CT for Suicidality (Andrew Butler & Greg Brown at AABT)

At the 2001 AABT convention Andrew Butler & Greg Brown reported on studies currently under way are demonstrating that CT with individuals who have made suicide attempts substantially reduces the frequency of subsequent suicide attempts (perhaps to 25% of the rate of those receiving treatment as usual).

Their clinical suggestions included:

1. With clients who are referred from the ER following a suicide attempt (as opposed to clients who are self-referred) you may need to put considerable effort into engaging the client in therapy. Active outreach and active efforts to maintain contact may be needed. Many of the individuals seen in the ER following a suicide attempt are poor individuals with significant life problems in addition to mental health and substance abuse problems. They are likely to need more than psychotherapy.

2. It can be important to validate the client’s feelings (their suffering and desparation) before targeting their suicidality or starting with problem-solving. [CT with suicidal individuals typically includes working collaboratively to understand their motivation for suicide, identifying reasons for living, reframing reasons for dying, helping the individual find plausible alternatives to suicide, counteracting the individual’s hopelessness, helping them pursue these alternatives, and helping them cope with suicidal thoughts and crisis situations.]

3. With suicidal clients it can be useful to provide them with personalized cards to aid in coping with suicidal impulses. These cards should include (1) Warning signs for them to watch for. (2) A plan for dealing with suicidal thoughts. (3) Reasons for living. (4) Reasons for dying with reframe. (5) Cards with suggestions for coping with the specific problem situations which are likely to arise.

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