What Therapists Should Actually Do for Suicidal Clients: Assessment, safety planning, and least intrusive intervention
Curt and Katie chat about suicide assessment, safety planning, and how to keep clients out of the hospital. We reviewed the Integrated Motivational Volitional Model for Suicide, we talked about what therapists should be assessing for in every session, what strong assessment looks like (and suggested suicide assessment protocols), and why the least restrictive environment is so important when you are designing interventions and safety planning. This is a continuing education podcourse.
Transcripts for this episode will be available at mtsgpodcast.com!
In this podcast episode we talk about suicide assessment, safety planning, and intervention
We continue our conversation on suicide, progressing from risk factors (from last week’s episode) to how to assess and safety plan with the least intrusive interventions at the earliest stages.
Review of the Suicide Model: Integrated Motivational Volitional Model by O’Connor and Kirtley
- Continued to review the IMV model (graphic in the show notes at mtsgpodcast.com)
What should therapists assess for in every session, related to suicide?
“When clinicians are burnt out, when we have caseloads that are too big, when we aren't taking care of ourselves, we tend to [think], “Okay, this client is at a six, they can live at a six for a while,” which is absolutely true. And if they can [live with this level of suicidality], and they have the good factors that allow them to live there – great. It's just how close are they to that 7, 8, 9?” – Curt Widhalm, LMFT
- Moderating motivational factors, which move clients from passive to more active suicidality (or the reverse)
- Looking at what is keeping someone from being at risk for suicide (protective factors)
- The importance of knowing our clients well before they move into the volitional phase
- Understanding the clinician factors and putting structure around assessment
Assessment for Suicide
“Assessment is intervention.” – Curt Widhalm, LMFT
- SAMHSA’s GATE protocol
- Gather information using a structured assessment tool (Columbia Scale, LRAMP)
- Looking at intention, means, plan as well as risk and protective factors
- Moving into a safety plan
- The importance of recognizing the human during the assessment (versus focusing only on the protocol or your liability)
- Seeking supervision or consultation – don’t do this alone
The importance of using the least restrictive intervention for suicide
“There is a rupture in the therapeutic relationship when you are sending your client or facilitating a hospitalization against their will. It can save their lives …but that may not always be the case.” – Katie Vernoy, LMFT
- The idea of “responsible” action
- The range of options for keeping a client safe
- Having a conversation with the client on how to avoid attempting suicide
- The potential impacts of hospitalization, including trauma
- The danger of hospitalizing someone who does not need this level of intervention
- Additional intervention between sessions
- The practicalities to set up your schedule and your practice to support your clients and your self
- Additional risk factors (transition phases between providers)
