About the Book

To best help the suicidal person, you must join them in the darkness.

You also need to know how to ask the right questions, make good use of the answers, and use techniques that directly address suicidal thoughts.

And you need to sustain your own hope and fortitude in the deep, hard work of helping someone to save their own life.

Helping the Suicidal Person: Tips and Techniques for Professionals will help you achieve all of the above.

Helping the Suicidal Person provides a highly practical toolbox for mental health professionals. The book first covers the need for professionals to examine their own personal experiences and fears around suicide, moves into essential areas of risk assessment, safety planning, and treatment planning, and then provides a rich assortment of tips for reducing the person’s suicidal danger and rebuilding the wish to live.

The techniques described in the book can be interspersed into any type of therapy, no matter what the professional’s theoretical orientation is and no matter whether it’s the client’s 1st, 10th, or 100th session. Clinicians don’t need to read this book in any particular order, or even read all of it. Open the book to any page, and find a useful tip or technique that can be applied immediately.

TABLE OF CONTENTS

I. Understanding Suicide and You

Tip 1: Reflect on Your Biases about Suicide. Tip 2: Take Stock of Your Experiences with Suicide (or Lack Thereof). Tip 3: Confront “Suicide Anxiety.” Tip 4: Be Alert to Negative Feelings Toward the Suicidal Person. Tip 5: Reject the Savior Role. Tip 6: Maintain Hope.

II. Overcoming the Taboo

Tip 7: Face Your Fears. Tip 8: Directly Ask about Suicidal Thoughts. Tip 9: Turn to Techniques for Eliciting Sensitive Information. Tip 10: Embrace a Narrative Approach: “Suicidal Storytelling.” Tip 11: Ask about Suicidal Imagery, Too. Tip 12: Uncover Fears of Hospitalization and Other Obstacles to Disclosure.

III. Joining with the Suicidal Person

Tip 13: Recognize that, for Some People, You are an Enemy. Tip 14: Avoid Coercion and Control Whenever Possible. Tip 15: Resist the Urge to Persuade or Offer Advice. Tip 16: Understand the Person’s Reasons for Dying. Tip 17: Validate the Wish to Die. Tip 18: Acknowledge that Suicide is an Option.

IV. Assessing Danger

Tip 19: Gather Remaining Essentials about Suicidal Thoughts and Behavior. Tip 20: Learn About Prior Suicidal Crises: The CASE Approach. Tip 21: Cautiously Use Standardized Questionnaires. Tip 22: Privilege Warning Signs Over Risk Factors. Tip 23: Screen for Access to Firearms. Tip 24: Inquire about Internet Use. Tip 25: Probe for Homicidal Ideation. Tip 26: Collect Information from Family, Professionals, and Others.

V. Assessing Protective & Cultural Factors

Tip 27: Examine Reasons for Living. Tip 28: Identify Other Protective Factors. Tip 29: Pay Attention to Culture. Tip 30: Investigate Religious and Spiritual Views of Suicide.

VI. Putting It All Together: Estimating Risk

Tip 31: Solicit the Person’s Own Assessment of Suicide Risk. Tip 32: Estimate Acute Risk for Suicide. Tip 33: Estimate Chronic Risk for Suicide. Tip 34: Document Generously.

VII. Attending to Immediate Safety

Tip 35: Know When and Why to Pursue Hospitalization. Tip 36: Know When and Why Not to Pursue Hospitalization. Tip 37: Do Not Use a No-Suicide Contract. Tip 38: Collaboratively Develop a Safety Plan. Tip 39: Encourage Delay. Tip 40: Problem-Solve around Access to Firearms. Tip 41: Discuss Access to Other Means for Suicide, Too. Tip 42: In Case of Terminal Illness, Proceed Differently (Perhaps). Tip 43: Seek Consultation.

VIII. Planning for Treatment

Tip 44: Make Suicidality the Focus. Tip 45: As Needed, Increase Frequency of Contact. Tip 46: Treat Chronic Suicidality Differently. Tip 47: Involve Loved Ones. Tip 48: Suggest a Physical Exam. Tip 49: Recommend an Evaluation for Medication. Tip 50: Continue to Monitor Suicidal Ideation.

IX. Alleviating Psychological Pain

Tip 51: After Safety, Address Suffering. Tip 52: Look for Unmet Needs. Tip 53: Target Social Isolation. Tip 54: Use Grounding Exercises.

X. Exploring Motivations and Misgivings

Tip 55: Assume Nothing: Does the Person Want to Give Up Suicide? Tip 56: Tap Into Ambivalence. Tip 57: Compare Reasons for Living and Dying. Tip 58: Invite the Person to Look for the “Catch.” Tip 59: Search for Exceptions.

XI. Inspiring Hope

Tip 60: Frame Suicide as a Problem-Solving Behavior. Tip 61: Help Brainstorm an “Options List.” Tip 62: Teach the Problem-Solving Method. Tip 63: Nourish Future Plans and Goals. Tip 64: Incorporate a Hope Kit. Tip 65: Highlight Strengths.

XII. Drawing from Cognitive Behavior Strategies

Tip 66: Connect Suicidal Thoughts to Other Thinking. Tip 67: Educate about Cognitive Distortions. Tip 68: Help Challenge Negative Thoughts. Tip 69: Elicit Coping Statements. Tip 70: Rescript Suicidal Imagery. Tip 71: Discourage Thought Suppression. Tip 72: Foster Acceptance of Suicidal Thoughts.

XIII. Improving Quality of Life

Tip 73: Enhance Coping Skills. Tip 74: Cultivate Mindfulness. Tip 75: “Broaden and Build” Positive Emotions. Tip 76: Pair Behavioral Activation with Values.

XIV. Moving Forward After a Suicide Attempt

Tip 77: Differentiate Between Suicidal and Non-Suicidal Self-Injury. Tip 78: Determine the Person’s Reaction to Having Survived. Tip 79: Conduct a Chain. Analysis Tip 80: Evaluate Where the Safety Plan Fell Short. Tip 81: Take Advantage of the “Teachable Moment.” Tip 82: Attend to the Therapeutic Relationship. Tip 83: Address the Trauma of the Suicide Attempt. Tip 84: Explore Shame and Stigma.

XV. Building Resilience

Tip 85: Warn about the Possibility of Relapse. Tip 86: Review Lessons Learned. Tip 87: Complete a Relapse Prevention Protocol. Tip 88: Propose a Letter to the Suicidal Self. Tip 89: Follow Up.

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