Teachable Moment Brief Intervention

Domain II · Behavioural & cognitive · O'Connor, Comtois · 2015

What it is

The TMBI is a brief, single-session, collaborative psychological intervention. It is delivered at the bedside to people admitted to an acute medical or surgical setting (including ICU) after a medically serious suicide attempt. It adds to usual consultation-liaison care rather than replacing it.…

Format

• Format. One individual session at the bedside. In the 2015 trial it lasted a mean of about 44 minutes (SD ~13); O'Connor describes 30–45 minutes as typical. Settings:
• Session structure. The published sequence of components is as follows.

Who practises it, and how they are trained or regulated

• Who delivers it. Originally, the developer, a clinical psychologist. In the 2018 pilot, staff trained on the manual from psychiatry, social work and counselling, who achieved similar adherence ratings. Fidelity was checked by a second clinician (in 2015, the second author, K. A. Comtois) reviewing audio-recorded sessions against an adherence measure. Formal training requirements are not published.
• Place in the care pathway. Usual care (psychiatric consultation, risk assessment, diagnosis, disposition planning, possible psychiatric admission, community clinic referral) continues alongside. The developers observed that usual care concentrated on keeping the patient safe and managing risk in the short term. It did not intervene directly on the specific drivers of the attempt, such as perceived burdensomeness,…

Evidence status, as the guide reports it

• Criteria for starting. The patient must be medically able to take part. In the trials, timing was adjusted around imminent surgery or altered mental status, and patients who were too cognitively impaired were excluded. The session took place the same day as the research baseline interview, before…

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

• Commitment talk about specific services and willingness to sign releases show it is working. If the patient says yes to everything but seems flat, check what they actually intend.
• The patient recognises the list as theirs and, ideally, corrects your wording. A list the patient merely tolerates suggests the functional assessment was clinician-driven; revisit it briefly.
• drowsiness, confusion or fluctuating attention (defer the session); severe pain or nausea; a hostile or tearful refusal (respect it and offer a later time); an imminent discharge (prioritise and…
• the patient starts to see a sequence they had not seen before ("I didn't realise how much the drinking set it up"), names their own drivers, and the account becomes more specific. Not working: the…
• Rapport is sufficient when the patient begins telling the story in their own words, with some detail, rather than answering in a yes/no style. Signs it is not yet there: guarded answers, "I already…

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.