What Therapists Should Actually Do for Suicidal Clients: Assessment, safety planning, and least intrusive intervention

Oct 3, 2022

What Therapists Should Actually Do for Suicidal Clients: Assessment, safety planning, and least intrusive intervention

Curt and Katie chat about suicide assessment, safety planning, and how to keep clients out of the hospital. We reviewed the Integrated Motivational Volitional Model for Suicide, we talked about what therapists should be assessing for in every session, what strong assessment looks like (and suggested suicide assessment protocols), and why the least restrictive environment is so important when you are designing interventions and safety planning. This is a continuing education podcourse.

Transcripts for this episode will be available at mtsgpodcast.com!

In this podcast episode we talk about suicide assessment, safety planning, and intervention

We continue our conversation on suicide, progressing from risk factors (from last week’s episode) to how to assess and safety plan with the least intrusive interventions at the earliest stages.

Review of the Suicide Model: Integrated Motivational Volitional Model by O’Connor and Kirtley

Continued to review the IMV model (graphic in the show notes at mtsgpodcast.com)

What should therapists assess for in every session, related to suicide?

“When clinicians are burnt out, when we have caseloads that are too big, when we aren't taking care of ourselves, we tend to [think], “Okay, this client is at a six, they can live at a six for a while,” which is absolutely true. And if they can [live with this level of suicidality], and they have the good factors that allow them to live there – great. It's just how close are they to that 7, 8, 9?” – Curt Widhalm, LMFT

Moderating motivational factors, which move clients from passive to more active suicidality (or the reverse)
Looking at what is keeping someone from being at risk for suicide (protective factors)
The importance of knowing our clients well before they move into the volitional phase
Understanding the clinician factors and putting structure around assessment

Assessment for Suicide

“Assessment is intervention.” – Curt Widhalm, LMFT

SAMHSA’s GATE protocol
Gather information using a structured assessment tool (Columbia Scale, LRAMP)
Looking at intention, means, plan as well as risk and protective factors
Moving into a safety plan
The importance of recognizing the human during the assessment (versus focusing only on the protocol or your liability)
Seeking supervision or consultation – don’t do this alone

The importance of using the least restrictive intervention for suicide

“There is a rupture in the therapeutic relationship when you are sending your client or facilitating a hospitalization against their will. It can save their lives …but that may not always be the case.” – Katie Vernoy, LMFT

The idea of “responsible” action
The range of options for keeping a client safe
Having a conversation with the client on how to avoid attempting suicide
The potential impacts of hospitalization, including trauma
The danger of hospitalizing someone who does not need this level of intervention
Additional intervention between sessions
The practicalities to set up your schedule and your practice to support your clients and your self
Additional risk factors (transition phases between providers)

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Receive Continuing Education for this Episode of the Modern Therapist’s Survival Guide

Hey modern therapists, we’re so excited to offer the opportunity for 1 unit of continuing education for this podcast episode – Therapy Reimagined is bringing you the Modern Therapist Learning Community!

Once you’ve listened to this episode, to get CE credit you just need to go to moderntherapistcommunity.com/podcourse, register for your free profile, purchase this course, pass the post-test, and complete the evaluation! Once that’s all completed - you’ll get a CE certificate in your profile or you can download it for your records. For our current list of CE approvals, check out moderntherapistcommunity.com.

You can find this full course (including handouts and resources) here: https://moderntherapistcommunity.com/podcourse/

Continuing Education Approvals:

When we are airing this podcast episode, we have the following CE approval. Please check back as we add other approval bodies: Continuing Education Information

CAMFT CEPA: Therapy Reimagined is approved by the California Association of Marriage and Family Therapists to sponsor continuing education for LMFTs, LPCCs, LCSWs, and LEPs (CAMFT CEPA provider #132270). Therapy Reimagined maintains responsibility for this program and its content. Courses meet the qualifications for the listed hours of continuing education credit for LMFTs, LCSWs, LPCCs, and/or LEPs as required by the California Board of Behavioral Sciences. We are working on additional provider approvals, but solely are able to provide CAMFT CEs at this time. Please check with your licensing body to ensure that they will accept this as an equivalent learning credit.

Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!

SAMHSA’s TIP with the GATE Protocol

COLUMBIA-SUICIDE SEVERITY RATING SCALE

LINEHAN RISK ASSESSMENT AND MANAGEMENT PROTOCOL (LRAMP)

References mentioned in this continuing education podcast:

Carmel, A., Templeton, E., Sorenson, S. M., & Logvinenko, E. (2018). Using the Linehan Risk Assessment and Management Protocol with a chronically suicidal patient: A case report. Cognitive and Behavioral Practice, 25(4), 449-459.

Goldman-Mellor S, Olfson M, Lidon-Moyano C, Schoenbaum M. Association of suicide and other mortality with emergency department presentation. JAMA Netw Open. 2019; 2(12):e1917571.

Interian, A., Chesin, M., Kline, A., Miller, R., St. Hill, L., Latorre, M., ... & Stanley, B. (2018). Use of the Columbia-Suicide Severity Rating Scale (C-SSRS) to classify suicidal behaviors. Archives of suicide research, 22(2), 278-294.

Linehan, M. M., Comtois, K. A., & Ward-Ciesielski, E. F. (2012). Assessing and managing risk with suicidal individuals. Cognitive and Behavioral Practice, 19(2), 218-232.

Pinals, D. A. (2019). Liability and patient suicide. Focus, 17(4), 349-354.

Posner, K., Brent, D., Lucas, C., Gould, M., Stanley, B., Brown, G., ... & Mann, J. (2008). Columbia-suicide severity rating scale (C-SSRS). New York, NY: Columbia University Medical Center, 10.

Substance Abuse and Mental Health Services Administration (US); (2009. Addressing Suicidal Thoughts And Behaviors in Substance Abuse Treatment [Internet]. Rockville (MD): (Treatment Improvement Protocol (TIP) Series, No. 50.) Available from: https://www.ncbi.nlm.nih.gov/books/NBK64022/

*The full reference list can be found in the course on our learning platform.

Relevant Episodes of MTSG Podcast:

Part 1: Risk Factors for Suicide: What therapists should know when treating teens and adults

Rage and Client Self-Harm: An interview with Angela Caldwell

Work Harder Than Your Clients

Who we are:

Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com

Katie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.