Fantastic Email–“I was planning to commit suicide the day you left a copy of Feeling Good at my front door!”

Fantastic Email–“I was planning to commit suicide the day you left a copy of Feeling Good at my front door!”

Dear friends and colleagues,

I thought you might enjoy this wonderful email I received several days ago, and publish here with the permission of Dr. Robert Schachter, from New York city.

David

Dear David,

I want to share an experience that almost made me cry.  A woman from Nebraska had tracked me down on the internet to treat her mid-20’s daughter who was living in New York.  She said that she had been profoundly affected by Feeling Good: The New Mood Therapy.

She went on to say that when her daughter was in preschool, the nursery school teacher was fired and had been very distraught. She had liked this woman and felt very bad for her. So, she went to her house but the woman would not come to the door. She then went home and took her copy of Feeling Good and left it on the woman’s doorstep.

Their paths diverged, but some time later she bumped into her.  The woman came up to her and said, “I just want to thank you.  I want you to know that you saved my life!  My father had committed suicide and the day that you came by, I was planning my own suicide.  That book saved my life.

Thank you.”

Then my patient’s mother said, “God Bless Dr. Burns.”

Bob
Robert Schachter, Ed.D.
Licensed  Psychologist

 

If you are reading this blog on social media, I appreciate it! I would like to invite you to visit my website, http://www.FeelingGood.com, as well. There you will find a wealth of free goodies, including my Feeling Good blogs, my Feeling Good Podcasts with host, Dr. Fabrice Nye, and the Ask Dr. David blogs as well, along with announcements of upcoming workshops, and tons of resources for mental health professionals as well as patients!

Once you link to my blog, you can sign up using the widget at the top of the column to the right of each page. Please forward my blogs to friends as well, especially anyone with an interest in mood problems, psychotherapy, or relationship conflicts.

Thanks! David

Can We Prevent Suicide Attempts?

Can We Prevent Suicide Attempts?

tHi www.FeelingGood.com friends and colleagues,

I just received the following email from a therapist who was shocked to discover that her patient was suicidal after reviewing his scores on the Brief Mood Survey. Her intervention likely saved his life.

Patient suicides are not uncommon, sadly, and represent the dark side of our profession. The death of any patient is an enormous tragedy for the patient, obviously, and is devastating for the family and friends as well. Patient suicides can be incredibly demoralizing and anxiety-provoking for the therapist, too. It is imperative, in my opinion, that therapists have the best, state-of-the-art tools for detecting the emergence of suicidal urges so that we can intervene and have the greatest chance of preventing these horrible events.

In two upcoming Feeling Good Podcasts, Fabrice and I will discuss what happened to a psychologist named Harold who thought he did not need to use the Brief Mood Survey to track his patients’ symptoms at the start and end of every therapy session. Like so many therapists, Harold  was convinced that he was sensitive and empathic and really understood how his patients felt with reasonable accuracy. When his favorite patient unexpectedly committed suicide following a particularly “good” therapy session, Harold was understandable devastated. He felt intensely depressed, anxious, ashamed, inadequate, alone, hopeless, and angry. You may find these two podcasts interesting and sobering.

My research and training experience indicate that therapists’ perceptions of how their patients feel (in terms of suicidal urges as well as severity of depression , anxiety and anger) are often way off-base, but therapists don’t realize this because most of them are not assessing assessment scales to track progress at every session. In addition, therapists’ perceptions of how empathic and helpful they are also way off-base much of the time for the same reason. They don’t measure empathy, and most don’t even ask patients to rate how warm and understanding they are.

That’s why I developed tools like the Brief Mood Survey, so therapists can track patient progress in multiple dimensions before and after every therapy session. I believe it’s use represents a major breakthrough in psychotherapy, because it’s like having an emotional X-ray machine to inform the therapist about what’s really going on, and to guide the treatment. Of course, I’m more than a little biased on this point! And the use of the BMS requires lots of courage, because the vast majority of patients are shockingly honest in the way they rate their therapists on these scales, and while the information can be invaluable, and even life-saving, it can also be quite disturbing and threatening to the therapist’s ego.

