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Treating Suicidal Behavior : An Effective, Time-Limited Approach - M. David Rudd

Treating Suicidal Behavior

An Effective, Time-Limited Approach

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This manual provides an empirically supported approach to treating suicidality that is specifically tailored to today's managed care environment. Structured yet flexible, the model is fully compatible with current best practice standards. The authors establish the empirical and theoretical foundations for time-limited treatment and describe the specific tasks involved in assessment and intervention. The book then details effective ways to conduct a rapid case conceptualization and outpatient risk assessment, determine and implement individualized treatment targets, and monitor treatment outcomes. Outlined are clear -cut intervention techniques that focus on symptom management, restructuring the patient's suicidal belief system, and building such key skills as interpersonal assertiveness, distress tolerance, and problem solving. Other topics covered include the role of the therapeutic relationship, applications to group work and longer-term therapy, the use of medications, patient selection, and termination of treatment. Illustrated with helpful clincial examples, the book also features dozens of tables, figures, and sample handouts and forms.

Industry Reviews

"Offer[s] clinicians for the first time a flexible and unique therapeutic program that is direct, time-limited, and buttressed by empirical support. Thus, clinicians facing the urgency of suicidal behavior can decide on the content and timing of interventions designed to eliminate suicidal behavior, and assess in an ongoing way the effectiveness of their efforts. Even if not often confronted with suicidal behavior, clinicians who become familiar with the procedures outlined in this manual will gain confidence in their ability to deal with suicidal crises." --From the Series Editor Note by David H. Barlow

"This important book presents a short-term cognitive-behavioral treatment model that will be perused with interest by all contemporary suicidologists. The authors are exemplary scientist-practitioners within the field of psychology. They have produced a noteworthy, clinically useful contribution." --Edwin S. Shneidman, PhD., Professor of Thanatology Emeritus, University of California, Los Angeles

"From premier scholar-clinicians, this remarkable book deftly guides the practitioner through the considerable challenges of working with suicidal patients. It is among the first (and only) comprehensive works of its kind. The authors manage to incorporate the wisdom of empirical science into a realistic and user-friendly practical approach, a rare accomplishment in the contemporary literature. The liberal use of intriguing case examples helps illustrate a broad range of theoretically grounded, intuitively appealing techniques and interventions that are essential to lifesaving clinical work. Written with great clarity, the book will be valuable for everyone from graduate students to mature clinicians. I am certain that the ripple of this book's impact on the field of clinical suicidology will be seen for many years to come." --David A. Jobes, PhD, Department of Psychology, The Catholic University of America; Past President, American Association of Suicidology

"This book fills an important gap in the array of manualized treatment approaches that are currently available. Drawing on extensive research and experience in the treatment of suicidal individuals, the authors have fashioned a flexible, empirically validated, time-limited approach that will be welcomed by therapists of all persuasions. The book provides specific, detailed information on the 'why' and 'how' of a variety of integrated techniques. Replete with assessment forms, charts, and practical guidelines, this book will serve as a basic reference for therapists facing one of the most challenging clinical situations." --George A. Clum, PhD, Department of Psychology, Virginia Polytechnic Institute and State University

"The text has numerous strengths including its theoretically grounded approach towards assessing suicide risk, clear session-by-session outlines of the implementation of both short- and long-term treatment strategies, and rich descriptions of empirical support for the techniques proposed....An exceptional guide to help clinicians effectively and efficiently treat suicidality, and the authors animate the test by providing a multitude of client worksheets, session transcripts, and flow charts. This book will definitely be on my list of recommendations for students and colleagues who want either to build or to strengthen their foundation in conducting cognitive therapy."--Cognitive Behavioral Therapy Book Reviews

"Provides practitioners with a working manual for dealing with the most serious, complex, and potentially lethal clinical problem found in any treatment and psychiatric rehabilitation setting....Should be on the shelf of all practitioners who interface and treat suicidal individuals."--Psychiatric Rehabilitation Journal

"A lifeline for both the patient and the therapist....Provides a rich web of techniques, advice, suggestions, and instructions to which the therapist and patient can hold onto in times of a life-and-death crisis without the therapist being overburdened by the sense of responsibility or the patient with uncontrollable anxiety....Very impressive."-- Death Studies

"By incorporating the clinical information contained in this book, clinicians will be better able to decide when and how to effectively intervene in the suicidal syndrome....This book is comprehensive, well-organized, and articulate."--Journal of Nervous and Mental Disease

