5
Outpatient Interventions With Suicidal Patients
Promoting Acceptance and Value-Based Problem Solving
In this chapter we present an intervention approach that you can use with suicidal patients encountered in diverse outpatient settings, such as a private practice office, crisis unit, primary care clinic, or school-based program. These treatment settings will in some ways dictate the outcomes you will be trying to achieve. For instance, you may be conducting a one-time crisis session in which the goal is to stabilize the patient and refer him or her for further ongoing treatment. In another setting, your aim may be to establish the rapport needed to build a longer-term treatment relationship. Regardless of the length of your involvement, the chief clinical goals and strategies for meeting those goals are the same: first, establish a consistent, caring, and credible therapeutic framework that will reassure your patient; second, abate the suicidal crisis; and third, teach the patient the skills needed to accept, rather than avoid, mental pain and to use value-based problem-solving strategies rather than avoidance-based coping
It is critical that you understand any of your own issues that might confound or undermine these objectives. Review Chapter 2 (“The Clinician’s Emotions, Values, Legal Exposure, and Ethics”) before proceeding with interventions. The attitude and behavior of the provider are often the most important determinants of successful treatment. The issue of suicidal behavior is so volatile for some clinicians that it is better for them to stabilize the immediate situation and refer a patient to another provider. Know yourself—be aware of your hot buttons and what you can and cannot comfortably deal with in this area. Knowing your limits is an important part of your competence, not a sign of personal weakness.
Overview of Basic Principles
A suicidal crisis occurs when your patient is using an avoidance-based problem-solving approach to cope with a painful situation that he or she believes to be inescapable, intolerable, and interminable—the three Is (see Chapter 3, “A Basic Model of Suicidal Behavior”). The goal of your treatment is to change one or more of these Is. This mission can be accomplished by guiding your patient through an experiential-based learning process that encourages practicing new skills in session and at home. You have to show the patient that emotionally laden life situations that are viewed as inescapable can be dealt with effectively, and sometimes even resolved for the better, using value-based problem-solving strategies. You have to show that distressing, unwanted emotions are only made worse when they are suppressed or avoided. You also can present an alternative: that by adopting a stance of acceptance, negative feeling states can simply be accepted for what they are, without judging them or attempting to change them. When any or all of these three goals are even partially obtained, your patient’s competencies and resources have the opportunity to take over and complete the work. In the end, your patient needs to know that the best teacher is life, not sitting in front of a therapist talking about life.
In this chapter we present a variety of clinical interventions focused on the three underlying themes of emotional acceptance, mindfulness, and value-based problem solving. When the patient can accept the presence of legitimate emotional distress, without struggle or evaluation, and respond in a way that is consistent with deeply held personal values, there is no beachhead for suicidal behavior to land on. Table 5–1 lists the basic principles of this acceptance- and action-based treatment.
|
|
|
|
|
|
|
The patient will need to develop three skill sets:
- Emotional acceptance, or the willingness to come directly into contact with mental pain without resorting to suppression and/or avoidance
- Mindfulness, or the ability to be in the present moment and to take a detached, nonjudgmental stance toward distressing, unwanted thoughts, feelings, memories, urges, or physical sensations
- Value-based problem solving, or the ability to approach problematic life situations and act in ways that are consistent with personal values
In the process, the patient must first learn to connect the dots between mental pain, personal values, and value-based problem-solving efforts. This connection will address the patient’s perception that mental pain is inescapable by enabling him or her to solve what were previously thought to be unsolvable problems.
Second, the patient needs to develop mindfulness strategies in order to simply observe natural and spontaneous fluctuations in emotional pain levels and to practice nonjudgment and self-compassion in the moment of pain. Once made, these actions will undermine the patient’s conviction that emotional pain is intolerable. Mental pain is unbearable only when one tries to quell it and refuses to treat oneself with kindness and compassion in the moment of pain.
Third, the patient needs to learn that even intense mental pain has a natural half-life and that as long as the pain is accepted, it can naturally evolve into something else. Often, this “something else” is an important insight into what matters to the patient and a recognition that pain is signaling to the patient that the current life context is not supporting what matters. This insight often reveals a seemingly new problem that the patient may not have been willing to take on but that now may be more directly solvable. At the end of successful treatment, the patient will understand that although emotional pain is part of life, it is not the enemy within, does not go on forever, and can in fact be part of a process of personal growth.
