Conference Coverage

Suicide prevention starts with the patient’s narrative



– An effective approach to suicide prevention engages the patient in a therapeutic relationship that starts with the patient’s narrative, Katherine A. Comtois, PhD, said at the American Association of Suicidality annual conference.

“The narrative should be the first touch” with the patient, advised Dr. Comtois, professor of psychiatry at the University of Washington, Seattle. “Start the narrative and form a connection, and then get to the other stuff.” She also recommended that therapists place themselves next to the patient, “court” the patient, be persistent, give positive reinforcement, and “give it all you’ve got.”

Dr. Katherine A. Comtois of the University of Washington, Seattle Mitchel L. Zoler/MDedge News

Dr. Katherine A. Comtois

To succeed with suicide prevention, “you only need to give reasonable doubt that suicide is not the right option,” Dr. Comtois noted.

She endorsed the Aeschi model for suicide prevention, the treatment approaches recommended in The Way Forward, published in 2014 by the National Action Alliance for Suicide Prevention, and application of dialectical behavior therapy.

Dr. Comtois subdivided therapeutic interventions into two broad categories: management and treatment.

Management uses interventions aimed at modifying risk factors and reducing risks that relate to suicide, such as connectedness, treatment of the diagnosis, means safety, and safety planning; external factors that affect suicide risk. Although a collaborative approach between the therapist and patient is ideal for achieving management goals, it is not mandatory.

Treatment involves interventions that get at the internal factors that intrinsically drive a patient to suicide and aims to resolve the risk they pose. “Figure out what is driving suicidality, what makes life not worth living, and stop that.” By necessity, treatment is a collaborative process. Ideally over time, the collaboration allows the patients gain confidence and take responsibility for self-managing their internal suicide risks.

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