Using the Linehan Risk Assessment and Management Protocol With a Chronically Suicidal Patient: A Case Report

The Linehan Risk Assessment and Management Protocol (LRAMP) is an empirically supported, comprehensive framework used to assess suicide risk and protective factors, and provide a guide for the therapist to consider reasonable options for intervening on suicidal behavior. This protocol includes a structured checklist for assessing, managing, and documenting suicide risk. It also structures the documentation to clearly describe the presentation, assessment, in-session interventions, decision-making process, and follow-up to other members of the treatment team. This paper describes a case in which the LRAMP was used to guide the assessment, intervention, and documentation of the suicidal behavior of a patient, “Ann,” being treated with outpatient Dialectical Behavioral Therapy in a community mental health clinic. Each section of the LRAMP is discussed as it was used with this complex patient, who had history of high utilization of acute psychiatric services. Application of the LRAMP included the assessment of risk and protective factors, and the use of an individualized crisis plan that engaged the patient, her family, the therapist, and the clinical team, to decrease acute risk, continue outpatient treatment, and avoid inpatient hospitalization. The considerations for documenting clinical decision-making with chronically suicidal patients are discussed.     

Assessment and Management of Suicide Risk in Children and Adolescents

This article presents a pragmatic approach to assessing and managing suicide risk in children and adolescents. We first present general recommendations for conducting risk assessments with children and adolescents, followed by an algorithm for designating risk. Risk assessment and designation should be based on both distal (i.e., a prior history of self-harm behaviors) and proximal (i.e., suicide ideation, plans, intent, and preparations) predictors of suicide attempt. We then discuss safety planning as an easy-to-implement approach for intervening and managing suicide risk when working with children and adolescents. We end with a case example illustrating the implementation of risk assessment, risk designation, and safety planning with an adolescent client and her mother.     

Being transformed: Delivering a psychotherapeutic group intervention targeting repeat suicide attempts

Clients who make repeat suicide attempts have complex needs, are at high risk of completed suicide and pose a range of challenges for clinicians. Targeted interventions are required. Acceptability, the perceived appropriateness of an intervention, is associated with successful implementation, engagement and effectiveness of interventions. Despite the advantages of group interventions, there is limited research into the acceptability of groups with this population. Using Interpretative Phenomenological Analysis, this paper reports on facilitators’ experiences (n = 9) of the acceptability of a therapeutic group intervention (PISA – a Psychoeducational/psychosocial Intervention for persons who make recurrent Suicide Attempts). Analysis of focus group data revealed how involvement with the intervention profoundly influenced facilitators’ perceptions of and approach to their work with this client group. They embraced the model, developed a deeper appreciation of clients’ resources and became unburdened from sole responsibility for the clients, the therapeutic process and outcomes. PISA provided a model that helped facilitators to work in a focused, compassionate and creative manner as they addressed the central concern of these clients, their suicidal desire, with newly found confidence and eagerness. PISA was experienced as acceptable to facilitators as it was useful to them and deemed appropriate and beneficial to the target population.     

Healing from the loss of a loved one to suicide

Healing from the Loss of a Loved One to Suicide is a personal journey to creatively process emotions and memories associated with losing my brother in 2012. This auto-ethnography is a patchwork that flows from present to past events in unforeseeable directions. The process of writing transported me back to the moment. I found out about my brother’s death up to present day. It engages the topics of depression, guilt, blame and trauma that survivor’s feel and offers an approach to finding inner peace.     

Identifying the role of sociodemographic factors in major depressive disorder and suicidality among Spanish-speaking Latino patients in a federally qualified health center

Rates of suicide and major depressive disorder (MDD) are currently at the highest point in the history of the United States (US). However, these rates are not distributed evenly among the population and Latinos show disproportionately high rates of both suicide and MDD. Yet, past research has infrequently explored factors related to suicide and MDD in primary care settings that serve as the major community portal for mental health among the Latino population. Thus, the current study investigated sociodemographic variables (marital status, nativity, education, employment, primary language, age, and gender) in terms of their relations with suicidal ideation, suicide risk, MDD, and MDD symptom severity among Latino primary care patients in a Federally Qualified Health Center (N = 634, M _age = 39.46, SD = 11.46, 87.1% female). Results indicated that gender and Nativity were associated with suicidal ideation, older age was associated with suicide risk, and higher education and having a partner were negatively associated with MDD and depressive symptom severity. These results provide novel insight into the role of sociodemographic factors predicting suicide and MDD among Latinos in primary care, and suggest greater scientific and clinical attention can be focused on certain sociodemographic factors to offset mental health disparities among this group.     

