Cognitive therapy for suicide prevention

Domain II · Behavioural & cognitive · Wenzel, Brown, Beck · 2005

What it is

Cognitive Therapy for Suicide Prevention (CT-SP) is a structured, time-limited, individual outpatient cognitive therapy for adults who have recently attempted suicide or who have serious suicidal ideation. It treats suicidal thoughts and behaviour as the primary target in their own right, not as a…

Format

• Phase 1: Early phase (sessions 1 to about 3). Engagement, assessment and crisis management.
• Treatment goals and an individualized treatment plan.

Who practises it, and how they are trained or regulated

• Format. Individual, outpatient, adults. About 10 weekly sessions of roughly 50 minutes. Focus (2022) gives 10–12 weekly sessions for acute treatment, plus an optional continuation phase of up to 6 sessions over 12 weeks. Penn does not specify a session count. Penn offers training for adults only, because CT-SP has not been adapted and tested with youth.
• work on the agenda items: new cognitive restructuring or skills training;
• Training route:

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• All-or-nothing planning. Celebrate partial completion.
• Abstract teaching. Always use the client's own material.
• Goals too broad ("be happy"). Goals unconnected to suicide risk.
• Overloading the client with lifestyle goals. Keep it to one or two.
• Distraction via alcohol or drugs; isolation masked as 'distraction'.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.