I spend a lot of time talking about suicide with clients, and for many it’s the centerpiece of therapy agendas for months. In the case of DBT, it’s tracked on a diary card (log of symptoms, emotions, and skills used). During behavioral or CBT sessions, I usually do a verbal check-in and a PHQ-9 every four weeks. I have one client right now who isn’t experiencing suicidal thinking to some degree. That I’m aware of, anyway; this person could be keeping something from me.
I went to the Beck Institute training on CBT for Depression and Suicidality, which was very fabulous and worth attending if you are a clinician. Of the many things I learned, one was a protocol on suicide prevention. Part of the protocol – and we were told we often wouldn’t do this with folks due to time constraints and client readiness – is on treating suicide attempts as traumatic events
How we (therapists who use therapies related to CBT) treat traumatic events is through prolonged exposure – the person tells their story and listens to their story on recording over and over and over, amongst other things. The trainer said the process used is sort of like prolonged exposure and stressed we seek supervision should we decide to do it.
I’ve known attempting suicide is frequently traumatic for people. It doesn’t take much brain power to figure that out. What hadn’t clicked until then was my clients don’t describe suicide attempts as traumatic. They may bring up traumatic events during hospitalization, restraints in particular. The suicide itself, no. I’m not entirely sure why, and I plan on asking those who’ve made attempts about it.