Cognitive Therapy of Suicidal Behavior: A Manual for Treatment

Abstract

What About No-Harm Contracts? Cognitive Therapy of Suicidal Behavior: A Manual for Treatment Arthur Freeman and Mark A. Reinecke New York: Springer Publishing Company, 1993,239 pp. $37.95 (hardcover) Freeman and Reinecke have condensed a wealth of research and experience into a practical reference book, Cognitive Therapy of Suicidal Behavior: A Manual for Treatment. The first two chapters provide a general introduction to suicidal behavior and cognitive therapy. Different views (genetic, biochemical, psychoanalytic, religious, and learned helplessness) and types (hopeless, histrionic, psychotic, and rational) of suicidal behavior are discussed briefly. The role of cognition in the development of depression and suicidal behavior, along with research documenting this relationship, is reviewed. Concise descriptions of 16 factors contributing to vulnerability to suicidal behavior and 14 common cognitive distortions are included. The development of "depressogenic schemata and assumptions" (p. 37) is discussed in terms of attachment theory and early experiences of loss and abandonment, fusing more dynamic concepts with the cognitive perspective. Three chapters contain the essential guidelines for cognitive therapy with suicidal patients and could almost serve as a self-contained reference manual. These chapters cover a variety of assessment methods (self-reports, interviews, and testing), 20 cognitive and eight behavioral treatment techniques, methods for overcoming 13 obstacles to treatment, relapse prevention, and terminating therapy relative to suicidal behavior. Samples of patient/therapist dialogue and case examples are used effectively to illustrate cognitive techniques and overcoming obstacles, respectively. The importance, purpose, and benefits of homework in cognitive therapy; the (in)significance of suicide notes; biological markers for suicidal behavior; and the method of Socratic questioning are also discussed. Conspicuously absent from the lists of cognitive and behavioral treatment techniques is the no-harm contract. Could it be that the no-harm contract is not a cognitive/behavioral technique? This nagging question prompted a quick (but not exhaustive) literature review. Surprisingly little research and few references on the use or efficacy of no-harm/no-suicide/ stay-alive contracts were found. A new question emerged. Is there evidence to support the use of no-harm contracts when treating suicidal behavior? Regardless of the answer to this question, because no-harm contracts are commonly and frequently used with suicidal patients, saying nothing appears to be a serious omission. Two chapters provide information on working with special needs (children and adolescents) or high-risk (elderly, chronically ill, and Native American) populations. The last chapter focuses on factors that tend to exacerbate suicidal behavior (alcohol and drug abuse, posttraumatic stress disorder [PTSD], and multiple attempts). In contrast to the succinctness of previous chapters, the more detailed information presented in these final chapters sometimes appears to be excessive, unnecessary, or misplaced. …