It is necessary to integrate the three skill sets in a manner that allows the patient to use them to address all sorts of difficulties. Although one objective of therapy is to reduce suicidal behavior, the process involves helping an individual see how mindfulness, emotional acceptance, and value-based problem solving are the building blocks of psychological health in general. The success of treatment is measured by the capacity to weave these three abilities into the fabric of the patient’s life. You should not make a distinction between the patient’s journey through life and the patient’s specific presenting problem. The two are intertwined, and solutions for one are very likely solutions for the other.
Letting Go of Polarities
The suicidal patient is often trapped in a pattern of black-and-white thinking that leads to conflicting beliefs about the same issue. For example, the patient views happiness and sadness as opposites because he or she is socially conditioned to view one as good and the other as bad. However, neither emotion can exist in a meaningful way without the other. Reconciling the necessity of having both happiness and sadness in one’s life lends full meaning to the actual experiences of happiness and sadness.
Although this concept is not new, many modern-day therapies do not specifically focus on the yin and yang of emotional experience but instead tend to apply a linear approach to what are often nonlinear life issues. The linear approach emphasizes the role of logic and deductive reasoning as a way to run one’s life. In this model of change, if the therapist can show that the advantages of suicide do not outweigh the disadvantages, the patient is expected to be rational and stop the suicidal behavior. This stance is potentially destructive and often unsuccessful with suicidal patients. First, it reinforces the notion that health is achieved through the elimination of bad feelings, which the suicidal patient has usually, and unsuccessfully, already tried to do. This approach can inadvertently escalate a suicidal crisis rather than calm it. Second, if the patient does not go along with this approach, the therapist might blame the patient for the failing treatment process by using pejorative labels such as “resistant,” “oppositional,” and “manipulative.” When the patient senses that this labeling is occurring, a natural defensiveness can emerge that can harm the therapeutic relationship.
You want the patient to honor and value both the dark side and the light side of emotional experience rather than feeling that one of them must vanquish the other. This approach means that the patient accepts the necessity and complementary nature of pleasant and painful mental experiences. Such an approach helps to create a gray zone of nonjudgment that is necessary for a psychologically flexible approach to painful life situations. If one wants to experience the positive emotional benefits of intimate attachment, one must at the same time be willing to be laid low with grief when that attachment is broken. There are lots of polarities like this in life.
Remember, to help the patient relinquish attachment to picking one side of a polarity, you need to understand that the tendency to search for the one right answer can be seductive both for your patient and for you. People in distress experience a temptation to decide on a particular kind of meaning to the exclusion of potentially opposite kinds of meanings. A suicidal crisis is about living and dying, not the triumph of dying over living. To develop an affirmation of life, one must understand that life can and will produce desperately low moments. The yin and the yang must be in focus simultaneously for effective behavioral and emotional functioning. This work is difficult for a therapist who is feeling pressure to do something constructive and optimistic in the midst of a suicidal crisis. Sometimes the most effective moments of therapy occur when the therapist models an acceptance of these competing forces.
When your suicidal patient attempts to avoid or suppress mental pain, he or she is in effect rejecting both the reality and the validity of the simultaneous capacity of a human value to produce pain and pleasure. Any individual who consistently fails to accept opposites runs the grave risk of engendering tremendous amounts of suffering because there is no balance that the individual can attain when suffering is present. Both you and your patient need to understand that the dilemma is in how to be both in control (of pursuing valued ends) and out of control (having to accept the emotional consequences of any action taken or not taken). By letting go of control, suicidal patients can attain balance. Control is the problem, not the solution.
The goal of establishing balance is essential not only for the immediate suicidal crisis but also for developing a more robust adaptation to subsequent periods of pain and suffering. When you teach your patient to look at all sides of the issue when describing an experience, you are teaching an acceptance of seemingly conflicting viewpoints. When you join experiences that look mutually contradictory and help your patient accept both, your patient learns that these seeming contradictions can coexist within the same life space; a person does not have to vanquish one to make room for the other. In the linear therapeutic approach, this shifting between positive and negative viewpoints is referred to as ambivalence. The therapist must then help the patient resolve ambivalence by arguing the case for staying alive. In the mindful, emotional acceptance mode, the patient’s attitudes concerning life and death resonate off each other. There is no need for the therapist to convince the patient of anything. We leave it to you to figure out which explanation sounds like a problem and which sounds like a resolution.
