Working with Psychosis

This is the first of four papers about working with psychosis in a newly established post of psycho-analytic psychotherapist in an acute psychiatric unit in Australia. In this paper the author gives an account of some early impressions and experiences with staff and patients, particularly connected with an unacknowledged grief in the aftermath of psychosis. The author next discusses some of the psycho-analytic theory about psychosis which he found containing and helped make some sense of his experiences. He then introduces a case study of an exploratory psycho-analytic psychotherapy with a 40-year-old man suffering from a bi-polar disorder. The beginning of the therapy is described when this man revealed feelings of grief and despair about his illness. Being able to face and bear these feelings enabled him to begin to mourn what was irretrievably lost because of his illness and to contemplate what might still be possible. The author describes some of the early themes and one session in detail, and discusses how fluctuations in contact with the client reflect his retreat to a pathological organization in the mind. This psychic retreat was dominated by a psychotic process, and the retreat offered refuge from a dread of fragmentation and the pain of mourning and loss.     

Changes in suicidal ideation following cognitive processing therapy in a VA residential treatment program

ABSTRACT

In 2015, suicide accounted for over 44,000 deaths and was the 10th leading cause of mortality in the US. Although Veterans, in general, are at a high risk for suicide, Veterans with Posttraumatic Stress Disorder (PTSD) are at even greater risk. While evidence suggests that PTSD symptoms are reduced by Cognitive Processing Therapy (CPT), little is known about how this treatment impacts changes in suicidal ideation across residential treatment. Studies with active duty personnel have found reductions in suicidal ideation following CPT treatment; however, only one study to date has examined this question in a Veteran sample. The current study examined (a) changes in suicidal ideation across a residential CPT treatment program and (b) the influence of demographic variables on change in suicidal ideation across treatment. Participants (N = 303) were admitted to a residential PTSD treatment in a VA medical center and completed pre-, mid-, and post-treatment assessments. Multilevel modeling of archival data revealed that suicidal ideation significantly decreased over the course of CPT (B = ?0.153, SE =0.028, 95%CI =[?0.21, ?0.10], t= ?5.40, p< .001); however, this change did not differ based on age, marital status, sex, or race/ethnicity. Clinical and research implications are discussed.     

The mirror effect: Self-awareness alone increases suicide thought accessibility

According to objective self-awareness theory, when individuals are in a state of self-awareness, they tend to compare themselves to their standards. Self-to-standard comparison often yields unfavorable results and can be assimilated to a failure, activating an escape motivation. Building on recent research on the link between failure and suicide thought accessibility, the present experiment tested the hypothesis that mirror exposure alone provokes an increase in suicide thought accessibility. Participants were exposed to their mirror reflection (or not) while completing a lexical decision task with suicide-related words. Self-to-standard discrepancy salience was manipulated by asking participants to list actual and ideal traits before versus after the lexical decision task. As predicted, mirror-exposed participants recognized suicide-related words quicker than those unexposed to their mirror image. Self-to-standard discrepancy salience did not moderate this effect. Discussion focuses on the role of the motivation to escape self-awareness in the availability of suicide-related ideas.     

Prévention du suicide de la personne âgée : la place des interventions communautaires

Although elders’ social isolation has been a topic of interest for public policies in the recent years, its prevention, specifically in relation to suicide prevention, has not stimulated the interest of researchers, yet. This paper present the results from a literature review aiming to identify the actions in elders’ suicide prevention. From the 425 initial papers identified on elders’ suicide prevention, only 57 describe “actions” in suicide prevention, 47 of which are actions targeting individuals, with psychological, psychiatric or psychotherapeutic interventions. Only eight researches integrate the social environment as a facilitator for suicide prevention. We discuss the particularity of this field, the limits of an individual-centred approach, and the interests of community, integrative interventions.     

Rumination and suicidal ideation: The moderating roles of hope and optimism

The current study aimed to investigate whether the correlation between rumination and suicidal ideation is moderated by the presence of hope and optimism. It was hypothesized that both hope and optimism would moderate (weaken) the relationship between rumination and suicidal ideation. Two hundred and ninety-eight participants completed self-report measures of hope, optimism, rumination (brooding and reflection), and depression. Results demonstrated that both hope and optimism weakened the relationship between rumination and suicidal ideation, as well as the relationships between both subscales of rumination and suicidal thinking. These results were found when controlling for symptoms of depression. Results suggest that a ruminative thinking style may be most harmful when an absence of hope or optimism is also present.     