Establishing a Foundation for Treatment
What Do We Really Know about Treating Suicidality?: A Critical Review of the Literaturep. 3
The Available Literature: A Limited Databasep. 4
A Critical Review of Intervention Studies: Do Simple Procedural Changes Make a Difference?p. 6
Implications for Clinical Practicep. 8
A Critical Review of Treatment Studies: An Emerging Trend for Cognitive-Behavioral Therapyp. 8
Implications for Clinical Practicep. 11
The Therapeutic Relationship in Treating Suicidality: Attachment, Hope, and Survivalp. 12
Implications for Clinical Practicep. 13
Unanswered Questions: The Challenge Awaits Usp. 14
A Cognitive-Behavioral Model of Suicidalityp. 15
Existing Theoretical Models of Suicidal Behavior: A Brief Overviewp. 15
Static and Dynamic Variables Predicting Suicidalityp. 17
Application of Theory and Empirical Findings in Treatment: The Problem of Limited Clinical Relevancep. 18
Basic Assumptions of Cognitive Theory and Therapy: Implications for Suicidalityp. 20
The Essential Requirements for a Cognitive-Behavioral Model of Integrating Empirical Findings and Ensuring Clinical Relevancep. 23
The Suicidal Mode as a Cognitive-Behavioral Model of Suicidality: An Elaboration and Specific Application of Beck's Theory of Modes and Psychopathologyp. 24
Defining the Suicidal Mode: Characteristics of the Various Systemsp. 27
Completing the Suicidal Mode: Individual Case Conceptualizationp. 33
Implications of the Suicidal Mode for the Organization, Content, and Process of Treatmentp. 40
Theoretical Flexibility of the Suicidal Mode for Psychotherapy Integrationp. 41
The Therapeutic Relationship in Cognitive-Behavioral Therapy: Three Fundamental Assumptionsp. 42
An Overview of the Treatment Processp. 44
Completing the Clinical Picture: Understanding Severity, Chronicity, and Diagnostic Complexityp. 45
Identifying Treatment Componentsp. 46
An Overview of the Goals for Each Treatment Componentp. 49
An Overview of the Steps in Treatment Planningp. 50
Understanding the Treatment Process: Treatment Components and Corresponding Levelsp. 52
Defining the Component Levelsp. 53
Symptom Management Componentp. 55
Cycling through Components and Levelsp. 58
The Role of Medicationsp. 60
Skill-Building Componentp. 61
Personality Development Componentp. 62
Variation in Therapist Rolep. 63
A Clinical Example of Acute Suicidality: The Case of Mr. Ep. 64
Monitoring the Treatment Processp. 66
Process Tasks and Markersp. 66
Provocations and Resistance in the Therapeutic Relationship: How a Clear Organizational Framework Helpsp. 70
Quantifying Change: How to Measure and Monitor Change in Treatmentp. 70
Treatment Withdrawal and Noncompliancep. 71
Ensuring Treatment Fidelityp. 72
Termination: When, Why and Howp. 73
Interpersonal Process Groups and Booster Sessionsp. 73
The Role of the Treatment Teamp. 74
The Need for Long-Term Care in a Time-Limited Worldp. 75
Assessment and Treatment
Treatment Course and Session-by-Session Guidelinesp. 79
The Beginning of Treatment: Sessions 1-4p. 81
Symptom Management, Cognitive Restructuring, Reducing and Eliminating Suicidal Behaviorsp. 94
Emphasis on Skill Buildingp. 96
A Shift toward Personality Development and Longer-Term Treatmentp. 98
The Evaluation Process and the Initial Interviewsp. 100
Risk Assessment Goals: The Importance of Establishing a Baseline for Ongoing Monitoringp. 104
Treatment Conceptualization and Consent: Setting the Stagep. 105
The Use and Role of Psychometric Testingp. 117
Establishing the Therapeutic Relationshipp. 121
Assessing Suicide Riskp. 126
Distinguishing between Risk Assessment and Prediction: Defining the Nature of Clinical Responsibilitiesp. 127
The Importance of Precise Terminology: Saying What We Know and Knowing What We Sayp. 128
Essential Components of a Clinical Risk Assessment Interviewp. 131
Tips on Eliciting Information on Intent and Self-Controlp. 135
Risk Categories: Baseline, Acute, Chronic High Risk, and Chronic High Risk with Acute Exacerbationp. 136
Rating Severity: A Continuum of Suicidalityp. 138
