crises have resolved.
They examined 23 randomized or controlled studies targeting suicidality, particularly examining treatment studies.
They noted that short-term cognitive- behavioral therapy, integrating problem-solving as a core intervention, is effective at reducing suicidal ideation, depression, and hopelessness over periods up to 1 year; however, reducing suicide attempts requires longer-term treatment and treatment modalities that target specific skill deficits. These deficits included emotion regulation, poor distress tolerance (i.e., impulsivity), anger management, interpersonal assertiveness, and other enduring problems, such as interpersonal relationships and self-image disturbance (Rudd, Joiner, Jobes, & King, 1999).
Their article:
Rudd, M.D., Joiner, T.E., Jobes, D.A., & King, C.A. (1999). The outpatient treat- ment of suicidality: An integration of science and recognition of its limitations. Professional Psychology Research and Practice, 30(5), 437–446.
Our needs analysis (from which I draw my comments above):
Lynette Joubert MA DLitt et Phil , Melissa Petrakis PhD MSW & Enrico Cementon MBBS MMed (Psych) FRANZCP (2012): Suicide Attempt Presentations at the Emergency Department: Outcomes From a Pilot Study Examining Precipitating Factors in Deliberate Self-Harm and Issues in Primary Care Physician Management, Social Work in Health Care, 51:1, 66-76
To link to this article: http://dx.doi.org/10.1080/00981389.2011.622673
(This is available through my ResearchGate page.)
"relationship issues" and "interpersonal communication" (as mentioned above by Melissa) seem to me the most important factors to prevent suicide - therefore I suppose that group therapy is the chance to EXPERIENCE
- to be accepted as a member of the group
- to be perceived and respected by and important for others
- common ground and differences
so that ANY topic of conversation may serve this aim - while the therapist is in the role of a shepherd, keeping the flock together
Thanks for your questions, Corinna. I appreciated Tony, Melissa, and Eva's insightful comments and helpful resources.
To add to the discussion, I'd recommend an integration of psychoeducation and supportive group processes that would harness some of Yalom's therapeutic factors (e.g., universality, instillation of hope, altruism, group cohesiveness, existential factors, interpersonal learning, etc.). I've also found that "indirect compliments" from solution-focused brief therapy (SFBT) can facilitate group members' realization of their self-efficiency and self-confidence.
Those presenting as having serious suicidal ideology in the form of repeated, serious attempts at suicide need much support. Currently, the inner fear of involuntary commitment trumps one's ability to speak openly regarding the true nature of intentional suicide plans. Therapists should, in my opinion, use a very tailored approach to these people. Taking into account faith-based therapy approaches to the problem might prove helpful. Knowing a client's perspective on life after death philosophies could provide a definitive role in helping some clients cope with thoughts or plans to commit suicide. A whole person approach to treatment is entirely necessary when dealing with such complex issues. In many cases, providers seek to place a band-aid on a bullet wound in relation to addressing immediate risk of suicide in clients. Unwilling hospitalization of one expressing suicidal ideation is counter-productive in the sense that it offers little insight into the causes of the feelings that prompt suicide being a solution to life difficulties. Furthermore, these kinds of emergency alternatives to immediate risk of suicide can add to the stigma associated with wanting to kill one's self. Here is a helpful link that discusses faith-based approaches to treatment and identification of those with serious intent to take his/her life. These methods can be employed cross-culturally and are not designed for use in any specific religious affiliation. http://www.overcomingthedarkness.com/the_christian_perspective.html