Deliberate Practice in Assessing Self-Directed Violence

To help address the suicide public health crisis, this book presents deliberate practice exercises to reduce clinicians’ fears of talking about suicide and self-injury with clients and assessing for risk with skill and empathy.

These exercises present role-playing scenarios in which two trainees act as a client and a therapist, switching back and forth under the guidance of a supervisor. The therapist improvises appropriate and authentic responses to client statements organized into three difficulty levels—beginner, intermediate, and advanced.

The first 10 exercises review skills that can be incorporated into any approach to assess self-directed violence (SDV), such as exploring the deeper meaning behind statements that indicate a desire to engage in SDV, asking scaling questions to assess the likelihood of acting on these desires, collaborative safety planning, and communicating with clients about the therapist’s ethical and legal responsibilities. Two comprehensive exercises follow in which trainees integrate these skills into a transcribed session and mock therapy sessions.

Step-by-step instructions guide participants through the exercises, identify criteria for mastering the skills, and explain how to monitor and adjust difficulty. Guidelines to help trainers and trainees get the most out of training are also provided.

To demonstrate how deliberate practiceopens in new window can be fully integrated into a professional curriculum, this series features exercises developed and refined within the clinical training curriculum at the Sentio online marriage and family therapy (MFT) therapist training programopens in new window in California, which is where we started developing this series. These exercises, which have been tested at clinical training sites around the world, are used to enhance clinical outcomes within the firsthybrid MFT program approved by the California Board of Behavioral Sciencesopens in new window (BBS) to fully integrate deliberate practice into its entire curriculum. By integrating these models into its hybrid MFT program in California, Sentio University demonstrates that therapist training graduate programs can use deliberate practice to bridge the gap between theory and clinical mastery through repetitive, feedback-informed practice to support the development of modern, outcome-focused clinicians.

Series Preface
Tony Rousmaniere and Alexandre Vaz

Acknowledgments

Part I Overview and Instructions

• Chapter 1. Introduction and Overview of Deliberate Practice in Assessing Self-Directed Violence
• Chapter 2. Instructions for the Self-Directed Violence Assessment Deliberate Practice Exercises

Part II Deliberate Practice Exercises for Self-Directed Violence Assessment Skills

Exercises for Beginner Self-Directed Violence Assessment Skills

• Exercise 1. Exploring the Meaning of Client Statements
• Exercise 2. Assessing Precipitating Factors
• Exercise 3. Asking Scaling Questions
• Exercise 4. Exploring and Encouraging Social Support

Exercises for Intermediate Self-Directed Violence Assessment Skills

• Exercise 5. Safety Planning
• Exercise 6. Working With Ambivalence
• Exercise 7. Using Self-Directed Violence Assessment Measures

Exercises for Advanced Self-Directed Violence Assessment Skills

• Exercise 8. Providing Rationales for Focusing on Self-Directed Violence
• Exercise 9. Responding to Ruptures in the Therapeutic Alliance
• Exercise 10. Communicating Therapist Boundaries and Responsibilities

Comprehensive Exercises

• Exercise 11. Annotated Transcript of Self-Directed Violence Assessment in a Psychotherapy Session
• Exercise 12. Mock Sessions for Self-Directed Violence Assessment in Psychotherapy

Part III Strategies for Enhancing the Deliberate Practice Exercises

• Chapter 3. How to Get the Most Out of Deliberate Practice: Additional Guidance for Trainers and Trainees

Appendix A. Difficulty Assessments and Adjustments

Appendix B. Deliberate Practice Diary Form

Appendix C. Sample Self-Directed Violence Assessment Skills Syllabus With Embedded Deliberate Practice Exercises

References

Index

About the Authors

Robert Scholz, MA, LMFT, LPCC, founder of The Change Place, Inc.opens in new window, is a marriage and family therapist and professional clinical counselor. He is well-known for his work as a trainer and consultant in assisting schools and communities prepare for and respond to major crisis events like wildfires, mass shootings, and suicides. A member of the Motivational Interviewing Network of Trainers, Robert has trained thousands in motivational interviewing skills and other evidence-based therapeutic approaches. He has authored publications on disaster mental health, addiction treatment, threat assessment, and men’s mental health.

Susan R. Hall, JD, PhD, is a tenured associate professor of psychology at Pepperdine University’s Graduate School of Education and Psychology. She has published and presented nationally on topics related to clinical/counseling practice and training; trauma and positive psychology; and psychology, public policy and law, including two APA books: Courtroom Modifications for Child Witnesses and Laws Affecting Clinical Practice. Dr. Hall served on the editorial board of the Journal of Youth and Adolescence, was treasurer for APA’s Society for Child and Family Policy and Practice (Division 37), and received Pepperdine’s Howard A. White Award for Excellence in Teaching.

Brian Van Brunt, EdD, is director of behavior and threat management for D-Prep Safetyopens in new window and the president of the Workplace Violence Prevention Associationopens in new window. Author of over a dozen books, Brian has worked as a child and family therapist, university professor, assistant deputy director of training at Secure Community Network, and president of the National Association for Behavioral Intervention and Threat Assessment. He is an internationally recognized expert in behavioral intervention, threat assessment, crisis preparedness, mental illness, and instructional design. Brian has provided consulting services to schools around the world on student mental health, counseling, campus violence, and behavioral intervention.

Alexandre Vaz, PhD, is chief academic officer of Sentio University marriage and family therapy (MFT) program in Californiaopens in new window. This innovative online/hybrid California MFT degreeopens in new window was the first approved by the California Board of Behavioral Science for MFT licensure to fully integrate deliberate practiceopens in new window into its curriculum to ensure superior clinical outcomes. He is also director of clinical training for the Sentio Counseling Centeropens in new window which is Sentio MFT program’s guaranteed practicumopens in new window site where students provide low-cost online couples therapy in Californiaopens in new window. Dr. Vaz is the author/coeditor of many books on deliberate practice and psychotherapy training.