Terror as Usual: The Role of the Model Minority Myth in Asian American Women’s Suicidality

ABSTRACT

This article examines the influence of the model minority myth on the formation of suicidal tendencies among Asian American women. These women experience fractured realities under the myth as a form of everyday trauma, or “terror as usual,” which may influence their suicidal thinking or attempts. Using interview data collected from 44 Asian American women suicide survivors, this study employs narrative analyses of the interviews, drawing from the theoretical frameworks of women of color feminism, critical race studies, postmodern psychology, and critical anthropology. The first part of this article deconstructs the model minority thesis as a problematic framework for understanding Asian American achievement. The second part examines how these pressures are experienced by Asian American women as destructive material and psychic constraints. Specifically, the model minority myth contributes to Asian American women’s suicidality in three major ways: (a) the pressure to succeed creates unbearable stress for individuals as they try to live up to the stereotypical image of Asian American success; (b) the dissimulation of the myth as a social fact influences Asian American women to internalize model minority expectations and thus blame themselves if they are unable to succeed; and (c) the image of model success contributes to Asian American women becoming over-looked in the distribution of needed help and resources, further exacerbating their suicidal conditions. The article concludes with a discussion of implications of this study for both clinical and nonclinical practices needed to create social conditions for Asian American women’s mental wellness.     

Soldier Background and Postinvestigative Events Associated With Timing of Suicide Following Deployment of U.S. Army National Guard Soldiers

The present study examined the timing of suicide and its associated soldier background and postinvestigative events among deployed Army National Guard (ARNG) soldiers from calendar years 2007 through 2014. Suicide deaths were nearly equally distributed between soldiers who had been deployed and those who had not. Among those deployed, however, suicides occurred mostly 1 year or more after having returned from deployment. Soldier background and postsuicide investigative events were associated with the timing of suicide. Having more years of military service, more previous deployments, and being married were associated with in-theater suicides. Soldiers younger in age (17–24 years), single, nonprior service, and lower in rank, in addition to having parent-family conflicts, full-time employment problems, and military transition problems were associated with suicides that had occurred 1–120 days and 120–365 days since return from deployment. Soldiers aged (24–29 years), married, and higher in rank, along with more reported problems including past behavioral health conditions, postdeployment behavior health referrals, criminal behaviors, and military performance were associated with suicides that had occurred 1 year or more after return. Findings likely represent time periods of suicide vulnerability for identifiable groups of soldiers, based on soldier background and events surrounding the suicide. Practical and theoretical implications of the findings are discussed.     

A Letter to Mom During CPE

This article is a fictional letter. A seminarian writes to his mother during his Clinical Pastoral Education internship at a mental hospital, and the letter raises a number of issues, including the nature of the Bible, the essence of salvation (and Hell), the role of evangelism, and the sexual dynamics of the counseling relationship. William James’s The Varieties of Religious Experience is mentioned, and cultural questions regarding psychology are raised. There are other avenues to be explored, but the reader might start by reflecting on the issues noted.Nathan S. Carlin has been a graduate student at Princeton Seminary and has worked closely with Donald Capps and Robert Dykstra, leading scholars in the field of pastoral psychology. Carlin has published numerous articles as a Master of Divinity student. He is now a graduate student in Religious Studies at Rice University. Correspondence to Nathan Steven Carlin, 1515 Bissonnet Street, Unit 186, Houston, TX 77005-1629, USA; e-mail: Nathan.Carlin@rice.edu     

A Psychobiographical Analysis of Faith, Hope, and Despair in Suicide

This paper presents a psychobiographical analysis of a young woman who committed suicide over 50 years ago. Among the documents analyzed are her letters, a high-school diary, creative writing, college newspaper book reviews, and academic papers. Using both an Eriksonian and object-relational theoretical framework, the roles of faith, hope, and despair in suicide—and the ways in which these were represented in the young woman's self-system—are analyzed. Although she possessed strong elements of both faith and hope, along with a will to implement them in a purposeful manner, she was prone to the defense mechanisms of splitting, devaluation, and dissociation, which led to an inability to create an abiding sense of self that may have prevented her descent to despair. Among other issues discussed in the article are the usefulness of psychobiography as a method of studying suicide and both the benefits and limitations of spiritual faith in countering depression and suicide.