David

Hi David,

I just wanted to let you know that I recently started using the THERAPIST’S TOOLKIT and found myself in a similar situation you described. I recently had a patient whose scores were virtually ZERO on the Brief Mood Survey one week (meaning no symptoms at all), so I was convinced he was doing well. However, the following week I was alerted to high scores on your two-question “suicidal impulses” scale, which, to my chagrin, I nearly missed. That’s because I am in a new office with low lighting and I am visually impaired. But when I looked more closely, I discovered there my patient not only had suicidal thoughts and urges, but an actual plan for suicide!!!

Boy was I grateful having on hand the full blown Suicidal Urges Survey and Suicide Assessment Interview, which I proceeded to do in a two-hour session the following day. Just as surprising, his scores following THAT session were all ZERO again (except for Empathy and Self Help:-)

(David’s explanation. Scores of zero on the Depression, Suicide, Anxiety and Anger Scales are the best possible scores, indicating no symptoms at all. In contrast, scores of 20 out of 20 on the end-of-session Empathy and Helpfulness Scales are the best possible scores, indicating that the therapist was tremendous empathic and helpful during the session.)

Although I was/am at least temporarily relieved by the rapid reversal, I can’t say I know how to account for it, since most of the interview was assessment based, unless I just ooze TEAM-CBT without realizing it!

All that came to mind was “Hawthorne Effect.” As an aside, I know the “Suicidal Urges” survey is one of the “experimental” ones, but I saw no scoring sheet; I imagine they generally correspond with the BMS, the higher the worse.

Also, in answer to your query, I for one would LOVE to learn more about the Self-Defeating Beliefs survey and/or any info you impart in this regard. I was focused on that with the patient when I almost missed his staggering scores on the two questions on suicidal impulses. But I would like to return to it, and I will plan to give it for homework on a weekly basis to check his “emotional temperature” which is vitally important for this patient as you can imagine, I will consult some colleagues as well who have expertise in ethics and legal issues.

My TEAM CBT group (with Lynne Spevack) meets tomorrow, and we will focus on Testing, yay! And on Monday I will be starting Taylor Chesney’s TEAM CBT group! Both groups meet 2x/month. If only there were a group that met every day:-)

Meanwhile, I hope you’ve received my check by now for the EASY Diagnostic System which I cannot wait to get my hands on and need it desperately!!! When might I expect to receive the email with this valuable info?

I am enjoying your Feeling Good Podcasts, as well as your Feeling Good Blog and newsletter. I am more than fairly certain, were it not for your inventory (the Brief Mood Survey), I would have missed this potentially life-saving intervention. I’d even done a brand new Intake the week before. Although we do not have the power 100% to prevent a person from committing suicide, if we do not detect it we don’t have a fighting chance. I at least have the peace of mind now that with this knowledge, I can do everything in my power to insure this patient gets all the help he needs and hopefully the right help.

Thank you for being you and your contributions for making such a meaningful difference in the world for our patients and us therapists!

Kathy

PS I also really appreciated your podcast on anti-depressants, which I LOVED and wasn’t surprised. I’m sure that took tremendous courage, along with your well-intact integrity to speak your truth. I wish more Psychiatrists were like minded. Until there is such a paradigm shift, which I think is coming, such decisions will have to be decided between the patient and their doc largely comprised of big Pharma mentality. who’ve drunk the cool aid, sadly.

Hi Kathy,

Thank you for your enlightening email. I greatly enjoyed reading it, and kudos to you for saving your patient’s life.

You asked about the scoring of the two-item Suicidal Urges scale. I intentionally don’t have a strict numerical scoring key, as I want the therapist to attend to it thoughtfully. There are some guidelines in the massive update to the Therapist’s Toolkit. You probably have it already, but email me if you need it.

The first of the two screening items asks about suicidal thoughts and fantasies. Most depressed individuals will have these thoughts, such as the idea that they might be better off dead, but this is not generally alarming if there are no suicidal urges. Of course, you will always want to back up the survey with some questions to make sure.

The second of the two screening items asks about suicidal urges or plans. Any endorsement of this item is more worrisome, and usually merits a suicide assessment interview, just as you did. In general, you will only have to do this once with any particular patient, and it should ideally be done at the beginning of therapy, at the initial evaluation.

A third thing is to note changes in how the patient answers these two items, since any increase in the scores can indicate the development of increased suicidal urges. And as you say, we cannot 100% prevent suicide attempts in our patients, but the Brief Mood Survey will give you vastly improved information, since you will have the patient’s scores at the start and end of every therapy session.

