Growth and Crisis (DeBrule & Range)
Patient Age and Critical Risk Factors (Bongar)
VII 2002 APA Convention Program
from the Section VII Business Meeting
Offer for Section VII Members
Force on Education and Training
In Behavioral Emergencies
Phillip M. Kleespies, Ph.D.
Treasurer and Task Force Chair
The Section VII Task Force on Education and Training
remains active in advocating for improved graduate education in the
evaluation and management of behavioral emergencies. Our position
continues to be that all psychology clinicians and counselors need
training in this area of practice since all should be prepared to
deal with the life-threatening emergencies that can arise in professional
work with emotionally disturbed clients or patients. In our ongoing
discussions about education and training with one of the major psychology
training councils, the question of the limits of a clinician’s
ability to predict and prevent suicide and violence was raised. This
is a very legitimate question, and one that we have always felt needed
to be addressed as part of the educational process in this area of
practice (Kleespies and Dettmer, 2000; Kleespies, Deleppo, Gallagher,
and Niles, 1999).
There is no doubt that, with current knowledge and methods, it is
not possible to predict accurately such statistically rare events
as suicide and homicide. To take suicide as an example, it has a base
rate of approximately 11 per 100,000 in the general U. S. population
and approximately 55 per 100,000 in the psychiatric population. Numerous
writers (e.g., Hilliard, 1995; Murphy, 1984) have demonstrated that
with such low base rate events the number of false positives is too
high to allow for prediction. As a result, the field has shifted to
the more modest and realistic goal of attempting to improve our ability
to estimate levels or probabilities of risk. It is exceedingly important
for our students to be educated about these limitations. Acknowledging
limitations does not diminish our clinical and ethical responsibility
to attempt to prevent behaviors which, in our judgment, we see as
very likely to be life-threatening, but it can curtail the development
of unrealistic self-expectations about being able to rescue all clients
In terms of new initiatives, the Task Force has launched a survey
of all 562 pre-doctoral internship programs that are members of the
Association of Psychology Postdoctoral and Internship Centers (APPIC).
The purpose of this survey is to determine which internship programs
offer training in behavioral emergencies so that internship applicants
who desire such training might know where to apply. The initial response
to the survey has been very good. It is being done with the approval
of the APPIC Board of Directors, and APPIC has agreed to attach a
listing of the relevant programs to their web site once the survey
is completed. The listing will also be attached to our Section VII
web site (www.apa.org/divisions/div12/section7). By the time of our
next newsletter, I hope to be able to report on the outcome of this
Hilliard, J. R. (1995). Predicting suicide. Psychiatric
Services, 46, 223-225.
Kleespies, P., and Dettmer, E. (2000). An evidence based approach
to evaluating and managing suicidal emergencies. Journal of Clinical
Psychology, 56, 1109-1130.
Kleespies, P., Deleppo, J., Gallagher, P., and Niles, B. (1999). Managing
suicidal emergencies: Recommendations for the practitioner. Professional
Psychology: Research and Practice, 30, 454-463.
Murphy, G. (1984). The prediction of suicide: Why is it so difficult?
American Journal of Psychotherapy, 38, 341-349.