Rational Suicide: An Impoverished Self-Transformation

ABSTRACT: The normal human condition is such that even with the best that life can offer suicide is understandable. Life is short, often painful, unpredictable, and lonely. In addition the lives of some individuals are in effect “suicidal careers” in that the harshness of normal life is combined for them with extra suicidal catalysts. Suicide makes sense. Minimally suicide resolves the life problem for the suicide. At the same time suicide is an impoverished self-transformation. Life, as trying and despairing as it can be, is still all we have. The suicide resolves the life problem by obliterating life itself, rather than by transforming self, history, and society. The suicide gives his or her life back inappropriately. In this sense no suicide is ever rational.     

Patient Suicide: A Survey of Therapists' Reactions

A substantial proportion of therapists will at some point in their professional life experience the loss of a patient to suicide. Our aims were to assess how therapists react to patient's suicide over time and which factors contribute to the reaction. One third of the therapists, mostly women, suffer from severe distress. The impact is not different for therapists in institutional settings and therapists in private practice. The item “overall distress” immediately after the suicide predicts emotional reactions and changes in behavior. Our data suggest that identifying the severely distressed subgroup could be done using a visual analogue scale for overall distress. As a consequence, more specific and intensified help could be provided to these individuals.     

How Psychotherapists Address Hypothetical Multiple Relationships Dilemmas with Asian American Clients: A National Survey

This study examined how psychotherapists address hypothetical nonsexual multiple relationships dilemmas with Asian American clients and identified predictors of conservative decisions and the use of culture-based rationales. This survey of 787 Asian American and non-Asian American psychotherapists revealed that clinicians rely on mostly their personal policies and seldom focus on the clients' cultural backgrounds. Psychotherapists who consider their clients' Asian culture have more cultural knowledge and awareness, have been mental health providers longer, and are Asian American and female. Clinicians who avoid multiple relationships tend to cite formal policies as justification and are less likely to consider clients' cultural worldviews, the therapeutic relationship, or their own values. The results are discussed in terms of specific revisions needed in the American Psychological Association Ethics Code, the benefits of more frequent consultation with colleagues and supervisors about ethical dilemmas, and recommendations for psychotherapists.     

A Community of Psychotherapists

Services for chronic mental patients in this era of deinstitutionalization present a major challenge to clinicians and planners alike. The complexity of these patients' clinical and other programmatic needs requires that an array of viable comprehensive services be made available to them. Following certain established principles of service planning will help facilitate patients' longitudinal, psychological, financial, and geographical access to care.     

Rational Suicide: An Empirical Investigation of Counselor Attitudes

This study investigated attitudes of mental health counselors toward rational suicide. Over 80% of respondents were moderately supportive of the idea that people can make well‐reasoned decisions that death is their best option, and further, they identified a consistent set of criteria to evaluate such decisions. Additionally, analyses revealed that as the scenario moved from client, to friend, to self, rational suicide seemed to gain in acceptability for these professionals. Implications for training and practice in light of the apparent responsibilities with suicidal clients defined in the 1995 American Counseling Association's Code of Ethics and Standards of Practice are discussed.     

当代中国心理咨询和治疗师的知情同意与保密状况研究

本研究采用问卷调查法,以自编"心理咨询和治疗伦理问题调查问卷(咨询师版)"对全国范围内1 000名心理咨询和治疗师进行调查,以了解心理咨询和治疗师的知情同意和保密情况.结果发现目前国内的心理咨询和治疗从业者知情同意和保密原则的伦理意识和行为比较欠缺.需要增加专业的训练、进行统一伦理规范.     

Toward Empirically Based Standards for Abuser Intervention

Summary

This article describes the development of operational guidelines for Abuser Intervention Programs in Maryland. Unlike in many states which have adopted quite specific standards regarding program format, duration, etc., the Maryland guidelines address a fairly narrow range of issues. These include outreach to victims, communication with the courts, and the need for intervention programs to address domestic abuse directly in their program content. Maryland has also established a research task force on Abuser Intervention Programs, whose goal is to use empirical data to inform the use of best practices in the state, to facilitate empirical research at abuser intervention programs in Maryland, and to develop more detailed program standards in the future.     

