- Hardcover: 272 pages
- Publisher: W. W. Norton & Company; First Edition edition (April 22, 2013)
- Language: English
- ISBN-10: 0393706524
- ISBN-13: 978-0393706529
- Product Dimensions: 6.5 x 1.1 x 9.6 inches
- Shipping Weight: 1.3 pounds (View shipping rates and policies)
- Average Customer Review: 6 customer reviews
- Amazon Best Sellers Rank: #569,919 in Books (See Top 100 in Books)
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Relational Suicide Assessment: Risks, Resources, and Possibilities for Safety First Edition Edition
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“Flemons and Gralnik provide an excellent empirically grounded, therapeutically informed approach to suicide risk assessment. . . . [C]ould serve as the starting foundation for a practitioner new to suicide risk assessment and as a catalyst for practitioners who are more knowledgeable and experienced to refine their RSA.”
- Journal of Psychiatric Practice
“[A]n incredible reference book . . . . every page is filled with useful ideas. . . . I have wanted a book like this for a long time. The traditional methods of suicide assessment that I was taught were never as relational as I believed they needed to be. . . . This book offers a completely new and effective approach that is a combination of clinical wisdom and relevant research. . . . They offer therapists a way to forge ahead and make changes that can help, even while conducting the assessment. . . . I not only recommend this book to those new in the field, but also to experienced therapists who will find much to learn from Flemons and Gralnik. . . . [A] relevant resource book that will be a standard in libraries for years to come.”
- The Milton H. Erickson Foundation Newsletter
“[O]ffers a thoughtful and thoroughly systemic way of assessing a client’s risk of lethality, and features a tone reflective of the empathic, collaborative style it advocates. . . . [W]ell organized . . . . Well written and thoroughly referenced . . . . [A] valuable, comprehensive resource for all marriage and family therapists, as well as mental health professionals, and would be appropriate for graduate student audiences and beginning clinicians in training.”
- Journal of Marital and Family Therapy
“Clinical vignettes and practical examples and suggestions can be found throughout the book, helping the reader to relate the principles described to different scenarios in clinical practice. . . . [G]ives an account of essential steps that constitute a complete assessment of suicidal behaviors and provides guidance for the novice clinician starting a career in mental health. Experienced clinicians may appreciate the authors’ poignancy, practical suggestions, and empathic perspective central to improving the care required by suicidal individuals.”
- Journal of Nervous and Mental Disease
“[A] comprehensive book, which should be welcomed by systemic practitioners and clinicians who are routinely undertaking suicide assessments.”
- Contemporary Psychotherapy
“[A] thoughtful and well-rounded approach to suicide assessment . . . . [A] well organized and thoroughly referenced book. . . . This book is a valuable read for all mental health professionals involved in suicide assessment. . . . Douglas Flemons and Leonard M. Gralnik deserve recognition. . .”
- Psychiatric Services
“Informed and informative . . . exceptionally well written, organized and presented, making it a critically important contribution to professional and academic library Psychology/Psychiatry reference collections and supplemental studies reading lists.”
- Midwest Book Review
“I recommend this book to any therapist who might find themselves dealing with potential suicide, and also to any therapist wanting to deepen and extend their clinical effectiveness. . . . [P]ractical, human ideas and approaches to this terrible dilemma.”
- Rob McNeilly, author of Healing the Whole Person: A Solution-Focused Approach to Using Empowering Language, Emotions, and Actions in Therapy
About the Author
Douglas Flemons, PhD, LMFT, is Professor of Family Therapy and Co-Director of the Office of Suicide and Violence Prevention at Nova Southeastern University in Fort Lauderdale, Florida.
Leonard M. Gralnik, MD, PhD, is an adult and child psychiatrist and lives in Hollywood, Florida.
Top customer reviews
As a psychologist who works in a college counseling center, I was eager to draw on the expertise of authors Douglas Flemons, a family therapist, and Leonard M. Gralnik, a psychiatrist. Their relational approach to suicide assessment (RSA) focuses on assessing lethality not as a separate component of the clinical interview, but rather as part of an overall collaborative conversation between the therapist and the client. The authors are influenced by solutions-oriented work in that they view their approach not only as a means to assess for suicide but also as a strategy for weaving in possibility-focused language, thus identifying both sources of hope and potential resources throughout the process.
The authors cite a 2005 study (p. 9) which lists over 75 risk factors for suicide. Based on their own research, Flemons and Gralnik identify 21 what they called "risk descriptors," or classifiers that they have found to contribute to an individual's suicidality. They further group these 24 topics into the following broad categories:
1. Disruptions and Demands--includes stressors which can lead to a sense of hopelessness
2. Suffering--mental/physical symptoms which may contribute to feelings of desperation
3. Troubling Behaviors--may include social isolation, increased substance use, or self-harm
4. Desperation--includes feelings of hopelessness and intent/willingness to act
Chapter 3, "Risks and Resources," details how the authors inquire about these factors during the relational suicide assessment. To illustrate, they incorporate use of direct quotes, brief session excerpts, and more lengthy case scenarios. Generally, I find these type of hands-on examples to be extremely helpful, but unfortunately, the formatting felt choppy and confusing here. The awkward presentation of the various "Resources (for example, empathically connecting, managing anxiety) make them extremely easy to overlook--which is regrettable given the merit of this information.
The subsequent chapter, "Safety," was more straightforward and thus more readable. Although client examples were still utilized, these were confined to specific sections. However, one of the things that stood out for me the most from this chapter was the importance of therapists relying on intuition or "gut" feelings. Of course, the authors emphasize that it takes years of clinical experience to develop this sense, but they maintain that this professional judgment is an invaluable part of deciding whether a safety plan is even needed for a given client. Specific guidelines are also given for how to construct safety plans with clients who do need them.
The final chapter is "RSA in Action," or a complete review of the method using a single client example (somewhat helpful but also a bit tedious, at least for a more experienced therapist). The Appendix, "The Backpocket RSA," basically includes the same Risks/Resources charts that have been used throughout the book. Personally, I found these charts (which are formatted as four separated four-part graphs) cluttered and confusing rather than helpful.
In the end, Relational Suicide Assessment was somewhat of a disappointment. Although I am a psychologist with almost twenty years of experience in college mental health, I still expected to benefit from the expertise of the authors. And while Flemons and Gralnik did provide some effective conceptualizations, I did not find the overall format of their book to be practical. Perhaps this manual would be most useful as a training tool for newer therapists, as a beginning clinician might have more patience for distilling the valuable information from this work. As a training tool, I would rate the book 4 stars, but otherwise, my rating would be lower.