John Sommers-Flanagan - Suicide Assessment and Treatment Planning

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John Sommers-Flanagan

Rita Sommers-Flanagan

6101 Stevenson Avenue, Suite 600

Alexandria, VA 22304

www.counseling.org

Copyright © 2021 by the American Counseling Association. All rights reserved. Printed in the United States of America. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the written permission of the publisher.

American Counseling Association6101 Stevenson Avenue, Suite 600 • Alexandria, VA 22304

Associate Publisher • Carolyn C. Baker

Digital and Print Development Editor • Nancy Driver

Senior Production Manager • Bonny E. Gaston

Copy Editor • Beth Ciha

Cover and text design by Bonny E. Gaston

Library of Congress Cataloging-in-Publication DataNames: Sommers-Flanagan, John, 1957– author. | Sommers-Flanagan, Rita, 1953– author. Title: Suicide assessment and treatment planning : a strengths-based approach / John Sommers-Flanagan and Rita Sommers-Flanagan. Description: Alexandria, VA : American Counseling Association, [2021] | Includes bibliographical references and index. Identifiers: LCCN 2020041407 | ISBN 9781556204050 (paperback) Subjects: LCSH: Suicidal behavior—Diagnosis | Suicidal behavior—Treatment Classification: LCC RC569 .S64 2021 | DDC 616.85/8445--dc23 LC record available at https://lccn.loc.gov/2020041407

We dedicate this book to all the school, mental health,health care professionals, and students who are so busysaving lives that they will probably skip this dedication.We see you, and we honor you and your work.

Writing a book about suicide may not have been our best idea ever. Rita made the point more than once that reading and writing about suicide at the depth necessary to write a helpful book can affect one’s mood in a downward direction. She was right, of course. Her rightness inspired us to pay attention to the other side of the coin, so we decided to integrate positive psychology and the happiness literature into this book. As is often the case when grappling with matters of humanity, focusing on suicide led us to a deeper understanding of suicide’s complementary dialectic—a meaningful and fully lived life—and that has been a very good thing.

Before diving into these pages, please consider the following.

In the first chapter, we strongly emphasize how important it is to practice self-care when working with clients who are suicidal. Immersing ourselves in the suicide literature required a balancing focus on positive psychology and wellness. While you are reading this book and exploring suicide, you cannot help but be impacted emotionally, and we cannot overstate the importance of you taking care of yourself throughout this process and into the future. You are the instrument through which you provide care for others, and so we highly encourage you to repeatedly do the self-care thing.

Many people have asked, “What on earth do you mean by a strengths-based approach to suicide assessment and treatment planning?” In response, we usually meander in and out of various bullet points, relational dynamics, and assessment procedures and try to emphasize that the approach is more than just strengths based—it is also wellness oriented and holistic. By “strengths based,” we mean that we recognize and nurture the existing and potential strengths of our clients. By “wellness oriented,” we mean that we believe in incorporating wellness activities into counseling and life. By “holistic,” we mean that we focus on emotional, cognitive, interpersonal, physical, cultural-spiritual, behavioral, and contextual dimensions of living.

You will find the following strengths-based, wellness-oriented, and holistic principles woven into every chapter of this book: Empirically supported is used when there is substantial and specific research support; evidence based is used when there is general research support, but that support may not be especially robust or specific. We avoid using best practice because this phrase implies direct comparisons and rank orderings of all potential practices (which have not been done) and is often used to communicate normative practice standards rather than procedures with underlying empirical support.

1 Historically, suicidal ideation has been socially constructed as sinful, illegal, or a terribly frightening and bad illness. In contrast, we believe that suicidal ideation is a normal variation on human experience that typically stems from difficult environmental circumstances and excruciating emotional pain. Rather than fear client disclosures of suicidality, we welcome these disclosures because they offer an opportunity to connect deeply with distressed clients and provide therapeutic support.

2 Although we believe that risk factors, warning signs, protective factors, and suicide assessment instruments are important, we value relationship connections with clients over predictive formulae and technical procedures.

3 We believe that trust, empathy, collaboration, and rapport will improve the reliability, validity, and utility of data gathered during assessments. Consequently, we embrace the principles of therapeutic assessment.

4 We believe that counseling practitioners need to ask directly about and explore suicidal ideation using a normalizing frame or other sophisticated and empathic interviewing strategies.

5 We believe that traditional approaches to suicide assessment and treatment are excessively oriented toward psychopathology. To compensate for this pathology orientation, we explicitly value and ask about clients’ positive experiences, personal strengths, and coping strategies.

6 We believe that the narrow pursuit of psychopathology causes clinicians to neglect a more complete assessment and case formulation of the whole person. To compensate, we use a holistic, seven-dimension model to create a broader understanding of what is hurting and what is helping in each individual client’s life.