Table of Contents
Acknowledgments xi
Author's Note xii
About the Author xiii
Introduction 1
Chapter 1 Understanding Suicide and You 5
Tip 1 Reflect on Your Biases about Suicide 5
Tip 2 Take Stock of Your Experiences with Suicide (or Lack Thereof) 9
Tip 3 Confront "Suicide Anxiety" 13
Tip 4 Be Alert to Negative Feelings Toward the Suicidal Person 16
Tip 5 Reject the Savior Role 19
Tip 6 Maintain Hope 21
Chapter 2 Overcoming the Taboo 24
Tip 7 Face Your Fears 24
Tip 8 Directly Ask about Suicidal Thoughts 28
Tip 9 Turn to Techniques for Eliciting Sensitive Information 31
Tip 10 Embrace a Narrative Approach: "Suicidal Storytelling" 35
Tip 11 Ask about Suicidal Imagery, Too 38
Tip 12 Uncover Fears of Hospitalization and Other Obstacles to Disclosure 40
Chapter 3 Joining with the Suicidal Person 43
Tip 13 Recognize that, for Some People, You are an Enemy 43
Tip 14 Avoid Coercion and Control Whenever Possible 46
Tip 15 Resist the Urge to Persuade or Offer Advice 49
Tip 16 Understand the Person's Reasons for Dying 51
Tip 17 Validate the Wish to Die 53
Tip 18 Acknowledge that Suicide is an Option 55
Chapter 4 Assessing Danger 57
Tip 19 Gather Remaining Essentials about Suicidal Thoughts and Behavior 57
Tip 20 Learn about Prior Suicidal Crises: The CASE Approach 64
Tip 21 Cautiously Use Standardized Questionnaires 66
Tip 22 Privilege Warning Signs Over Risk Factors 69
Tip 23 Screen for Access to Firearms 72
Tip 24 Inquire about Internet Use 74
Tip 25 Probe for Homicidal Ideation 76
Tip 26 Collect Information from Family, Professionals, and Others 78
Chapter 5 Assessing Protective and Cultural Factors 81
Tip 27 Examine Reasons for Living 81
Tip 28 Identify Other Protective Factors 84
Tip 29 Pay Attention to Culture 86
Tip 30 Investigate Religious and Spiritual Views of Suicide 90
Chapter 6 Putting It All Together: Estimating Risk 93
Tip 31 Solicit the Person's Own Assessment of Suicide Risk 93
Tip 32 Estimate Acute Risk for Suicide 95
Tip 33 Estimate Chronic Risk for Suicide 99
Tip 34 Document Generously 102
Chapter 7 Attending to Immediate Safety 108
Tip 35 Know When and Why to Pursue Hospitalization 108
Tip 36 Know When and Why Not to Pursue Hospitalization 112
Tip 37 Do Not Use a No-Suicide Contract 115
Tip 38 Collaboratively Develop a Safety Plan 118
Tip 39 Encourage Delay 123
Tip 40 Problem-Solve Around Access to Firearms 125
Tip 41 Discuss Access to Other Means for Suicide, Too 129
Tip 42 In Case of Terminal Illness, Proceed Differently (Perhaps) 131
Tip 43 Seek Consultation 134
Chapter 8 Planning for Treatment 137
Tip 44 Make Suicidality the Focus 137
Tip 45 As Needed, Increase Frequency of Contact 140
Tip 46 Treat Chronic Suicidality Differently 143
Tip 47 Involve Loved Ones 146
Tip 48 Suggest a Physical Exam 148
Tip 49 Recommend an Evaluation for Medication 150
Tip 50 Continue to Monitor Suicidal Ideation 152
Chapter 9 Alleviating Psychological Pain 155
Tip 51 After Safety, Address Suffering 155
Tip 52 Look for Unmet Needs 159
Tip 53 Target Social Isolation 162
Tip 54 Use Grounding Exercises 165
Chapter 10 Exploring Motivations and Misgivings 168
Tip 55 Assume Nothing: Does the Person Want to Give Up Suicide? 168
Tip 56 Tap into Ambivalence 171
Tip 57 Compare Reasons for Living and Dying 173
Tip 58 Invite the Person to Look for the "Catch" 175
Tip 59 Search for Exceptions 177
Chapter 11 Inspiring Hope 179
Tip 60 Frame Suicide as a Problem-Solving Behavior 179
Tip 61 Help Brainstorm an "Options List" 181
Tip 62 Teach the Problem-Solving Method 184
Tip 63 Nourish Future Plans and Goals 186
Tip 64 Incorporate a Hope Kit 189
Tip 65 Highlight Strengths 192
Chapter 12 Drawing from Cognitive Behavior Strategies 194
Tip 66 Connect Suicidal Thoughts to Other Thinking 194
Tip 67 Educate about Cognitive Distortions 198
Tip 68 Help Challenge Negative Thoughts 202
Tip 69 Elicit Coping Statements 207
Tip 70 Rescript Suicidal Imagery 209
Tip 71 Discourage Thought Suppression 212
Tip 72 Foster Acceptance of Suicidal Thoughts 214
Chapter 13 Improving Quality of Life 217
Tip 73 Enhance Coping Skills 217
Tip 74 Cultivate Mindfulness 221
Tip 75 "Broaden and Build" Positive Emotions 225
Tip 76 Pair Behavioral Activation with Values 229
Chapter 14 Moving Forward After a Suicide Attempt 233
Tip 77 Differentiate Between Suicidal and Non-Suicidal Self-Injury 233
Tip 78 Determine the Person's Reaction to Having Survived 236
Tip 79 Conduct a Chain Analysis 238
Tip 80 Evaluate Where the Safety Plan Fell Short 241
Tip 81 Take Advantage of the "Teachable Moment" 243
Tip 82 Attend to the Therapeutic Relationship 245
Tip 83 Address the Trauma of the Suicide Attempt 248
Tip 84 Explore Shame and Stigma 250
Chapter 15 Building Resilience 252
Tip 85 Warn about the Possibility of Relapse 252
Tip 86 Review Lessons Learned 254
Tip 87 Complete a Relapse Prevention Protocol 256
Tip 88 Propose a Letter to the Suicidal Self 259
Tip 89 Follow Up 261
For More Information 264
Index 265
