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Unread March 5th, 2006, 06:01 PM
Da Friendly Puter Tech Da Friendly Puter Tech is offline
Join Date: Jul 2004
Posts: 60
Default Re: When the therapist screws up

Hey Dr. Reid,

I am interested in why you say suicide contracts doesnt work.

I worked as a volunteer at a suicide and crisis hotline for more than three years. We used suicide contracts quite a bit, and I have seen positive results from it. Yes, they only work if the suicidal caller feels heard and cared about, but in those situations they can provide a good base to work the person.

I have a couple of specific callers in mind, when I say that I have seen suicide contracts work.

Of course, in the end, if a caller is really set on "doing it", then no amount of contracts, caring or outreach can really prevent it. When it has come to the point of calm determination for the suicidal person then it will take a lot to prevent the suicide. Even so, those folks often need someone to talk to in order to say "good bye" to their life, and it is possible that we get them on the phone while the suicide is in progress or eminent, in that case something can still be done.

However, before reaching that point of calm determination the suicidal person goes through several different stages, and during those stages quite a bit can be done to prevent the downward slide into seriously suicidal behavior. In my experience safety contracts really work on a majority of suicidal callers.

You also say that safety contracts should not be used to make a clinician feel better - I know on the hotline I sometimes used very short term contracts to even start the conversation with the client. An example is - "Can you put away the gun just for the duration of this conversation? I can hear this is so hard on you, and I just really want to hear what you have to say, and its hard when I know you have the gun in your hand while I talk with you."

That sort of statement often worked to get the immediate danger down to a level that could be managed. In one instance the caller was able to find her own chosen local helper rather than have me call in the police. I waited on the phone with her until that person was present.

I have seen several other situations where safety contracts provided the impetus or the sense of safety from the client to actually reach for help at the last critical moment. I am not sure those last minute situations could have been stopped if not for safety contracts, and the experience the caller had previously of being heard when the called us.

Certainly, suicide contracts are not a guarantee, that should not prevent anyone from using them though.

Da Friendly Puter Tech
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