Tony Rousmaniere, PsyD, is president of Sentio University marriage and family therapy (MFT) program in Californiaopens in new window. He led the development of the online/hybrid MFT programopens in new window, which is the first MFT therapist training program approved by the California Board of Behavioral Science for MFT licensure that fully integrates deliberate practiceopens in new window. Dr. Rousmaniere is the author/coeditor of many books on psychotherapy training. He is also the executive director of the Sentio Counseling Centeropens in new window, which is Sentio MFT program’s guaranteed practicumopens in new window site where students provide sliding-scale online therapy in Californiaopens in new window, and past president of the APA’s Division 29.

I’m thrilled to see the publication of Deliberate Practice in Assessing Self-Directed Violence. Why? Because for decades we’ve needed a text with clear guidance to help students and practitioners develop skills for assessing self-directed violence (aka suicide assessment). Now we have it. This book moves training and practice in assessing self-directed violence to the next level.
—John Sommers-Flanagan, PhD, Director, Center for the Advancement of Positive Education, University of Montana, Missoula, and coauthor of Clinical Interviewing

Finally, a book that bridges the gap between a therapist’s knowledge of self-directed violence and how to use that knowledge during times it matters most. What sets this book apart is the shift in mindset, from the assumption therapists get better over time to the fact that intentional training and repetition through deliberate practice is what’s needed to bridge the gap between “I know this” and “I nailed it.”
—Lisa Pescara-Kovach, PhD, Director, Center for Education in Mass Violence and Suicide; Professor, Educational Studies, The University of Toledo, Toledo, OH; and coauthor of White Supremacist Violence: Understanding the Resurgence and Stopping the Spread

This book provides a clear, evidence-informed framework for training graduate students to competently assess and treat self-directed violence. It translates complex risk assessment concepts into practical, ethical decision-making tools that are accessible without oversimplifying the seriousness of high-risk situations. Through case examples, structured exercises, and step-by-step guidance, the text builds therapist confidence while emphasizing safety, supervision, and collaboration. A major strength is its explicit focus on reducing the trepidation and unease commonly experienced by both trainees and practicing clinicians when outcomes may be severe or life-threatening. Overall, the book meaningfully increases clinical competency and readiness, making it a valuable resource for graduate education and ongoing professional development.
—David J. Denino, MS, LPC, Director Emeritus, Counseling Services, Southern Connecticut State University, New Haven, and Disaster Mental Health Lead for CT/RI, American Red Cross

This book is part of the Essentials of Deliberate Practice series by Tony Rousmaniere and Alexandre Vaz. The materials on this page include a Deliberate Practice Reaction Form and a Deliberate Practice Diary Form that can be used with every book in this series, as well as volume-specific content.

These documents are offered for your personal use in clinical training or teaching courses. If you reprint or adapt them for publication, permission is required from the publisher.

Deliberate Practice Reaction Form

The Deliberate Practice Reaction Form can be used with any of the deliberate practice exercises throughout the series to measure how challenging it was for the trainees and to adjust the difficulty as needed. Appendix A includes a black-and-white version of the form with instructions for assessing and modifying an exercise’s difficulty. A color version of the Deliberate Practice Reaction Form is also available for individual download.

• Appendix A: Difficulty Assessments and Adjustmentsopens in new window (PDF)
• Deliberate Practice Reaction Formopens in new window (PDF)

Deliberate Practice Diary Form

The Deliberate Practice Diary Form is an optional form that trainees can complete during a training session’s final evaluation or between sessions to process their experiences with the activity, including what was and was not helpful and what they learned. Appendix B, which is the same across all books in the series, presents this form.

• Appendix B: Deliberate Practice Diary Formopens in new window (PDF)

Volume-specific materials

The following content is unique to Deliberate Practice in Assessing Self-Directed Violence and includes a sample syllabus that integrates the deliberate practice exercises into a standard clinical course.

• Appendix C: Sample Self-Directed Violence Assessment Skills Syllabus With Embedded Deliberate Practice Exercises (PDFopens in new window | Wordopens in new window)

Video demonstration

A YouTube series (Practice Time! with Amy DeSmidt and Jamie Manser)opens in new window highlights authentic deliberate practice sessions featuring exercises from various volumes in the Essentials of Deliberate Practice series.

Supplemental resources for therapist training

Designed for faculty at graduate institutions, these supplemental resources provide a framework and clear examples for implementing deliberate practice within existing therapist training curricula. Sentio University is where we started to develop what would become the APA Essentials of Deliberate Practice series. We provide a comprehensive suite of free psychotherapy training resources based on the deliberate practice methodologyopens in new window. These materials are designed to supplement modern hybrid and online therapist training curricula and are used extensively within our own clinical programs.

• California MFT program integration: These materials are a core component of the Sentio hybrid MFT program in Californiaopens in new window, the first in the state to fully integrate DP into its entire curriculum and receive California Board of Behavioral Sciences approval for licensure.
• Free deliberate practice exercises: Access our library of therapist skill-building worksheetsopens in new window used to enhance the online California MFT degree through repetitive, feedback-informed practice.
• Deliberate practice video demonstrations: Visit our YouTube channel for free therapist training videosopens in new window to view clinical demonstrations from the APA Essentials of Deliberate Practice book series. These videos illustrate key skills used to enhance the online California MFT degree through repetitive, feedback-informed practice.
• AI and emerging therapy resources: Learn how deliberate practice can be used to safely and ethically integrate AI for therapist trainingopens in new window. Review our AI research programopens in new window and our clinical guidelines on using AIopens in new window to prepare for the modern landscape of digital mental health.