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Behavioral Emergencies Update

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The 109th Annual APA Convention

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Minutes from the Section 7 Business Meeting


Helping Youth Cope with Terrorism

Task Force Update


Graduate Student Spotlight

Publication Highlights

Special Offer for Section VII Members

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Graduate Student Spotlight

Behavioral Emergencies:
New Efforts to Improve Psychology Training

By Jason S. Spiegelman, M.A., Section VII Graduate Student Representative,
&
Alec L. Miller, Psy.D., Section VII Representative to APA Division 12

Editor’s note: This article will also appear in the Association of Psychology Postdoctoral and Internship Centers (APPIC) Newsletter.

With the help of ubiquitous 24-hour per day media coverage, suicidal and violent behaviors in the general population have caught the attention of our nation’s communities. While situations like Columbine High School help to dispel the myth that one need not be diagnosed with a chronic mental disorder to engage in such behaviors, both lay people and trained mental health professionals continue to be naïve regarding the factors that place individuals at risk for suicide and violence directed toward others.

Question: Why is it that large numbers of mental health professionals, including licensed psychologists, are unaware of the risk factors for self- and other-directed violent behaviors? Answer: Very few of the institutions responsible for the education and development of these future professionals offer courses on assessing and treating violence (Kleespies, 1993; Ellis & Dickey, 1999).

Ironically, student-therapists are more susceptible to experiencing a client crisis of this nature during their training years than during their professional years (Guy, Brown, & Poelstra, 1990; Guy & Brady, 1998). While some research has examined the nature of clinic response to such events, including remediation, supervisory strategies, and short and long-term effects on the developing therapist, it is crucial that research begin to focus on the factors that increase the risk for student-therapists. One explanation is that student-therapists are often given higher-risk patients since they are considered good “training cases.” Other unknown factors must also play a role.

At the heart of this question lies a broad based question: What types of supervisory, didactic and experiential training in assessment and intervention of patient violence are necessary for student therapists? Some models of supervision (e.g., the Stoltenberg model) suggest that earlier training should employ a more directive relationship between supervisor and trainee, where the student is given clear directives on how to proceed with a client. As the trainee gains experience and strengthens his/her professional identity, the model suggests that the supervisor should adopt a more consultative role, allowing the student-therapist to find his or her own style for responding to various psychotherapeutic issues. When dealing with life and death issues such as suicide and homicide, is this model effective? Data regarding risk factors for suicide have never been more abundant. It is our opinion that students first receive intensive didactic training in these risk factors and then learn how to conduct a thorough clinical assessment of self- and other-directed violence.

At what point do we recognize that there are certain training goals that must be accounted for by the training ‘entity’, whether it is a master’s or doctoral level class and practicum or a doctoral internship? To this end, the Association of Psychology Postdoctoral and Internship Centers (APPIC) has identified a number of specific training domains for the directors of predoctoral internships to consider. These domains allow the internship site to identify those areas of training that receive specific focus within their own service. One of the possible specialization areas is “Crisis Intervention.” Intern applicants can determine whether the prospective internship site offers either ‘informal’ or ‘major’ rotations in crisis intervention.

While this is a step in the right direction, Section VII is currently undertaking a research initiative to identify exactly what is meant by internship sites who offer either type of rotation in crisis intervention. The goal of this study is to foster increased understanding of the nature of such training for three reasons: 1) to obtain a baseline assessment of internship training sites that conduct specialized trainings in crisis intervention; 2) to develop a nomenclature that is well-defined and comprehensible to training sites and intern applicants alike (i.e., crisis intervention may mean very different things to different sites); and 3) to inform intern applicants of the specific site offerings in an effort to enhance the match with his or her training needs. This research project is consistent with the goal of Section VII, which is to foster a broad understanding of not only the etiology of client violent behaviors, but also effective means of responding to them and minimizing further occurrences.

Students from various mental health disciplines, including but not limited to clinical, child, school, and counseling psychology, are in a tremendous position to make contributions to this very important clinical and training issue. Increased research is needed on a variety of fronts. Some topics of investigation might include: outcome studies of various treatment approaches targeting suicide and violence prevention; the impact of treatment duration on the frequency of crisis situations; effective treatment strategies for victims of interpersonal violence; and the identification of specific techniques utilized post-crisis to help reduce recidivism of such an event. These topics clearly represent just a small sample of ideas yet to be adequately investigated. This arena of research is currently ripe for the taking. In fact, NIMH is encouraging new researchers to conduct studies of suicide and violence.

Students interested in becoming involved with this movement to conduct and report sound research in this area are encouraged to become more active in Section VII. The potential to network and establish relationships with some of the world leaders in suicide, violence, and crisis intervention, both through the section listserve as well as at the annual convention of the American Psychological Association, is enormous. Student input is actively sought by the Section VII executive board, and the board includes a graduate student representative and a representative-elect, both of whom are appointed annually and carry one-year terms.

Student therapists are likely to have patients during their training years who will engage in suicidal crises and/or interpersonally violent behaviors. As licensed professionals, we must be equally well-equipped for such occurrences. It is imperative that we accept these realities and face the fact that we as a field are undertrained, and thus must pursue the necessary education that will serve ourselves and our patients most effectively. Further, we owe it to our patients to continue our pursuit of knowledge by researching the very problems we inevitably have to treat: suicidal and violent behaviors. Any and all students are encouraged to join the fight to raise the bar on our current level of training and research. It is our mission to do so and the mission needs you.

References

Ellis, T.E., & Dickey, T.O. (1999). Procedures surrounding the suicide of a trainee's patient: A national survey of psychology internships and psychiatry residency programs. Professional Psychology: Research & Practice, 29(5), 492-497.

Guy, J.D., Brown, C.K., & Poelstra, P.L. (1991). Living with the aftermath: A national survey of the consequences of patient violence directed at psychotherapists. Psychotherapy in Private Practice, 9(3), 35-44.

Guy, J.D., & Brady, J.L. (1998). The stress of violent behavior for the clinician. In P.M. Kleespies (Ed.), Emergencies in mental health practice: Evaluation and management. (pp. 398-417). New York: Guilford Press

Kleespies, P.M. (1993). The stress of patient suicidal behavior: Implications for interns and training programs in psychology. Professional Psychology: Research and Practice, 24, 477-482.