The Role of Suicidal Behavior in Therapy
You are inviting failure if the sole goal of therapy is to prevent suicidal behavior in your patient. If suicidal behavior occurs again after therapy has started, and it sometimes does, you may feel both defeated by and angry at your patient. An alternative view is that there is a continuity between real life and therapy that will not change because your patient has entered treatment. There is little reason to believe that most individuals will stop being suicidal simply because they have come to you. It is helpful to remember the old saying “It is much better to ride in the same direction as the horse.” Avoid defining the context as one in which success is measured by whether the patient does or does not think about or attempt suicide. Make it crystal clear that the recurrence of suicidal behavior is regrettable, but do not assume that the very problem for which the patient is seeking help will disappear solely as a consequence of the individual’s entering treatment. If that were true, the act of entering treatment would be the treatment. We could discharge every patient after (or perhaps before) the first contact. Working with a suicidal person rarely involves an instant save. Your first task is to get down to the hard work of developing a consistent, honest, and caring approach.
Beware of the dilemma your rescue fantasies can produce. Members of our profession sometimes do not take kindly to people who are reluctant to be rescued. To avoid the traps that the role of rescuer inevitably introduces to the situation, reflect honestly, and compassionately, on your wish to be important and how this may negatively affect your ability to be attuned to the patient’s interior experience at that moment. The rescuer often feels frustrated that the person in need is not responsive and grateful, which may lead the rescuer to feel victimized and, in turn, justified in being angry and aggressive. This triangle of rescuer-victim-perpetrator is not easily escaped once it is in place. The patient will play an unwitting role in the therapist’s triangular drama. Such a drama relates to the emotional needs of the therapist and is not in the service of the well-being of the patient.
Initial Contact: Treatment Starts in the First Minute
Table 5–2 presents the most important goals and strategies of the initial meeting with a suicidal patient. These goals and strategies are valid whether the contact is the first in a series of repeated therapeutic contacts, a one-time session for generating a referral, or an unplanned crisis management session occasioned by the return of suicidality in one of your ongoing patients.
Goals | Strategies |
| 1a.“Normalize” suicidal behavior. 1b.Legitimize feeling suicidal in the current context. 1c.Talk about different forms of suicidal behavior calmly and openly. |
| 2a.Validate the patient’s sense of pain. 2b.Form a collaborative set with the patient. 2c.Validate the presence of the three Is (the situation is inescapable, intolerable, and interminable). 2d.Look for competent social supports. |
| 3a.Reframe suicidal behavior as an avoidance behavior designed to quell distressing, unwanted private experiences. 3b.Isolate any spontaneous value-based problem-solving actions and reinforce them. 3c.Develop the idea of studying suicidal behavior in the context of problem solving. 3d.Form a short-term (e.g., 3–5 days), positive action plan. |
| 4a.Create a coping card with the patient (see Chapter 8, “Managing Suicidal Emergencies”). 4b.Schedule a support call. 4c.Initiate a medication regimen when appropriate. 4d.Set a follow-up appointment or give the patient a referral. |
Focusing on the Main Objectives
The objectives of the initial treatment session are to reframe suicidal behavior as a problem-solving behavior designed to exert control over distressing, unwanted emotions and to provide the assurance and emotional support the patient needs. There is usually a sense of urgency in the initial meeting that the therapist will seek to defuse. This goal is achieved by forming a positive, accepting relationship with the patient and responding to the many concerns that go along with a potentially explosive situation. At this initial meeting, you need to attend to simple realities. Documentation of various aspects of suicidality is important (see Appendix E, “Suicidal Thinking and Behaviors Questionnaire”). However, there is not much likelihood that either a brilliant maneuver, or a bad gaffe, will prevent or precipitate some form of suicidal behavior. The odds against your patient’s dying by suicide are high, and as our review of that literature shows (see Chapter 1, “Dimensions of Suicidal Behavior”), traditional risk factors are of little use to you in predicting your patient’s behavior, especially in the short run. Accordingly, the value gained from this initial meeting is not simply keeping your patient alive but the degree to which you begin to collaborate on building better solutions in your patient’s life. Although you might not be able to prevent a suicide, you can do a lot to address the human suffering that is in front of you. Whether those two outcomes are linked is anybody’s guess at this point.
