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Teaching Suicide Risk Assessment: Spotlight on the Therapeutic Relationship

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References

  1. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Leading causes of death by age group, united states-2017. Web-based Injury Statistics Query and Reporting System (WISQARS). http://www.cdc.gov/violenceprevention/suicide/statistics/leading_causes.html Accessed 15 June 2020.

  2. Franklin JC, Ribeiro JD, Fox KR, Bentley KH, Kleiman EM, Huang X, et al. Risk factors for suicidal thoughts and behaviors: a meta-analysis of 50 years of research. Psychol Bull. 2017;143(2):187–232.

    Article  Google Scholar 

  3. Barzilay S, Schuck A, Bloch-Elkouby S, Yaseen ZS, Hawes M, Rosenfield P, et al. Associations between clinicians’ emotional responses, therapeutic alliance, and patient suicidal ideation. Depress Anxiety. 2020;37(3):214–23.

    Article  Google Scholar 

  4. Scocco P, Toffol E, Pilotto E, Pertile R. Psychiatrists’ emotional reactions to patient suicidal behavior. J Psychiatr Pract. 2012;18:94–108.

    Article  Google Scholar 

  5. Galynker I. The suicidal crisis: clinical guide to the assessment of imminent suicide risk. New York: Oxford University Press; 2017.

  6. Practice Guidelines for the Psychiatric Evaluation of Adults, Third Edition. In: The American Psychiatric Association Practice Guidelines for the Psychiatric Evaluation of Adults. American Psychiatric Association; 2015. https://doi.org/10.1176/appi.books.9780890426760.pe02 Accessed 22 June 2020

  7. Assessment and Management of Patients at Risk for Suicide. In: VA/DoD Clinical Practice Guidelines. U.S Department of Veterans Affairs. 2019. https://www.healthquality.va.gov/guidelines/MH/srb/VADoDSuicideRiskFullCPGFinal5088212019.pdf. Accessed 22 June 2020

  8. Beck AT, Steer RA, Ranieri WF. Scale for suicide ideation: psychometric properties of a self-report version. J Clin Psychol. 1988;44(4):499–505.

    Article  CAS  Google Scholar 

  9. Hasley JP, Ghosh B, Huggins J, Bell MR, Adler LE, Shroyer ALW. A review of “suicidal intent” within the existing suicide literature. Suicide Life Threat Behav. 2008;38(5):576–91.

    Article  Google Scholar 

  10. O’Connor SS, Carney E, Jennings KW, Johnson LL, Gutierrez PM, Jobes DA. Relative impact of risk factors, thwarted belongingness, and perceived burdensomeness on suicidal ideation in veteran service members. J Clin Psychol. 2017;73(10):1360–9.

    Article  Google Scholar 

  11. Deisenhammer EA, Ing C-M, Strauss R, Kemmler G, Hinterhuber H, Weiss EM. The duration of the suicidal process: how much time is left for intervention between consideration and accomplishment of a suicide attempt? J Clin Psychiatry. 2009;70(1):19–24.

    Article  Google Scholar 

  12. Stone D, Simon T, Fowler K, Kegler S, Yuan K, Holland K, et al. Vital signs: trends in state suicide rates — United States, 1999–2016 and circumstances contributing to suicide — 27 States, 2015. MMWR Morb Mortal Wkly Rep. 2018;67:617–24.

    Article  Google Scholar 

  13. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13.

    Article  CAS  Google Scholar 

  14. Richards JE, Whiteside U, Ludman EJ, Pabiniak C, Kirlin B, Hidalgo R, et al. Understanding why patients may not report suicidal ideation at a health care visit prior to a suicide attempt: a qualitative study. Psychiatr Serv. 2019;70(1):40–5.

    Article  Google Scholar 

  15. Dunster-Page C, Haddock G, Wainwright L, Berry K. The relationship between therapeutic alliance and patient’s suicidal thoughts, self-harming behaviours and suicide attempts: a systematic review. J Affect Disord. 2017;223:165–74.

    Article  Google Scholar 

  16. Flückiger C, Del Re AC, Wampold BE, Horvath AO. The alliance in adult psychotherapy: a meta-analytic synthesis. Psychotherapy. 2018;55(4):316–40.

    Article  Google Scholar 

  17. Flückiger C, Del Re AC, Wlodasch D, Horvath AO, Solomonov N, Wampold BE. Assessing the alliance-outcome association adjusted for patient characteristics and treatment processes: a meta-analytic summary of direct comparisons. J Couns Psychol. 2020;67:706–11.

    Article  Google Scholar 

  18. Probst GH, Berger T, Flückiger C. The alliance-outcome relation in internet-based interventions for psychological disorders: a correlational meta-analysis. Verhaltenstherapie. 2019. https://www.karger.com/DOI/10.1159/000503432 Accessed 22 June 2020

  19. Horvath AO. Research on the alliance: knowledge in search of a theory. Psychother Res. 2018;28(4):499–516.

    Article  Google Scholar 

  20. Maltsberger JT, Buie DH. Countertransference hate in the treatment of suicidal patients. Arch Gen Psychiatry. 1974;30(5):625–33.

