Task 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 or patients.

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 survey.

References

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.