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