    Article  CAS  Google Scholar 

  21. Modestin J. Counter-transference reactions contributing to completed suicide. Br J Med Psychol. 1987;60(Pt 4):379–85.

    Article  Google Scholar 

  22. Barzilay S, Yaseen ZS, Hawes M, Gorman B, Altman R, Foster A, et al. Emotional responses to suicidal patients: factor structure, construct, and predictive validity of the Therapist Response Questionnaire-Suicide Form. Front Psychiatry. 2018;9:104.

    Article  Google Scholar 

  23. Prabhakar D, Balon R, Anzia JM, Gabbard GO, Lomax JW, Bandstra BS, et al. Helping psychiatry residents cope with patient suicide. Acad Psychiatry. 2014;38(5):593–7.

  24. Jobes DA. The Collaborative Assessment and Management of Suicidality (CAMS): an evolving evidence-based clinical approach to suicidal risk. Suicide Life Threat Behav. 2012;42(6):640–53.

    Article  Google Scholar 

  25. Dimeff L, Linehan M. Dialectical behavior therapy in a nutshell. California Psychol. 2001;34.

  26. Hayes JA. The inner world of the psychotherapist: a program of research on countertransference. Psychother Res. 2004;14(1):21–36.

    Article  Google Scholar 

  27. Tuckett D. Does anything go? Towards a framework for the more transparent assessment of psychoanalytic competence. Int J Psychoanal. 2005;86(1):31–49.

    Article  Google Scholar 

  28. Perry JC, Bond M, Presniak MD. Alliance, reactions to treatment, and counter-transference in the process of recovery from suicidal phenomena in long-term dynamic psychotherapy. Psychother Res. 2013;23(5):592–605.

    Article  Google Scholar 

  29. Moukaddam N, Andry T, Cao J, Moon Y, Tucci V, Shah A, et al. Instant countertransference affects assessment and treatment recommendations for depression in patients openly professing religious faith. Spiritual Clin Pract. 2018;6(2):100–9.

    Article  Google Scholar 

  30. Michaud L, Ligier F, Bourquin C, Corbeil S, Saraga M, Stiefel F, et al. Differences and similarities in instant countertransference towards patients with suicidal ideation and personality disorders. J Affect Disord. 2020;265:669–78.

    Article  Google Scholar 

  31. Burwell-Pender L, Halinski KH. Enhanced awareness of countertransference. J Profess Counsel: Pract Theory Res. 2008;36(2):38–51.

    Google Scholar 

  32. Yaseen ZS, Foster AE. What Is Empathy? In: Foster AE, Yaseen ZS, editors. Teaching empathy in healthcare: building a new core competency. Cham: Springer Nature; 2019. p. 3–16.

    Chapter  Google Scholar 

  33. Lomax JW, Foster AE. The empathy seminar: Building a strong foundation for caregiving competency. In: Foster AE, Yaseen ZS, editors. Teaching Empathy in Healthcare: Building a New Core Competency. Cham: Springer; 2019. p. 127–42.

    Chapter  Google Scholar 

  34. Bylund CL, Makoul G. Examining empathy in medical encounters: an observational study using the empathic communication coding system. Health Commun. 2005;18(2):123–40.

    Article  Google Scholar 

  35. Mercer SW, Maxwell M, Heaney D, Watt GC. The consultation and relational empathy (CARE) measure: development and preliminary validation and reliability of an empathy-based consultation process measure. Fam Pract. 2004;21(6):699–705.

    Article  Google Scholar 

  36. Munder T, Wilmers F, Leonhart R, Linster HW, Barth J. Working Alliance Inventory-Short Revised (WAI-SR): psychometric properties in outpatients and inpatients. Clin Psychol Psychother. 2010;17(3):231–9.

    PubMed  Google Scholar 

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Funding

This work was supported by the R34 MH119294-01 grant from the National Institute of Mental Health (NIMH) and AFSP # LSRG-1-050-18 from the American Foundation for Suicide Prevention.

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Correspondence to Adriana Foster.

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Disclosures

Adriana Foster, MD, is funded by National Institutes for Mental Health and American Foundation for Suicide Prevention for clinical research.

Karina McCoy, PsyD, is funded by National Institutes for Mental Health and American Foundation for Suicide Prevention for clinical research.

Igor Galynker, MD, PhD, is funded by National Institutes for Mental Health and American Foundation for Suicide Prevention for clinical research.

Matison Alderman, Daniel Safin, Xenia Aponte, and Meghan Caughey have no disclosures.

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Foster, A., Alderman, M., Safin, D. et al. Teaching Suicide Risk Assessment: Spotlight on the Therapeutic Relationship. Acad Psychiatry 45, 257–261 (2021). https://doi.org/10.1007/s40596-021-01421-2

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