Suicide in Later Life

SUMMARY

This paper outlines the suicide trends of different groups in Australian society, highlighting the continuing very high rates among elderly men in particular. Risk factors and protective factors are examined. As up to 90% of those who complete suicide have a depressive disorder at the time, this paper concentrates on the detection and treatment of depression. Treatment of depression at a broad community level may offer the best hope of suicide prevention. Survivors face intense unpleasant emotions, and sometimes allocate blame, which can be painful and divisive for all concerned.     

Actions speak louder than words: An elaborated theoretical model of the social functions of self-injury and other harmful behaviors

The question of why some people do things that are intentionally harmful to themselves continues to puzzle scientists, clinicians, and the public. Prior studies have demonstrated that one fairly extreme, direct form of self-harm, non-suicidal self-injury (NSSI), is maintained by both automatic (i.e., intrapersonal) as well as social (i.e., interpersonal) reinforcement. However, the majority of theoretical and empirical papers on this topic focus almost exclusively on the automatic functions. The purpose of this paper is to provide a more comprehensive analysis of the social functions of NSSI. Evidence is presented supporting the notion that NSSI is maintained by social reinforcement in at least a substantial minority of instances. Moreover, an elaborated theoretical model of the social functions of NSSI is outlined that proposes that this behavior represents a high intensity social signal used when less intense communication strategies fail (e.g., speaking, yelling, crying). The model further proposes that NSSI can serve not only as a signal of distress that is reinforced primarily by the caregiving behavior it elicits from others, but that it can also serve as a signal of strength and fitness that is reinforced by warding off potential threats (e.g., peer victimization), and in some cases can strengthen affiliation with others. Support for this theoretical model is drawn from diverse literatures including psychology, evolutionary biology, and cultural anthropology. The paper concludes with specific recommendations for empirical tests of the proposed model of the social functions of NSSI, as well as other harmful behaviors such as alcohol and drug use.     

A novel integrated knowledge explanation of factors leading to suicide

Psycho-social and biological theories of suicide are sometimes presented in a dichotomous manner. It is hypothesised that there is a base rate of suicide in all communities which is influenced not only by biological factors, but also by psycho-social factors. However, various countries or specific groups or regions within a country whose suicide rate diverges significantly from this base rate do so predominantly because of psycho-social factors. This theory has practical implications in terms of where certain countries or regions should focus their suicide prevention programmes.     

Community Data Collection with Children of Mothers Living with HIV: Boundaries of the Researcher Role

The TRACK‐II program is a multi‐site, community‐based randomized controlled trial evaluating an intervention to assist mothers living with HIV (MLH) in disclosing their HIV status to their young children. Many participants—both mothers and children—reported significant depression and/or suicidal ideation, a phenomenon that presented ethical challenges. This article focuses on participants at one site (Atlanta). Through the vignette of “Jordan,” we describe ethical challenges that may arise when faced with the responsibility of maximizing participants’ safety while maintaining the boundaries of the researcher role. Guided by community psychology values, our team has taken measures within our role as researchers to empower and protect children and mothers endorsing suicidal ideation. For example, we have relied on relationships with community‐based organizations and AIDS service organizations to connect HIV‐affected families to mental health services. Furthermore, we have expanded our system of documentation to follow‐up adequately with families at risk, and we track family resources to promote a strengths‐based framework. We have solicited families’ feedback about their supports and needs to understand how we may best serve them by connecting them to the resources they report needing most and empowering them to care for themselves.     

In a search for meaning: challenging the accepted know-how of working with suicide risk

This opinion piece considers the current predominance of assessment tools and strategies in working with people at risk of suicide, and questions their efficacy and how they are privileged in day to day mental health practice. While such tools and an evidence-based ‘scientific’ approach to assessment clearly has its place, the author instead asserts that the modus operandi of therapy – a discursive based exploration – has much more to offer and should be the primary intervention in understanding suicide potential. Helping the client to gain insight into the meaning of their suicidality helps position the client – and practitioner – in the best possible place to reduce risk.