Can We Prevent Suicide Attempts?

I just received the following email from a therapist who was shocked to discover that her patient was suicidal after reviewing his scores on the Brief Mood Survey. Her intervention likely saved his life.

Patient suicides are not uncommon, sadly, and represent the dark side of our profession. The death of any patient is an enormous tragedy for the patient, obviously, and is devastating for the family and friends as well. Patient suicides can be incredibly demoralizing and anxiety-provoking for the therapist, too. It is imperative, in my opinion, that therapists have the best, state-of-the-art tools for detecting the emergence of suicidal urges so that we can intervene and have the greatest chance of preventing these horrible events.

In two upcoming Feeling Good Podcasts, Fabrice and I will discuss what happened to a psychologist named Harold who thought he did not need to use the Brief Mood Survey to track his patients’ symptoms at the start and end of every therapy session. Like so many therapists, Harold  was convinced that he was sensitive and empathic and really understood how his patients felt with reasonable accuracy. When his favorite patient unexpectedly committed suicide following a particularly “good” therapy session, Harold was understandable devastated. He felt intensely depressed, anxious, ashamed, inadequate, alone, hopeless, and angry. You may find these two podcasts interesting and sobering.

My research and training experience indicate that therapists’ perceptions of how their patients feel (in terms of suicidal urges as well as severity of depression , anxiety and anger) are often way off-base, but therapists don’t realize this because most of them are not assessing assessment scales to track progress at every session. In addition, therapists’ perceptions of how empathic and helpful they are also way off-base much of the time for the same reason. They don’t measure empathy, and most don’t even ask patients to rate how warm and understanding they are.

That’s why I developed tools like the Brief Mood Survey, so therapists can track patient progress in multiple dimensions before and after every therapy session. I believe it’s use represents a major breakthrough in psychotherapy, because it’s like having an emotional X-ray machine to inform the therapist about what’s really going on, and to guide the treatment. Of course, I’m more than a little biased on this point! And the use of the BMS requires lots of courage, because the vast majority of patients are shockingly honest in the way they rate their therapists on these scales, and while the information can be invaluable, and even life-saving, it can also be quite disturbing and threatening to the therapist’s ego.

David

Hi David,

I just wanted to let you know that I recently started using the THERAPIST’S TOOLKIT and found myself in a similar situation you described. I recently had a patient whose scores were virtually ZERO on the Brief Mood Survey one week (meaning no symptoms at all), so I was convinced he was doing well. However, the following week I was alerted to high scores on your two-question “suicidal impulses” scale, which, to my chagrin, I nearly missed. That’s because I am in a new office with low lighting and I am visually impaired. But when I looked more closely, I discovered there my patient not only had suicidal thoughts and urges, but an actual plan for suicide!!!

Boy was I grateful having on hand the full blown Suicidal Urges Survey and Suicide Assessment Interview, which I proceeded to do in a two-hour session the following day. Just as surprising, his scores following THAT session were all ZERO again (except for Empathy and Self Help:-)

(David’s explanation. Scores of zero on the Depression, Suicide, Anxiety and Anger Scales are the best possible scores, indicating no symptoms at all. In contrast, scores of 20 out of 20 on the end-of-session Empathy and Helpfulness Scales are the best possible scores, indicating that the therapist was tremendous empathic and helpful during the session.)

Although I was/am at least temporarily relieved by the rapid reversal, I can’t say I know how to account for it, since most of the interview was assessment based, unless I just ooze TEAM-CBT without realizing it!

I am enjoying your Feeling Good Podcasts, as well as your Feeling Good Blog and newsletter. I am more than fairly certain, were it not for your inventory (the Brief Mood Survey), I would have missed this potentially life-saving intervention. I’d even done a brand new Intake the week before. Although we do not have the power 100% to prevent a person from committing suicide, if we do not detect it we don’t have a fighting chance. I at least have the peace of mind now that with this knowledge, I can do everything in my power to insure this patient gets all the help he needs and hopefully the right help.