One of the toughest challenges of clinical practice, and certainly the most consequential of them for literally being about “life and death,” is dealing with the potential or actual suicide of a client. I run case consultation groups for those clinicians who have been through my 100 Hour Training in Clinical Hypnosis and Strategic Psychotherapy, and just this past month the issue of suicide came up in a number of these group meetings. One highly experienced therapist had seen a man only once who subsequently completed a suicide, leaving her anxiously wondering what more she could have done to prevent it despite following all the recommended treatment protocols. Another therapist reported on a supervisee who had a client who completed suicide and she, too, wondered what more she could have done to prevent it. For these therapists, and for anyone who has ever dealt with this sensitive issue, the result is a great deal of guilt, anxious self-recrimination, depressing self-doubts about personal and professional competence, and all the other emotional reactions you’d expect when connected in some way to such a terrible tragedy.
It was especially good (and lucky) timing that a new study was just published in the February issue of Psychological Bulletin about trying to predict suicide. The researchers conducted a meta-analysis of studies that have tried to predict suicide. Their meta-analysis included 365 studies involving 3,428 total risk factor effect sizes spanning the last 50 years. 50 years! The studies examined risk factors such as previous suicide attempts, stress life events, substance abuse, and depression. Perhaps surprising to some, no broad category or subcategory of risk factors accurately predicted suicide any better than chance. Furthermore, the ability to predict suicide is no better now than it was 50 years ago!
We know the individual risk factors matter, of course, but the “wild card” of suicide, the factor that makes prediction so difficult is impulsivity. Impulsivity defies prediction. It’s just too hard to know out of all the things that fly through someone’s brain which one they might actually act on.
I write this with one great intention: I want therapists to do all they can, of course, to pick up on suicidal ideation and associated suicide risks. I want therapists to take the steps whenever they can to prevent suicide. But, I hope therapists won’t reflexively go into harmful self-blame when reflecting on what else might have been. Being a therapist isn’t a job for the faint of heart, I know. The challenges are many. But, this new study brings an important perspective to a tough subject, one that holds promise to save a great deal of unnecessary agonizing when the unthinkable- and unpredictable – happens.
Link to the article: http://psycnet.apa.org/journals/bul/143/2/187/