Making a Meaningful Initial Impression
A suicidal crisis is a scary thing for a patient. In all likelihood, your patient is already buried in a mound of self-criticism about perceived or real personal shortcomings or life setbacks, including the inability to stop thinking about suicide or to control suicidal urges (and sometimes behavior). Therefore, the patient is going to be sensitized to and vigilant of your attitude and behaviors. This process can be the most dominant characteristic of your initial encounter with a suicidal patient. Your patient is ascertaining your attitudes about suicide. Do you label suicide as abnormal, do you become anxious or upset, or do you seem to accept suicidal thinking as an everyday problem and move on? Your patient is checking to see what you do about suicidal behavior per se. Are you going to take an invasive, directive approach or a less invasive, more tolerant approach? Most important, your patient is checking to see whether you seem comfortable talking about and dealing with his or her sense of desperation.
Some clinicians experience a form of desperation in this initial session: a sense of needing to do something definitive to prevent a suicide. This feeling in itself creates a sense of anxiety within this initial session. Your patient will be extremely sensitive to signs of discomfort on your part. In the worst case, a nervous, pressured therapist creates a nervous, pressured client. Your composure and confidence are at least as important as the content of the interventions agreed to in the first meeting. Although there is an impact associated with using specific techniques, it is better to have a relaxed, matter-of-fact, calm clinician using a few techniques than a nervous, jittery, anxious clinician using many techniques. The goal, as the British government encouraged during the blitz in World War II, is to “keep calm and carry on.”
Validating and Dignifying the Patient’s Pain
The biggest barrier to forming a bond with a suicidal patient occurs when the patient ends the session feeling not listened to. In our early treatment development work, this was the postsession feedback most frequently given by suicidal patients. Thus, a key outcome of the initial encounter is to validate your patient’s emotional pain such that the patient is very confident that you have listened and you understand his or her mental pain and sense of desperation. Ascertain quite early in the interview how your patient feels and what problems are producing these feelings. At the first interview, the suicidal patient is often preoccupied with negative feelings and has a limited sense of problem-solving options. You must help your patient begin to understand and become more comfortable with emotional distress. The best way to give this assistance is to have your patient talk about the life circumstances involved in the crisis and then begin to thoroughly explore the ins and outs of the patient’s emotional reactions, judgments, and predictions about the future. You are curious, not nervous, about the patient’s emotional topography. Your curiosity demonstrates an interest in getting to know your patient’s reality better. More importantly, just hovering around the patient’s mental pain will likely help the patient get present, giving you an opportunity to help the patient practice emotional acceptance in the moment. The following clinical dialogue demonstrates one way you can validate the patient’s mental pain and, at the same time, begin to change the meaning the patient assigns to it.
Therapist [holds hand out flat, palm down in front of patient]: Let’s imagine my hand is a coin, with two sides. Right now, you can only see the top side, even though you know there is a bottom side. Let’s imagine the top side of the coin contains all these painful things you’ve been sharing with me, like fear of being alone, mistrust of people, memories of being abused when you were young. All of that stuff is on this side of the coin. [Flips hand over so palm is up.] On the bottom side, which is now the top side, are the things that really matter to you in life. It is these beliefs and values that are producing the pain. Tell me what those beliefs and values are, as best you can.
Patient: Well, I never thought that pain was anything other than just pain and suffering. That life just sucks and there’s nothing I can do about it. I don’t know how to answer…maybe, well, I guess I want someone in my life and I don’t want to live alone and feel unloved. I’m afraid that will happen.
Therapist: OK, good. So, in other words, your desire to be connected to someone else, to be intimate, to feel loved, is also reflected in the intense sense of aloneness you feel right now. Because if none of that mattered to you, you wouldn’t be feeling anything, right? Including, maybe taking your own life because of the pain of not realizing that sense of being connected. [Turns hand back and forth.] But the problem is you can’t have one of these without having the other. They are two sides of the same coin. The only way I can help you X out your pain is to X out your values and intentions with it. So, which would you choose? To be a person without emotional pain and no sense of caring about anything in life or to be a person who cares about important life matters and is willing to have mental pain in that pursuit?
Patient: Well, now that you put it that way, I don’t really want to be dead inside.
Even if your patient is chronically suicidal, there are usually precipitating events, however trivial, that have recently increased emotional pain and desperation. As you listen, take the opportunity to produce empathetic statements about the patient’s sense of desperation but without necessarily agreeing that the situation is indeed unsolvable. Here is an example of such a response: “The problems you have told me are difficult ones. Almost anyone in your position would feel depressed and angry.”
