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Assessment and Treatment of Suicidal Behavior 

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Thomas Joiner, Ph.D. is the Bright-Burton Professor of Psychology at Florida State University.

In this video, Dr. Joiner presents a practical, effective method for assessing suicidality and teaches an evidence-based cognitive behavioral strategy to treat suicidal behavior. This material follows naturally from Joiner’s video on ‘The Desire and Capability for Suicide.’ Viewers can understand and apply the assessment and treatment strategies taught in the current video even if they have not seen Joiner’s video, ‘The Desire and Capability for Suicide;’ however, ‘The Desire and Capability for Suicide’ provides a rich background and context for the strategies taught in this video.

As Dr. Joiner notes, there are so many “risk factors” for suicide that it is impossible to assess all of them. So, how should clinicians assess suicidality? Dr. Joiner presents data that reveal the factors that clinicians’ should focus upon to conduct a valid assessment. Morevoer, he arranges the relevant questions in a hierarchy, producing a decision-tree that clinicians can use to guide their risk assessments.

During the discussion of assessment, Dr. Joiner provides particular detail concerning the characteristics of suicidal ideation that suggest a serious suicide attempt may be imminent versus suicidal ideation that is not generally associated with an actual attempt. He illustrates the former with journal entries from individuals who actually committed suicide and the latter with journal entries that preceded suicide attempts that were low in lethality and did not lead to death.

Viewers will also be able to download and print a brief measure of suicidality that Dr. Joiner developed and validated. Clinicians can copy this measure and administer it to their clients at no charge. This brief questionnaire is particularly useful for tracking a client’s suicidality over time.

Leading to the discussion about treatment, Dr. Joiner also addresses the relationship between various psychiatric diagnoses and suicidality. This topic is important for both risk assessment and treatment planning. Concerning risk assessment, several psychiatric disorders have a 10+% mortality rate due to suicide. And, as Dr. Joiner explains, varying courses of treatment may be warranted depending on the diagnostic context in which suicidal ideation arises.

With regard to treatment, Dr. Joiner carefully delineates the goals for each module of cognitive behavior therapy for suicidal behavior. Topics addressed include use of behavioral activation, coping cards, and the suicidal thought record. As Dr. Joiner explains, most of the therapeutic work involves problem-solving, cognitive restructuring and emotion regulation work that is focused on the real-life situations revealed by the Suicidal Thought Record.

In addition to the specifics of treatment, Dr. Joiner addresses a variety of other important issues that are relevant to the treatment of suicidal clients. These include the potential conflict between patient safety and client confidentiality, the possibility that perceived rejection by the therapist can lead to suicidal behavior, and documentation. The evidence concerning the efficacy of suicide contracts is also discussed and a better alternative is offered.

Learning Objectives: After viewing the current program, viewers will be able to...

1) describe a practical strategy for assessing suicidality.

2) describe the key goals for each stage of cognitive behavior therapy with suicidal clients and methods to accomplish them.

This program is self-contained (i.e., has no prerequisites), but viewers will benefit more if they have already seen Joiner’s video, ‘The Desire and Capability for Suicide.’ The current program is appropriate for all mental health clinicians (psychologists, psychiatrists, social workers, and counselors).

CE credit: 2 hours

Dr. Joiner does not receive funding from any corporate or private entities.

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