Dr. Lisa Cohen: Suicide Crisis Syndrome & the Narrative Crisis Model of Suicide

Thoughts on Record: Podcast of the Ottawa Institute of Cognitive Behavioural Therapy

Unfortunately, many mental health clinicians will experience a client’s suicide in the course of their career. The loss of a client to suicide often reflects a life changing experience which can require considerable processing to reconcile and reach some kind of understanding. In parallel, risk assessment can reflect a major source of distress, not only for clinician trainees but likewise for seasoned clinicians. Clinical psychologist, professor and author, Dr. Lisa Cohen, joins us for a very important discussion around novel ways of conceptualizing suicide and suicide risk assessment which focus on when a client may be at most risk for suicide as opposed to who is at most risk over the course of their lives. This novel way of conceptualizing suicide may allow for more effective, well-placed interventions as well as augment clinician confidence in their risk assessments. In this conversation we cover:

• the prevalence rates of suicide and how the risk stratifies by age & gender
• the most common mental disorder comorbidities of suicide
• what is known about individuals who complete suicide with little to no apparent warning "out of the blue"
• a brief review of some of the proposed constructs that have emerged for characterizing pre suicidal mental state (e.g., Suicidal Behaviour Disorder, Suicide Crisis Syndrome, Acute Suicidal Affective Disturbance)
• how these constructs differ from “longer-term” considerations of predictive risk around suicidality that most clinicians would be familiar with (e.g., hopelessness etc.)
• how assessment of risk should be undertaken as a function of what is known about shifts in cognitive, behavioural and emotional patterns in the days leading up to a suicide attempt
• the kinds of psychotherapeutic or psychiatric interventions that flow from perhaps a higher resolution picture of what the days or hours leading up to a suicide crisis look like
• measures that are available to assess acute risk
• an overview of the Narrative Crisis Model
• how clinicians can emotionally relate in a healthy, balanced and sustainable way to the ongoing risk of losing a client to suicide
• the value of safety plans/contracts
• misconceptions that clinicians may be laboring under with respect to the risk assessments they are undertaking

Dr. Lisa J. Cohen is clinical professor of psychiatry at the Carl Icahn School of Medicine at Mount Sinai, working at the Mount Sinai Beth Israel location. Dr. Cohen has long been involved with clinically relevant research in a wide range of topics relevant to psychiatry and psychology. Her more recent research domains have included the risk assessment and psychological correlates of suicide, risk factors for and differential diagnosis of personality pathology, the adult psychological sequelae of childhood maltreatment, as well as the childhood antecedents, psychological correlates, subjective experience and psychological burden of individuals with pedophilia. She has previously researched opiate addiction, bipolar disorder, & obsessive compulsive disorder. She has also written on psychological assessment. Dr. Cohen is an author on over 100 peer-reviewed journal articles and two books. Her third book presenting an integrative model of the psychotherapy of personality disorders will be published in 2022.
If you are experiencing thoughts of suicide please go to your local emergency room. The following resources are also available: Canada Suicide Prevention Service: 1-833-456-4566 (24/7), National Suicide Prevention Lifeline (United States): 1-800-273-8255, https://www.opencounseling.com/suicide-hotlines