Treating suicidal patients has been identified
as an “occupational
hazard” for psychologists based on the statistic that 22%
of psychologists will experience the death of a client by suicide
during their career (Chemtob, Hamada, Bauer, Torigoe, & Kinney,1988).
Further, almost all psychologists will treat a suicidal client
at some point. Given the high probability of working with suicidal
patients, shouldn’t it be mandatory that all psychologists
receive adequate training in how to manage a suicidal client?
to psychology program directors only 40% of graduate psychology
programs are offering formal training in the management of suicidal
clients (Bongar & Harmatz, 1991). Further, between
11% and 54% of mental health trainees experience a client suicide
(Courtenay & Stephens, 2001; Dewar, Eagles, Klein, Gray, & Alexander,
2000; Kleespies, Penk, & Forsyth, 1993; McAdams & Foster,
2000). Dexter-Mazza and Freeman (2003) surveyed 238 predoctoral
psychology interns and found that only 50% reported that they
had received formal training in managing suicidal clients during
their preinternship experiences. This leaves half of psychology
trainees receiving no formal training on how to work with suicidal
clients. Furthermore, approximately 5% of participants indicated
that they had a client suicide, and more over, 99% indicated
that they had treated at least one suicidal client during the
course of their graduate school years. Based on this data, it
is clear that psychologists are not receiving sufficient training
regarding how to deal with high-risk suicidal clients.
Dexter-Mazza completed a preliminary evaluation of a brief
training model in suicide risk assessment and intervention developed
by the American Association of Suicidology Education and Training
Committee. Participants included 63 first year graduate students;
36 received the brief training module and 27 received training
as usual (TAU). Five areas of suicidology were covered in the
training module; the areas included prevalence rates, theoretical
model of suicide, suicide assessment, suicide intervention,
and risk management/liability issues. The TAU group received a
general lecture on suicide risk assessment from the course professor.
The lecture included a true-false suicide quiz on myths and
facts of suicide, a review of the SAD Persons Scale (Patterson,
Dohn, Bird, & Patterson,
1983), and a review of the Specificity, Lethality, Availability,
Proximity (SLAP) suicide assessment model. Results indicated
that the Training group showed an increase in both knowledge
and clinical skill (e.g., assessment and intervention skills)
over the TAU group. Specifically, in videotaped interviews
with pseudo-clients, students in the Training
group conducted a more thorough suicide risk assessment and intervention
Notably, significant concerns arise when the
majority of students from both groups at pre-test rated themselves
at a “moderate
level” regarding their ability to assess and manage
suicidal clients, as well as their overall knowledge about
suicide. It is alarming to think that students feel competent
in this area when in actuality only one-third of the students
reported receiving training in managing behavioral emergencies
prior to starting graduate school. At post-test, differences
were notable between the Training and TAU groups with regard
to knowledge base. There was a significant difference in
the increase of self-ratings for the Training group in
all three areas, which included assessment skills, ability
to work with suicidal clients, and knowledge about suicide.
The TAU group only reported an increase in self-ratings
in the area of suicide assessment, however.
are consistent with previous ones (Dexter-Mazza & Freeman,
2003). Students are generally more likely to feel comfortable
with suicide assessment (as was observed with the TAU
group) since the majority of training programs address
this specific area, albeit briefly. Trainees often expect
to be receiving adequate training in the management of
suicidal clients and may believe that the informal review
of suicide assessment is enough to be able to effectively
manage this type of patient in ongoing treatment, leaving
them with a false sense of self-confidence.
among graduate programs with regard to the type of
training provided in managing suicidal clients may result in an
ethical dilemma for many trainees, especially if they
do not receive any type of formal training during their
predoctoral internship. According to APA Ethical Guidelines
recognize the boundaries of their particular competencies
and the limitations of their expertise. They provide only those services
and use only those techniques for which they are qualified
by education, training, or experience” (p. 1599). This statement
could cause ethical dilemmas for new psychologists
who have not received appropriate training in suicide as research
suggests that it is highly unlikely that a psychologist
will never treat a suicidal patient.
Overall, graduate programs need to do a
better job of providing formal training to students in working with
suicidal clients. Students should be provided with opportunities
to receive formal training through special topic courses,
lectures, workshops, and practicum experiences. Additionally,
suicidal clients should not be screened out and referred
to other agencies due to a student’s lack
of training. By “screening out” suicidal
patients, trainees miss opportunities early on to manage
high-risk patients in ongoing treatment while they
are receiving direct supervision and support. Otherwise,
trainees may not experience working with their first
suicidal patient until internship or after they graduate
when minimal supervision may be available.
American Psychological Association. (1992). Ethical principles of
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Chemtob, C. M., Hamada, R. S., Bauer, G., Torigoe, R. Y., & Kinney,
B. (1988). Patient suicide: Frequency and impact on psychologists. Professional
Psychology: Research and Practice, 19, 416-420.
Courtenay, K. P., & Stephens, J. P. (2001). The experience of
patient suicide among trainees in psychiatry. Psychiatric
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and the treatment of suicidal clients: The students’ perspective.
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Dewar, I., Eagles, J., Klein, S., Gray, N., & Alexander, D. (2000).
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