Suicide Assessment and Treatment Planning. John Sommers-Flanagan

in writing, speaking, teaching, and researching, John keeps busy watering the zucchini, picking beans, and starring in videos along with his grandchildren. He also excels at making pancakes, waffles, and quiche. He was drawn to writing this book because of his earnest belief that effective suicide assessment and intervention simply must become more positive, skilled, and compassionate. You can find what he is up to on his blog, https://johnsommersflanagan.com/.

      Rita Sommers-Flanagan, PhD, is an author, counselor, passive solar advocate, and professor emerita of counseling at the University of Montana, with many published books and articles. She enjoys collecting rocks and driftwood, jogging, blogging, and contemplating the meaning of life. Her experiences with and views about suicide have been shaped and changed by clients, colleagues, students, and friends who have had to cope with the phenomenon of suicide clinically and/or personally. She looks forward to writing further in this area, including addressing end-of-life policies and practices as they intersect with the materials in this book. In the meantime, you can follow her on her blogs: https://drbossypants.wordpress.com/author/ritasf13/and https://godcomesby.com/.

As coauthors, the Sommers-Flanagans have stylistic differences that are distinct but usually complementary. John dives way too far down various rabbit holes, skims and reads too many journal articles and book chapters, jots notes on several hundred different small pieces of paper, and then begins a word processing version of loose associations about arcane facts. (Did you know that suicide rates among males older than 85 in the United States are 13.17 times higher than suicide rates among females older than 85 in the United States? Should we include results from that one cool study showing that trait impulsiveness is not associated with increased suicide attempts but that negative state-triggered impulsiveness is linked to suicide attempts?) At some point, Rita nudges John out of his loose associations and research reveries, takes her commonsense garden clippers to John’s meandering prose, pulls a few of his worst puns, and voilà! After mostly agreeing with each other’s brilliance, they send the resulting draft out to a plethora of volunteer readers, collect feedback, marvel at the diversity in perspective, integrate the input, get organizing and copyediting assistance through the publisher, and end up with pretty much what you are about to read.

      Acknowledgments

      This book was made possible by the amazing work of many researchers, practitioners, suicide survivors, students, clients, and suicidologists who came before us and illuminated the way. We are indebted to all of them. We are also grateful to the American Counseling Association’s editorial team—Carolyn Baker, Nancy Driver, Bonny Gaston, and others—who have helped make our words clearer and our points sharper. A big thanks to Pete MacFadyen, Katie DiBerardinis, and Robin Hill of the Big Sky Youth Empowerment Program for their support of our work and their commitment to suicide prevention in Montana. Thanks also to Victor Yalom of Psychotherapy.net and Kelley Donisthorpe of the University of Montana.

      We offer special thanks to Erin Binkley of Wake Forest University and Victor Chang of Southern Oregon University for their thorough reviews and detailed feedback. Thanks also to the many professionals who volunteered to read a chapter or two or the whole manuscript. Your insightful comments and feedback have resulted in a better book:

       Alexis Cancemi – Alexis Mental Health, North Miami Beach, Florida

       Amanda Tashjian – University of Arizona

       Benjamin Willis – University of Scranton

       Beronica Salazar – Northwest Nazarene University

       Cara Metz – Ashford University

       Christie Nelson – University of North Carolina–Charlotte

       Claudia Sadler-Gerhardt – Ashland Theological Seminary

       Dari Tahani – University of Toledo

       Devyn Savitsky – Ohio University

       Diane Shea – Holy Family University

       Erin M. Hopper – Liberty University

       Jill Schott – Onward Behavioral Health

       Jo-Ann Sanders – Heidelberg University

       John Harrichand – State University of New York–Brockport

       Julie Williams – Thrive Counseling & Consultation, Tampa, Florida

       Kara Hurt-Avila – Montana State University

       Keiko Sano – Antioch University–Seattle

       Kenneth Messina – Slippery Rock University

       Kristin Bruns – Youngstown State University

       Kristopher K. Garza – Texas A&M University–Kingsville

       Latoya S. Moss – Savannah College of Art and Design

       Laura I. Hodges – Troy University Montgomery

       Laura M. Schmuldt – University of the Cumberlands

       Melissa Sanders-DeVillier – University of the Cumberlands

       Michelle Santiago – Moravian University

       Molly Stehn – Webster University

       Nicholas Rudgear – Grand Canyon University

       Patricia Brenner – Kutztown University of Pennsylvania

       Philip Gnilka – Virginia Commonwealth University

       Robin S. Archer – Mindful Paths

       Sara Carpenter – University of Texas–Austin

       Shalini J. Mathew – Northern State University

       Tara Gray – Prescott College

       Teah Moore – Spalding University

       Tracie Self – Ascend Therapeutic and Wellness Services

      Chapter 1

      Emotional Preparation

      All by itself, the word suicide activates anxiety for most mental health professionals. Imagine the following scenario:

      Your new Monday morning client shows up early for her 9 a.m. appointment. Her name is Alina. She is a 29-year-old lesbian woman. She lives alone, is unemployed, and complains that “life is impossible” without a partner. Alina is primarily of Croatian descent. Her family of origin lives about 500 miles away; Alina says she is glad to have distance from her family because “they’re all about judging me.”

      Alina talks about her chronic struggle with anxiety and depression and says, “I’m not sure anything can help me feel better.” She discloses that she wishes she could “go to sleep and not wake up.” You ask directly, “Have you had thoughts about suicide?” Alina admits to intermittent suicidality but denies an active plan. She says that even though she wants to stay alive, “thinking about suicide gives me a mental escape in case life gets worse.” Alina made a suicide attempt about 6 months ago using a combination of pills and alcohol. She ended up in the emergency department of her local hospital. She was glad to survive her attempt, which gives you hope about her motivation to live. After her suicide attempt, Alina was on antidepressant medications and had three counseling sessions, but she did not find either treatment helpful. She tells you she has heard you are a good counselor but that she would rather not take any medications.

      Although you are