Posttraumatic Stress Disorder Symptom Clusters and Acquired Capability for Suicide: A Reexamination Using DSM-5 Criteria

This study used the interpersonal–psychological theory of suicide to explore the relationships among DSM-5 posttraumatic stress disorder (PTSD) symptom clusters derived from the six-factor anhedonia model and facets of acquired capability for suicide (ACS). In a sample of 373 trauma-exposed undergraduates, most PTSD symptom clusters were negatively associated with facets of ACS in bivariate correlations, but the anhedonia cluster was positively associated with ACS in regression models. Structure coefficients and commonality analysis indicated that anhedonia served as a suppressor variable for the other symptom clusters. Our findings further elucidate the complex relationship between specific PTSD symptom clusters and ACS.     

Method of Suicide in the Mentally Ill: A National Clinical Survey

Comparisons of psychiatric patients who die by suicide using different methods are scarce. We aimed to establish the methods of suicide used by those who are currently or have recently been in contact with mental health services in England and Wales (N = 6,203), and describe the social and clinical characteristics of suicides by different methods. We found that hanging, self‐poisoning, and jumping (from a height or in front of a moving vehicle) were the most common methods of suicide, accounting for 79% of all deaths. The implications of these and other findings are discussed.     

Suicide Survivors Groups: Results of a Survey

Little is known about the nature of suicide survivors groups. Survey responses by 149 U.S. and Canadian groups are characterized as follows: (1) they are most often sponsored by mental health or social service agencies or have no sponsor; (2) groups have operated an average of 8 to 9 years; (3) fewer than 10 people typically attend monthly or twice monthly meetings; (4) group experience predominantly involves sharing personal experiences; (5) leadership generally involves either trained facilitators, mental health professionals, or both; (6) most groups are open ended; (7) all social/ethnic, income, and adult age groups are served, but few children and teenagers attend; and (8) referrals come predominantly by word-of-mouth or medical and religious sources. Further research is required regarding survivor group attributes and processes.     

Encountering the Body at the Site of the Suicide: A Population‐Based Survey in Sweden

Encountering the body of a child who died by suicide at the site of death is believed to be especially harmful for bereaved parents. We investigated the association between encountering the body at the site of the suicide and psychological distress in 666 suicide‐bereaved parents. Parents who had encountered their child's body at the site of the suicide (n = 147) did not have a higher risk of nightmares (relative risk [RR] 0.95, 95% confidence interval [CI] 0.67–1.35), intrusive memories (RR 0.97, 95% CI 0.84–1.13), avoidance of thoughts (RR 0.97, 95% CI 0.74–1.27), avoidance of places or things (RR 0.91, 95% CI 0.66–1.25), anxiety (RR 0.93, 95% CI 0.64–1.33), or depression (RR 0.94, 95% CI 0.63–1.42) compared with parents who had not encountered the body (n = 512). Our results suggest that losing a child by suicide is sufficiently disastrous by itself to elicit posttraumatic responses or psychiatric morbidity whether or not the parent has encountered the deceased child at the site of death.     

The River Model: A Metaphor and Tool for Training New Psychotherapists

A conceptual frame of reference called The River is presented for training of beginning psychotherapists. Using metaphors, trainees are taught specific tools (Equipment) and to identify salient features of the therapy process (Topography) by means of a series of metaphors for the process elements of timing and of level of intervention. Student therapist feedback indicated that this model facilitated learning of how much or little to do at given points in the therapeutic process, and that these metaphors appeared to transcend specific theoretical orientations.     

Support Groups for Suicide Survivors: Results of a Survey of Group Leaders

To update and expand Rubey and McIntosh's (1996) survivors of suicide support groups report, SPAN USA completed a survey of U.S. support group leaders (n = 100; 24% completion). There are now more survivor groups (from 280 to 417), and the majority of groups now have a survivor leader (78% vs. 25%). Groups continue to be small (88% < 10 members per session) and meet on a monthly basis (55%). Sharing continues to be a universal experience in groups, which tend to be open‐ended (85%). Current groups are newer, and more operate without a sponsor. Further research is needed to examine group member perspectives and effectiveness of groups.     