Validating emotional pain can be made more difficult if you are eager to rescue. Beware of your tendency to jump over the patient’s pain to get to the business of finding solutions and perhaps saving a life in the process. This tendency is a frequent cause of a negative outcome in the first encounter. Remember, the patient must understand that you believe that feeling suicidal is a valid, understandable response to emotional pain. When the patient’s pain is not being acknowledged, the patient may increase communications about suicidal feelings to the point that they drown out all other activities in the session. In the worst case, the patient’s suicidal potential may increase because the expressive component of the suicidal crisis has been downplayed or ignored. Tactics such as suggesting that the patient’s level of emotional pain is not justified by the facts or that the patient has a lot to be thankful for (e.g., saying, “Life is better than you think it is”) are almost guaranteed to produce losing results.
Reframing Suicidal Behavior as Problem-Solving Behavior
Another major objective of the first encounter is to ensure that the patient is on board when you repackage suicidal behavior as a form of problem-solving behavior. Your use of language is critical, and you should role-play different ways of introducing this idea with a colleague rather than experiment with this concept during a suicidal crisis. The way in which the patient’s problems with emotional acceptance are stated will help establish a clear connection between failed problem solving and escalating suicidal ideations or behavior. There may also be legitimate environmental stresses that need to be addressed in some way, but often the patient has gotten lost in the futile battle to control emotional pain and has not been taking action in the real world to modify the source of the mental pain. In all cases, you must avoid making judgments about whether your patient has truly tried to solve problems or criticizing the patient for ineffective or impulsive problem-solving behaviors. Show that you accept the likely reality that the patient’s prior attempts to solve problems may have met with limited success. At the same time, acknowledge that suicidal behavior is a legitimate problem-solving option when people are experiencing intense mental pain and see no way out. If this were not the case, suicidality would not be part of the patient’s current presentation. Even if your patient is ambivalent about following through with suicidal behavior, that ambivalence is no different from the ambivalence associated with pursuing any other solution. All solutions have positive and negative consequences associated with them, and to a certain degree, all solutions produce some level of ambivalence. The following clinical encounter illustrates how to use information to reframe a patient’s difficulties within a problem-solving context.
Therapist: I understand from your telephone message that you wanted to meet with someone to talk about suicidal feelings you’ve been having. Please tell me a little bit more about what’s going on in your life.
Patient: I’ve really been having a hard time lately. I’ve lost my job, and I’m not getting along well with my wife, and we’ve been talking about separating. I don’t know where I’d live if we did separate, and I’m not sure that I could stand losing her.
Therapist: How does that make you feel?
Patient: Well, I go from feeling really anxious about what’s going to happen to figuring that there’s no hope and it’s all going to end up bad. The reason I came here is because I’ve been thinking more and more about just ending it all. This is really starting to get scary. I’ve never felt this way before, and I’m beginning to wonder if I have control over what I’m going to do.
Therapist: It sounds like the situation is really difficult for you. There are lots of big losses and big question marks in your life. It’s obvious you’re experiencing a lot of painful feelings. Would you say that suicide would be one way of solving these problems?
Patient: Well, I’m just tired of feeling bad; that’s all I know.
Therapist: What is it about your attempt to solve these problems up to now that has led you to feel so bad?
Patient: Well, everything I’ve tried with my wife hasn’t really changed the situation, and I don’t see any prospect of getting work. I’ve put in several job applications, and all I keep getting is “no.”
Therapist: So you’re feeling really desperate because nothing you’ve tried with your partner seems to be working, and there’s no prospect in sight for getting a new job. That must bring up a lot of fears about being alone and not having money.
Patient: Yeah, it sure does, and I’m not going to live my life that way.
Therapist: So, what you’re saying is that if you can’t solve these problems, you’d rather be dead than to live the life you imagine unfolding in front of you, and with the feelings you would have to live with along the way.
Patient: Yeah, that’s pretty much it.
In this dialogue, the therapist both initiates a problem-solving reframe and validates the patient’s sense of emotional desperation. There is less emphasis on suicidal ideation as the problem and more emphasis on the patient’s view of suicide in the problem-solving context. This strategy allows you to avoid a showdown over the validity of suicidal problem-solving options while at the same time joining with your patient’s desperation around feeling bad and seeing no way out. Giving the patient permission to feel desperate and to see suicide as a potential option (even if it is not the best option) has an ameliorative impact on your patient’s sense of crisis. In the example, the patient is scared by the occurrence of suicidal ideation in the first place. Creating a problem-solving frame of reference tends to defuse the self-control issue inherent in suicidal crisis. The problem-solving frame provides a different way of looking at the occurrence of suicidal behavior and allows your patient to take some distance from it, to step back and view the distressing, unwanted emotional experiences in a longer-term context. This shift in perspective from viewing suicidality as an abnormal, stigmatized event to viewing it as an understandable attempt to solve problems is a fundamental aspect of defusing a suicidal crisis. For many patients, the sense of crisis will dissipate just by feeling that their pain is understood and hearing that people in pain often think of suicide.
