Preventing Suicide Attempts in 4 Sessions: Is It Possible?

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Attempted Suicide Short Intervention ProgramIn just four sessions, the Attempted Suicide Short Intervention Program aims to stop somebody who recently attempted suicide from making another attempt. This is quite an important goal, because a previous suicide attempt is the largest predictor of eventual suicide.

Is it really possible to prevent another suicide attempt with just four sessions of therapy? Preliminary research results are very promising.

The program was developed by Konrad Michel, a psychiatrist, and his colleague Anja Gysin-Maillart, a psychologist, both of Bern, Switzerland. The pair presented their research findings today at the Aeschi West conference in Vail, CO.

Research Findings

The research involved a randomized controlled trial – the gold standard of effectiveness research – with 120 people who had recently attempted suicide. The researchers followed up with all participants a year after they started the study.

Only 2 people in the group that received the intervention had attempted suicide by this point, compared to 15 people in the control group (people who did not receive the new intervention). These results are considered statistically significant, meaning that the different rates of suicide attempt almost certainly did not occur merely due to chance.

A caveat: So far, the data indicate that the intervention program does not help people with borderline personality disorder. Dr. Gysin-Maillart said that people with this complex condition likely require more intensive attention and skills training than the 4-session program provides.

Data are still being collected. Once the researchers have 2-year follow-up data, they will publish their results in an academic journal, Dr. Michel said.

Components of the Attempted Suicide Short Intervention Program

The Attempted Suicide Short Intervention Program focuses specifically on the prevention of another suicide attempt, not on the resolution of other ongoing problems such as PTSD. The program can complement ongoing therapy or therapy that occurs in an inpatient setting.

Here is a description of the intervention:

Session 1:

The foundation of the Attempted Suicide Short Intervention Program is the client’s narrative of what led up to the suicide attempt. It may seem obvious that clinicians should have the client tell their story to an attentive listener, but all too often, mental health professionals barrage the client with excessive questions that focus on diagnostic symptoms, rather than the client’s anguish, hopelessness, and other psychological pain.

To fully invite the client to share their narrative, clinicians are encouraged to open the interview with a phrase that includes “tell me” or “story.” For example:

“I would like for you to tell me how you got to the place where you decided to kill yourself.”

And then the clinician sits back, listens, and reflects key themes or points offered by the client. If the client has trouble telling their story, the clinician may gently probe for more information: “Tell me more about _________________,” is one example.

Session 2:

Recall that in the first session, the client is videotaped while telling the narrative. The feasibility of clinicians video recording their clients worries me. First, not everyone has the equipment to make such videos, although even an iPad or iPhone could be enlisted for the purpose. Second, many clients understandably might decline to be videotaped.

It is notable, though, that in more than 200 interviews conducted by Dr. Gysin-Maillart, only one person objected to being videotaped. Some individuals require that the video be destroyed at the end of the short intervention, which is not a problem.

Assuming that the first session was recorded on video, the client watches the video with the therapist in the second session. Hopefully, this will revive for clients the feelings that consumed them in the crisis that led to the suicide attempt.  (In clinical terms, this is called reactivating the suicidal mode.) It may sound painful and counterintuitive to have clients relive the events, but reviving the feelings enables the person to learn a new way of reacting to them.

Watching the video also can help distance the client from the events, enabling (one hopes) a more compassionate and reasoned view of what happened – and of what could have happened. For example, a client might recognize that she could have asked for help at a crucial time.

Often, someone who attempts suicide thinks afterward that the act happened out of nowhere. Watching the video and reliving the emotions can help them to recognize that warning signs actually did exist. The good news is that these warning signs can be heeded in the future.

Session 3:

The major activity of this session is safety planning. This plan details what the client can do if another suicidal episode occurs. The safety plan for this intervention involves several components:

  • Vulnerability
  • Long-term goals
  • Warning signs                                  
  • Actions the client can take to distract himself or herself or to stop from acting on suicidal thoughts
  • People the client can call for help

The plan and resources are printed on a sheet of paper that folds, accordion-style, into the size of a business card.

Session 4:

For the final session, the client again watches the video from the first session. This time, watching the video enables the client to rehearse using the safety plan during a future occurrence of suicidal thoughts. “Stop when you see something you could differently,” the therapist might say. If the client realizes that the safety plan will not work or will be difficult to carry out, this is a good time to revise it.


The intervention program does not fully end after the last session. The clinicians send  follow-up letters to the clients for two years, once every 3 months the first year, and once every 6 months the second year. The letters contain well-wishes from the clinicians and information on how they can be contacted again. Also, the letter includes brief advice or information specific to the individual client.

© Copyright 2013 Stacey Freedenthal, PhD, LCSW, All rights Reserved. Written For: Speaking of Suicide

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  1. Mari says:

    How about neurofeedback?

    • Stacey Freedenthal, PhD, LCSW says:

      That is a great question. I could not find any studies specifically on neurofeedback and suicidality, but there are quite a few that look at neurofeedback for depression. The results are promising. Here’s an article that summarizes research on neurofeedback for depression and presents results of a recent study: Neurofeedback and networks of depression, by David E.J. Linden.

  2. Reshmi Sahadevan says:

    Very good article …. definitely can be incorporated into therapy for depressed clients. Thank you for sharing the article :).

    • Stacey Freedenthal, PhD, LCSW says:

      Thank you, and I am glad you found the post helpful. Soon, I will post another article about a slightly longer CBT intervention that incorporates similar principles (but without using videorecordings) and that also has evidence of effectiveness. Stay tuned!