One additional point, most versions of the Brief Mood Survey ask how the patient is feeling right now, just prior to the start of the session, and once again right after the end of the session. This is so the therapist can find out how effective, or ineffective, the session was. Such information is incredibly valuable! However, you can also ask if the scores reflect how the patient was feeling during the week, between the sessions. This is important, because the patient may have had times when he or she was feeling more suicidal, and this might merit a more intensive interview to assess the risk.

When you receive you EASY Diagnostic System from me (I assume you’ve already don this), you’ll find a structured screening interview for suicidal patients at the end of the diagnostic manual. This can be very helpful. There’s also a chapter in my psychotherapy eBook (Tools, Not Schools, of Therapy) on “The Prediction and Prevention of Suicide and Violence” that can be helpful as well. I have also included that chapter in the upgrade to the Therapist’s Toolkit.

Finally, please give Lynne Spevack my regards. She is a terrific teacher and therapist! I enjoyed catching up with her at the Newark workshop and encouraged her to meet more frequently with her training group. I agree that twice a month is not really enough. Keep in mind we now have three TEAM-CBT training centers in New York (for links, check out my referral page), plus numerous weekly online training groups that therapists around the world can join.

All the best,

David

 

If you are reading this blog on social media, I appreciate it! I would like to invite you to visit my website, http://www.FeelingGood.com, as well. There you will find a wealth of free goodies, including my Feeling Good blogs, my Feeling Good Podcasts with host, Dr. Fabrice Nye, and the Ask Dr. David blogs as well, along with announcements of upcoming workshops, and resources for mental health professionals as well as patients!

Once you link to my blog, you can sign up using the widget at the top of the column to the right of each page. Please firward my blogs to friends as well, especially anyone with an interest in mood problems, psychotherapy, or relationship conflicts.

Thanks! David

Is Suicide Justified?

Dear Doctor David,

I read your book Feeling Good: The New Mood Therapy, with much interest. I think almost all what you say still applies today. But I have a question: in the book when you discuss suicide, you don’t mention physical pain as a reason.

I understand your belief that most, if not all, suicidal patients can be helped. But pain is not even listed in your index or table of contents. It seems like a strange omission to me.

So, do you think if one has enough incurable physical pain, it’s okay to commit suicide? I am not asking for personal help. This is just a general question.

Dave

Dr. Burns’ Response

I have fairly strong feelings on this subject, and all I can give you is my own personal take on it. I know it is complex and highly controversial. And in addition, each situation would have to be evaluated on its own merit. So my comments will be of a general nature only, and are not intended to be medical advice or recommendation.

When our beloved pets are in pain and dying, it is an act of love and mercy to let them go, rather than to make them suffer so horribly. I used to be a dog person, but my wife converted me to cats when our dog died of colon cancer a number of years ago. Now I am crazy about our cats, all of which are strays or rejected cats we adopted. I totally adore them, and you can read about one of them, Obie, on this website.

I have always told my cats that if they are old and suffering, I will not let them suffer. I have also told them that when they die, I will be there with them, giving them love and comfort to the very end.

Personally, I can’t see why we don’t treat our human loved ones with the same degree of mercy and compassion. Personally, I can’t see any merit at all in making a loved one suffer in agony. I don’t mean to inflict my views on anyone, and accept the fact that many people will have radically different and very strong views about this.

The situation of a loved one suffering in agony with a terminal illness is very different from individuals who are depressed or angry and wanting to commit suicide because of the distorted and unrealistic belief that they are hopeless, or in order to get revenge on others who they are angry with, perhaps because they feel rejected. I see suicide for emotional reasons as very violent and horrific act that is never justified or necessary. Once again, I realize and accept the fact that many others will have very different views on this topic.

That’s my take on it. Should I publish your excellent question and my answer on the website? Perhaps some others may be interested in this topic.

David Burns, MD

Dave’s Response to Dr. Burns

Dr. Burns,

I am delighted to get a response from you, particularly the response I was hoping for. Thank you so much for taking the time and making the effort to clarify your position for me.

Yes, after reading your book, I understood that for mental reasons, it’s seldom if ever rational to commit suicide. I was just wondering about the physical pain part.

Yes, by all means if you wish to post my question and your answer on your website, please do so. Good to know that you’re still actively involved in life. Good for you! Thanks again, Dr. Burns, for your answer!

Dave