Another way to establish a problem-solving set is to use humor. Although you should avoid humor that condescends to the patient or minimizes the impact of emotional pain, it is often effective to use a play on words or a pun in relation to suicide. Your sense of humor in such circumstances has a way of defusing the seriousness attached to the crisis. For example, you might end a session by saying, “I was just reading a study yesterday that conclusively showed that most treatments are ineffective if the patient is deceased. I thought you might like to know.” Use humor in a manner that implies your confidence in your patient’s ability to exercise self-control and get through the problem. This strategy can destabilize the patient’s rigid cognitive framework and can be an important way of challenging any one of the three Is.
Talking Openly About Suicide
Another important outcome in the first contact is to establish that it is okay to talk in a matter-of-fact, direct, and open manner about suicide. This framework will provide an alternative to the patient’s operating concepts. Patients often walk in the door carrying the deep, dark secret of suicidality. Often, no one in their social world has any knowledge of this because of the shame and stigma involved. Your willingness to talk openly and candidly about this taboo topic carries weight with the patient. At this juncture in treatment, it is even advisable to educate the patient about the ubiquitous nature of suicidal thinking in the general population, lifetime prevalence rates of serious suicidal ideation, and other facts about suicidality that you feel are appropriate to discuss. Acknowledge how suicide has become a common theme in social media as a reflection of many people’s struggles to find meaning in their lives. Such a conversation feeds the process of normalizing what the patient is going through and will make it easier to change the focus of treatment to developing the antidotes for suicidality—namely, emotional acceptance, mindfulness, and value-based problem solving.
Ending the Initial Session
The initial encounter should end with a plan of attack formulated and agreed to by you and your patient. This plan may involve an arrangement for your patient to have a follow-up session with you or to contact another provider. In this formulation, it is essential that you focus on small tasks rather than develop elaborate assignments. It is far more important for the patient to experience a small success than it is to strive for the rarely obtained miracle. It is often helpful to ask, “If we could select a small task that, if you accomplished it, would tell you that things were just a little better, what would that be?” Together the two of you may form an activities plan that will change your patient’s unrewarding daily routine or accomplish a specific problem-solving task that is viewed as a positive step forward. If you plan a follow-up appointment, consider the use of a self-monitoring activity to increase your patient’s ability to observe natural fluctuations in emotional states. This task should include noting both negative states such as hopelessness, intolerance of emotional pain, or suicidal ideation and positive states such as humor, appreciation of beauty in the surroundings, or kindly thoughts.
In Chapter 8 (“Managing Suicidal Emergencies”), we discuss case management and crisis intervention techniques. Many of the strategies in that chapter should be part of the concluding moments of this initial contact if your patient is continuing treatment with you. These strategies include such steps as setting up a crisis protocol with the patient and agreeing to an after-hours emergency protocol. Encourage your patient to focus on any moments between now and the next session when the situation spontaneously seems to be just a little bit better. Speak with your patient about methods for communicating with others in the social surround, including through social media, to decrease the sense of isolation. Talk about ways your patient can seek and receive social support from others without resorting to suicidal communications that might alarm or “turn off” people who might be in a position to provide emotional support. Encourage your patient to be sensitive to spontaneous positive occurrences and at the same time to be aware of the fact that there will likely be a continuation of less than pleasant emotional moments.
If your patient is going to see another provider, the two of you together should summarize the key ingredients of the initial contact, with special emphasis on what your patient thought was helpful. This information should be carefully relayed to the next provider so as to increase continuity of care.
Tips for Success
Related posts:
Suicidality and Special Populations
Suicidal Behavior and Use of Psychotropic Medications
The Repetitiously Suicidal Patient: An Intervention Approach for High-Risk Patients
Hospitals and Suicidal Behavior: A Complex Relationship
Suicidal Patients in Primary Care: Responding to the Challenge
Managing Suicidal Emergencies: Using Crisis to Create Positive Change
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
