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When initiating conversations with patients about suicide-related topics, including lethal means, there are a number of ways that this can be done including directly asking the patients about suicidality as part of the routine intake interview or asking about suicide within the context of other relevant variables. Clinicians are advised to show empathy and build rapport with the patient when asking that patient about suicide and suicide-related topics, such as lethal means.
Showing Empathy and Building Rapport with the Patient
These types of responses can cause a problem because if these are used to counter patient negativity, patients may come to a conclusion that the clinician “doesn’t get them,” and will hold on more strongly to their negative perceptions. In this case, using empathetic reflections can help the clinician to connect to the patient’s unbearable distress and depressive symptoms.
The “completely miserable and hopeless” reflection can be useful to the clinician in two different ways: First, this type of reflection demonstrates the clinician’s willingness to be with the patient in the middle of the patient’s despair; Second, this type of reflection could function as an amplified reflection, meaning that the patient could respond with talk of positive change.
When the clinician also uses validation and reassurance, this can also facilitate rapport with the patient. When using this type of conversation, it is important to remember that as long as your response is authentic, using immediacy or brief self-disclosure is a type of validation strategy that can deepen the alliance between the clinician and the patient.
Sometimes suicidal patient can become extremely irritable and can cause difficulties in the clinician developing rapport with the patient. Irritable patients can provoke negative emotional reactions from the clinicians. In this case, using a three-part response is recommended: 1) reflective listening, 2) gentle interpretation, and 3) a statement of commitment to keep working with and through the irritability.
Asking Directly about Suicide Ideation
Mood Scaling with a Suicide Floor
This strategy offers several advantages for clinicians. First, it is a process that facilitates engagement, and this engagement or in other words, interpersonal connection, is a central part of suicide interventions. Second, when patients are able to connect their low and high moods to concrete external situations, the clinician is able to gain the knowledge about the triggers that lift and depress the patient’s mood. Third, the mood scaling procedure can be abandoned (either temporarily or permanently) in favor of other opportunities. Fourth, the mood scaling can flow smoothly into safety planning or other suicide interventions through opening a discussion.
There are a number of conversation strategies that the clinician can utilize in order to open up the discussion of suicide and suicide ideation, including conversations about lethal means, with the patient. The list above is not all inclusive and is subject to the clinician’s judgement as to which strategy he or she might believe would be the better option for their patient.
- Sommers-Flanagan, John Ph.D. Conversations About Suicide: Strategies for Detecting and Assessing Suicide Risk. National Register of Health Service Psychologists. Winter 2018.
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