The Opinions of GP's Patients About Suicide,Assisted Suicide,Euthanasia, and Suicide Prevention: An Italian Survey

A survey about opinions on end‐of‐life issues of a population represented by 1,171 people in the waiting room of general practitioners' surgeries was conducted in a province of northern Italy. Most subjects did not consider suicide as a reasonable option even in cases of a serious and incurable disease. Moreover, subjects did not consider euthanasia as a possible option either; however, they did express an opposite attitude when considering euthanasia in a third‐person perspective. People with a personal history of suicidal behavior appear to present as a different population, overall expressing more open attitudes.     

Differentiating Suicide Attempters from Suicide Ideators: A Critical Frontier for Suicidology Research

Most individuals who consider suicide do not make suicide attempts. It is therefore critical to identify which suicide ideators are at greatest risk of acting on their thoughts. However, few seminal theories of suicide address which ideators go on to make attempts. In addition, perhaps surprisingly, most oft‐cited risk factors for suicide—such as psychiatric disorders, depression, hopelessness, and even impulsivity—distinguish poorly between those who attempt suicide and those who only consider suicide. This special section of Suicide and Life‐Threatening Behavior serves to highlight this knowledge gap and provide new data on differences (and similarities) between suicide attempters and suicide ideators.     

Developmental Process of Japanese Psychotherapists Based on Their Life Histories

We identified the mastery processes of experienced psychotherapists by drawing their life histories, which indicated principles for guiding the development of young psychotherapists. Participants were psychotherapists with over 30 years of experience (N = 7, six men and one woman, mean age = 71.86 years). The data were analyzed using the trajectory equifinality model (TEM). The results indicated that a psychotherapist might continue to practice even while experiencing conflicts and might eventually integrate and establish their unique therapeutic approach into their work. Essential factors in facilitating the motivation to be a psychotherapist include: hope; good friends, coworkers, and supervisors; experience with many cases; learning from a global perspective; and interest in human beings. Moreover, after the mid-career, adverse events in participants' private lives had positive effects on their development as experts. It was concluded that the development of a psychotherapist is a process of growth as a person. This study indicated factors necessary to continue as a psychotherapist while facing conflicts, which is considered useful for educating future Japanese psychotherapists.     

Bereavement after a Physician-Assisted Suicide: A Speculation Based on Theory

Despite the recent Supreme Court ruling upholding the ban on physician-assisted suicide, the practice continues in the United States. A majority of Americans support physician-assisted suicide, and several surveys document its use by physicians and nurses. This article explores the anticipated bereavement experience of significant survivors following a physician-assisted suicide. Theoretical approaches to bereavement frame the discussion of possible reactions to suicidal death: (1) psychodynamic, (2) attachment theory, (3) crisis theory, and (4) cognitive theory. Three case scenarios illustrate potential survivor reactions, with suggested intervention approaches.     

Treating the Capability for Suicide: A Vital and Understudied Frontier in Suicide Prevention

Current efforts at suicide prevention center largely on reducing suicidal desire among individuals hospitalized for suicidality or being treated for related psychopathology. Such efforts have yielded evidence‐based treatments, and yet the national suicide rate has continued to climb. We propose that this disconnect is heavily influenced by an unmet need to consider population‐level interventions aimed at reducing the capability for suicide. Drawing on lessons learned from other public health phenomena that have seen drastic declines in frequency in recent decades (HIV, lung cancer, motor vehicle accidents), we propose that current suicidality treatment efforts trail current suicidality theories in their lack of focus on the extent to which individuals thinking about suicide are capable of transitioning from ideation to attempt. We summarize extant evidence for specific capability‐centered approaches (e.g., means safety) and propose other options for improving our ability to address this largely overlooked variable. We also note that population‐level approaches in this regard would represent an important opportunity to decrease risk in individuals who either lack access to evidence‐based care or underreport suicidal ideation, as a reduced capability for suicide would theoretically diminish the potency of suicidal desire and, in this sense, lower the odds of a transition from ideation to attempt.