Motivational interviewing and suicidality

Acute or chronic suicidality or related acts of deliberate self-harm often "fly beneath the radar" and evade detection until or unless an "unanticipated" incident exposes the client to "crisis" management. Clients may frequently veil or distort information that could trigger detection. Viewed retrospectively, in the light of adequate information, many cases appear not only unsurprising but possibly predictable and preventable. Listening for change talk can be challenging in encounters with clients "in crisis." The drama of potential or actual suicidality, in the context of chronic illness, family conflict, or sudden destabilizing events, often includes many layers of information and communication that may obscure the client's actual desire, ability, reason, or need to engage in self-harm, or alternatively, to maintain safety. Exploring ambivalence, in the respectful and supportive spirit of motivational interviewing (MI), is a key to discerning appropriate further steps in the client's care while simultaneously supporting a therapeutic alliance and respecting the client's autonomy or, at a minimum, the right to receive treatment in the least restrictive setting possible. This chapter will describe the use of MI in crisis evaluation of clients who have just attempted suicide or who are believed to be threatening or contemplating suicide, or otherwise believed to be acutely at risk of suicide. (PsycINFO Database Record (c) 2010 APA, all rights reserved)