Suicide Risk Assessment and Risk Formulation Part II: Suicide Risk Formulation and the Determination of Levels of Risk

The suicide risk formulation (SRF) is dependent on the data gathered in the suicide risk assessment. The SRF assigns a level of suicide risk that is intended to inform decisions about triage, treatment, management, and preventive interventions. However, there is little published about how to stratify and formulate suicide risk, what are the criteria for assigning levels of risk, and how triage and treatment decisions are correlated with levels of risk. The salient clinical issues that define an SRF are reviewed and modeling is suggested for an SRF that might guide clinical researchers toward the refinement of an SRF process.     

An Innovative Approach to Treating Combat Veterans with PTSD at Risk for Suicide

Suicide rates among military personnel had a significant drop in 2013, but there is no evidence of a drop among veterans. The problem of suicide among combat veterans with posttraumatic stress disorder (PTSD) remains a source of concern. The Department of Defense and the Department of Veterans Affairs are now calling for innovative treatment approaches to the problem. A short‐term psychodynamic therapy presented here may be able to fill that need by dissipating the guilt from veterans' combat‐related actions that leads to suicidal behavior. The treatment showed promise of success with veterans of the war in Vietnam. Preliminary work with combat veterans of the wars in Iraq and Afghanistan indicates that it may be equally successful in treating them. Basic aspects of the psychodynamic approach could be incorporated into current therapies and should improve their ability to treat veterans with PTSD at risk for suicide.     

The application of prospective strategies to family therapy

Among the most frequently used theoretical orientations for administering family therapy are the systems, interactional, structuralist, problem-centered, and attachment approaches. Each of these methods proposes a theory concerning the etiology and resolution of conflict, a protocol of assessment, and a view on the therapist's role in advocating intervention techniques. Despite the success of these methods, however, families often leave treatment lacking the interpersonal skills for predicting potential conflict and for overcoming episodes of transition. This paper explores how the prospective approach may rectify this problem by enhancing the family members' use of intuition for experiencing transition and predicting upcoming change. As such, the application of the prospective technique may be beneficial for strengthening family relationships.     

Projective identification: Pros and cons. An essay review of Samuel Slipp,the technique and practice of Object Relations Family Therapy

This paper is a critical appraisal of Samuel Slipp's book on Object Relations Family Therapy (ORFT), which uses the concept of projective identification as a central thesis in explaining interpersonal influence. Slipp's book is praised for its excellent review of the literature of object relations theory and the major schools of family therapy, classification of families according to complementary projections, and revealing case material. Interpersonal-Systemic (I-S) theory and methodology with its use of the concepts of empathy, interpersonal influences, search for intimacy, maintenance of self-esteem, selective inattention, and reflected appraisals is offered as an alternative view to projective identification.     

Looking for reconciliations between anecdotes and causalities: The stoical model

Our bias in establishing causality ties which attribute to one consequence a unique cause make circular causality difficult as a way of thinking. Philosophy shows many theories about causality which all are ways to reduce anxiety. Our experiences sometimes require us to go farther than the instrumental (causal) level and to discover a place where disorder may be reestablished in the movement and contradiction. The Stoical model of expressive causality gives a different meaning to our work. In practice the anecdote becomes the essential element in a chair of expressive causalities. A clinical example shows how the anecdote can be the intersection between the family and therapist, offering a new dimension to circular causality and helps the therapist to understand and create another way of thinking about disorder and confusion.     

The relationship between coping style and loneliness in adolescents: can "sad passivity" be adaptive?

The authors' purpose in this paper was to examine how the use of the "sad passive" coping style may be related to adolescent self-reported loneliness. Subjects were asked to complete the revised UCLA Loneliness Scale (Russell, Peplau, & Cutrona, 1980) to determine self-reported loneliness and the Coping with Loneliness Questionnaire (CLQ; Rubenstein & Shaver, 1980) in order to examine coping styles. We hypothesized that those adolescents whose coping strategies fell into the category of sad passivity described by Rubenstein and Shaver would indicate greater loneliness than those adolescents whose coping strategies fell into other categories. Results indicated that sad passivity was used by both lonely and nonlonely adolescents, but that nonlonely youngsters resorted to this method only temporarily and in preparation for a more active coping style. Lonely teens, on the other hand, appeared to remain in the sad-passive mode to a maladaptive degree. These results were discussed in terms of their importance for theories of adolescent loneliness and for possible intervention strategies.     

Observing groups as seen from both sides of the looking glass

Conclusion This paper attempts to make a contribution to an area of the literature on group therapy about which very little has been published—the effects of the therapy group upon the observing group and the dynamics of the observing group as an entity in itself. Although work on which this paper is based took place in training institutions where education is the primary function, it is important to emphasize that education and personal change are interrelated. Psychotherapeutic activity takes place spontaneously with the observers and needs to be constructively utilized. This wealth of process and reaction is an untapped training opportunity for the observing group. The challenge of method, personal reactions, and group process responses are all opportunities for its members to both learn more as therapists and mature as individuals. At this juncture, we are trying to establish ways of     

Does family therapy produce change? an overview of outcome studies

Summary Families were randomly assigned to one of two forms of conjoint marital therapy: an insight-oriented treatment (n=10) or a problem-solving intervention (n=10.). The results on self-report measures of family functioning indicate that the problem-solving intervention produced more favorable changes after three months. However on long-term follow-up after a year, this more positive effect did not apparently persist, since the insight treatment group reported better results. Experienced therapists did better than inexperienced therapists in the insight treatment condition, but level of experience did not make a difference in the problem-solving intervention. A group of eight families who dropped out of the insight treatment group provided data on correlates of premature termination. Several of the practical obstacles to implementing an experimental design in a clinic setting are illustrated by the research.As we develop more sophisticated methodology, we hope that is the near future family therapy researchers will be better able to state which type of approach is more effective for whom and under what circumstances. A review of current studies of family therapy outcome research indicates that family therapy seems to be as effective as individual psychological treatment.