Clinical Documentation and the Process of Risk: The Concept of Risk Monitoringp. 141
The Role of Chronicity and Time in Risk Assessmentp. 143
Clinical Decision Making, Management, and Treatmentp. 143
Ongoing Monitoring of Treatment Outcome and Evaluationp. 145
The Persistence of Suicidal Thoughts: A Potentially Misleading Marker of Treatment Outcomep. 147
Crisis Intervention and Initial Symptom Managementp. 148
Key Tasks of Crisis Interventionp. 149
Ensuring the Patient's Safetyp. 153
Self-Monitoring during Crisesp. 154
Teaching the Patient to Rate Discomfort: A Self-Monitoring Taskp. 154
Completing the Suicidal Thought Recordp. 158
Depicting the Suicidal Cycle: The Suicidal Mode in Actionp. 159
Using Mood Graphsp. 160
Improving Distress Tolerance and Reducing Impulsivity: The Importance of Emphasizing That Bad Feelings Do Not Last Foreverp. 162
Targeting Source Hopelessness: A Different Kind of Problem Solvingp. 163
Symptom Matching: Improving Level of Functioning over the Short Termp. 165
The Importance of Structure: Providing a Crisis Response Planp. 166
Reducing and Eliminating Suicide-Related Behaviorsp. 170
Identifying Behavioral Targets in Treatment: Understanding the Suicidal Modep. 170
Distinguishing between Suicidal Acts and Instrumental Behaviorsp. 173
Dealing with Mixed Messagesp. 175
Identifying the Suicidal Cyclep. 176
The Process of Behavioral Change: Reducing and Eliminating Suicidal Behaviorp. 178
Inhibiting the Suicidal Cycle during Crisis States: Late-Cycle Interventionp. 183
Substitute Behaviors and Purposeful Hypervigilance: Early-Cycle Interventionp. 184
Shaping Behavior: A Process of Gradual Changep. 186
Exposure-Based Strategies: Role Playing, Cue Exposure, and Behavioral Rehearsalp. 187
Contingency Management and Treatment Successp. 187
Targeting Treatment Disruptionsp. 189
Provocation(s): The Currency of Interpersonal Relatedness in Suicidalityp. 191
Handling Provocation in Treatmentp. 194
The Evolution of Hope and the Elimination of Suicidal Behavior: A Few Concluding Wordsp. 197
Cognitive Restructuring: Changing the Suicidal Belief System and Building a Philosophy for Livingp. 198
Private Meaning and the Suicidal Belief System: The Role of Automatic Thoughts and Intermediate and Core Beliefsp. 198
A Straightforward Strategy for Cognitive Changep. 203
Dealing with Poor Motivation and Treatment Noncompliancep. 208
Building a Philosophy for Living: Change and Acceptance as New Rulesp. 209
Prevailing, Facilitating, and Compensatory Modes in Chronic Suicidality: Developing Adaptive Modes and Acknowledging Personal Qualities and Characteristicsp. 211
The Therapeutic Belief System: Therapy-Specific Beliefsp. 212
Outlining the Therapeutic Belief Systemp. 218
The Therapeutic Belief System of the Therapist Treating Suicidality: Monitoring Thoughts, Feelings, and Behaviors in Treatmentp. 222
Evaluating the Relationship: Patience, Determination, and Consistencyp. 224
Skill Building: Developing Adaptive Modes and Ensuring Lasting Changep. 226
Conceptualizing Skill Deficits in Cognitive-Behavioral Therapy for Suicidalityp. 226
Targeting Skill Deficitsp. 228
A Model for Problem Solving: Learning to Identify, Evaluate, and Pursue Alternatives to Suicidep. 234
Emotion Regulation Ability: The Art of Feeling Better When Suicidalp. 237
Self-Monitoringp. 239
Distress Tolerancep. 241
Interpersonal Skills: Learning to Be Assertive, Attentive, and Responsivep. 242
Anger Management: Early Identification, Appropriate Expression, and the Importance of Empathy, Acceptance, and Forgivenessp. 243
Skill Building and Personality Change: One and the Same?p. 247
Changing Interpersonal Process: Integrating Goup Treatmentp. 247
Referencesp. 251
Indexp. 261
Table of Contents provided by Syndetics. All Rights Reserved.

ISBN: 9781572306141
ISBN-10: 1572306149
Series: Treatment Manuals for Practitioners
Audience: General
Format: Hardcover
Language: English
Number Of Pages: 274
Published: 15th February 2001
Country of Publication: US
Dimensions (cm): 22.9 x 15.2  x 2.54
Weight (kg): 0.58