A Novel Therapy for People Who Attempt Suicide and Why We Need New Models of Suicide
Konrad Michel,Ladislav Valach, and Anja Gysin-Maillart
Int J Environ Res Public Health.
2017 March
This paper presents a model of suicidal behaviour based on suicide as a goal-directed action, and its implications. An action theoretical model has guided the authors in the development of a brief therapy for individuals who attempt suicide (ASSIP—Attempted Suicide Short Intervention Program). Key elements are an early therapeutic alliance, narrative interviewing, psychoeducation, a joint case conceptualization, safety planning, and regular letters over 24 months. In a randomized controlled trial, ASSIP was highly effective in reducing the risk of suicide reattempts. The therapeutic elements in this treatment are described and possible implications for future directions in clinical suicide prevention discussed...
ASSIP (Attempted Suicide Short Intervention Program)
“Being empathic with the suicidal wish means assuming the suicidal person’s perspective and ‘seeing’ how this person has reached a dead end without trying to interfere, stop, or correct the suicidal wishes. This means that the therapist attempts to empathize with the patient’s pain experience to such a point that he/she can ‘see’ why suicide is the only alternative available to the patient…Instead of working against the suicidal stream”.
ASSIP is a treatment administered in three 60–90 min sessions, ideally within three weeks. A fourth session can be added if considered necessary.
5.1. First Session
A narrative interview is conducted, in which patients are asked to tell their personal stories about how they had reached the point of wanting to kill themselves, and how they went about it. The aim of the narrative interview is to reach—in a biographical context—a patient-centred understanding of the individual mechanisms leading to psychological pain and suicidal behaviour, and to elicit specific vulnerability factors and trigger events. All interviews are video-recorded, with the patients’ written consent.
5.2. Second Session
The patient and therapist watch selected sequences of the video-recorded interview, sitting side-by-side. Thus, the patient is put into the observer’s seat, watching the suicide narrative recorded in session one. The therapist helps to provide a detailed reconstruction of the transition from an experience of psychological pain and stress, to the suicidal action. Automatic thoughts, emotions, physiological changes, and contingent behaviour are identified. At the end of the session, two patients are given a psychoeducative handout (“Suicide is not a rational act”) as a homework task, to be returned, with personal comments, at the next session. The handout aims to establish a shared model of suicidal behaviour, by integrating theoretical concepts such as suicide risk factors, psychological pain, and the suicidal mode, as well as basic neurobiological correlates of the suicidal mind. Following the second session, the therapist prepares a written draft of the case conceptualization.
5.3. Third Session
The patients’ written feedback, in response to the handout, is discussed. The draft of the case conceptualization is collaboratively revised. The case conceptualization formulates personal vulnerabilities and suicide triggers, providing the rationale for the need to develop individual warning signs and safety strategies for future suicidal crises. The written case conceptualization and the personal safety strategies are printed and handed out to the patient, with additional copies for the health professionals involved in treatment. Long-term goals, warning signs, and safety strategies are copied to a credit-card sized folded leaflet and given to the patient. Patients are instructed to carry this leaflet on them at all times, and to consult it in the event of an emotional crisis.
5.4. Letters
Participants are sent semi-standardized letters over a period of 24 months, 3-monthly in the first year, and 6-monthly in the second year. The letters remind participants of the long-term risk of future suicidal crises and the importance of the safety strategies. Letters are signed personally by the ASSIP therapists. Patients are informed that they do not have to respond to the letters, but that a feedback about how things are going would be welcome. In the cases where patients write back (usually vie e-mail), the ASSIP therapist acknowledges this in the next letter.
For further details, see the ASSIP manual...
Keywords: attempted suicide, suicide, suicide prevention, action theory, narrative interview, psychotherapy
Konrad Michel,Ladislav Valach, and Anja Gysin-Maillart
Int J Environ Res Public Health.
2017 March
This paper presents a model of suicidal behaviour based on suicide as a goal-directed action, and its implications. An action theoretical model has guided the authors in the development of a brief therapy for individuals who attempt suicide (ASSIP—Attempted Suicide Short Intervention Program). Key elements are an early therapeutic alliance, narrative interviewing, psychoeducation, a joint case conceptualization, safety planning, and regular letters over 24 months. In a randomized controlled trial, ASSIP was highly effective in reducing the risk of suicide reattempts. The therapeutic elements in this treatment are described and possible implications for future directions in clinical suicide prevention discussed...
ASSIP (Attempted Suicide Short Intervention Program)
“Being empathic with the suicidal wish means assuming the suicidal person’s perspective and ‘seeing’ how this person has reached a dead end without trying to interfere, stop, or correct the suicidal wishes. This means that the therapist attempts to empathize with the patient’s pain experience to such a point that he/she can ‘see’ why suicide is the only alternative available to the patient…Instead of working against the suicidal stream”.
ASSIP is a treatment administered in three 60–90 min sessions, ideally within three weeks. A fourth session can be added if considered necessary.
5.1. First Session
A narrative interview is conducted, in which patients are asked to tell their personal stories about how they had reached the point of wanting to kill themselves, and how they went about it. The aim of the narrative interview is to reach—in a biographical context—a patient-centred understanding of the individual mechanisms leading to psychological pain and suicidal behaviour, and to elicit specific vulnerability factors and trigger events. All interviews are video-recorded, with the patients’ written consent.
5.2. Second Session
The patient and therapist watch selected sequences of the video-recorded interview, sitting side-by-side. Thus, the patient is put into the observer’s seat, watching the suicide narrative recorded in session one. The therapist helps to provide a detailed reconstruction of the transition from an experience of psychological pain and stress, to the suicidal action. Automatic thoughts, emotions, physiological changes, and contingent behaviour are identified. At the end of the session, two patients are given a psychoeducative handout (“Suicide is not a rational act”) as a homework task, to be returned, with personal comments, at the next session. The handout aims to establish a shared model of suicidal behaviour, by integrating theoretical concepts such as suicide risk factors, psychological pain, and the suicidal mode, as well as basic neurobiological correlates of the suicidal mind. Following the second session, the therapist prepares a written draft of the case conceptualization.
5.3. Third Session
The patients’ written feedback, in response to the handout, is discussed. The draft of the case conceptualization is collaboratively revised. The case conceptualization formulates personal vulnerabilities and suicide triggers, providing the rationale for the need to develop individual warning signs and safety strategies for future suicidal crises. The written case conceptualization and the personal safety strategies are printed and handed out to the patient, with additional copies for the health professionals involved in treatment. Long-term goals, warning signs, and safety strategies are copied to a credit-card sized folded leaflet and given to the patient. Patients are instructed to carry this leaflet on them at all times, and to consult it in the event of an emotional crisis.
5.4. Letters
Participants are sent semi-standardized letters over a period of 24 months, 3-monthly in the first year, and 6-monthly in the second year. The letters remind participants of the long-term risk of future suicidal crises and the importance of the safety strategies. Letters are signed personally by the ASSIP therapists. Patients are informed that they do not have to respond to the letters, but that a feedback about how things are going would be welcome. In the cases where patients write back (usually vie e-mail), the ASSIP therapist acknowledges this in the next letter.
For further details, see the ASSIP manual...
Keywords: attempted suicide, suicide, suicide prevention, action theory, narrative interview, psychotherapy
