Suicide Prevention Blog Series: Clinical Tip #2

by Staff and Faculty of the QPR Institute Saturday, October 26, 2013


In honor of the launch of the HelpPRO Suicide Prevention Therapist Finder (see Press Releasewe bring you this five part series of clinical tips with the most up to date research and thinking on suicide prevention.  

Paul Quinnett, PhD, President and CEO, The QPR Institute, Inc, says 22 veterans will take their own lives today.  So will someone's daughter, a brother, a co-worker, and far too many working men and grandfathers.  According to the Centers for Disease Control and Prevention, in just one day, more then 105 of our fellow Americans will die by suicide.  Perhaps this clinical tip will save just one.

Clinical Tip #2 -- Documenting Reasons to NOT Hospitalize

When deciding not to hospitalize a patient at risk for suicide, it is important that the clinician conduct a risk-benefit analysis.  The reasons for hospitalization may include the relative assurance of a safer, more controlled environment, a beneficial milieu, multidisciplinary staff evaluation, initiation of stabilizing medications, etc.  The reasons not to hospitalize a suicidal person might include potential loss of self-esteem, stigmatization, risk of losing a job, fostering unwanted dependency, failure to benefit from prior hospitalizations, etc.  When confronted with a possible hospitalization, the patient may also express a willingness to participate in outpatient treatment and adhere to a medication regimen. 

Whatever your reasons to not hospitalize a consumer who has expressed suicidal ideations, prior plans or suicide attempts, it is strongly recommended that the primary care provider seek consultation and/or supervision regarding the decision and to carefully document the reasons for this decision.  In a world of increasing litigation for suicide malpractice, and if a bad outcome is experienced, an uniformed jury will need to be convinced that 1) you thought the problem through, 2) you weighed the risks and benefits carefully with the patient and his or her family, and 3) you took a reasonable and prudent course of action.

The QPR Institute ( provides Online Advanced Suicide Prevention Courses for a wide range of professionals including: Mental health professionals, school counselors, crisis line workers, substance abuse professionals, EMS/firefighters, law enforcement, primary care providers, nurses and correctional workers.

For more information please visit our full library of advanced courses!


Paul Quinnett, PhD., Founder & CEO QPR Institute,


Tags: , , , , ,

Self-Care | Social Work | Suicide Bereavement | Suicide Prevention | Treatment Modalities

Suicide Prevention Blog Series: Clinical Tip #1

by Staff and Faculty of the QPR Institute Friday, October 4, 2013


In honor of the launch of the HelpPRO Suicide Prevention Therapist Finder (see Press Release) we bring you this five week series of clinical tips with the most up to date research and thinking on suicide prevention.

Clinical tip #1 -- So-called “No-Suicide Contracts”

Despite clinical lore there is no scientific evidence that so-called “no suicide” contracts actually save lives or prevent suicide attempts.  Despite their widespread use, specific training in their purpose, utility, and employment is largely unavailable.  

The use of a no-suicide contract as a defense against a complaint of suicide malpractice is at best dubious and at worst negligent.  However, experts generally agree that the refusal of a suicidal person to enter into a good-faith agreement to remain safe (which implies a willingness to participate in recommended treatment), suggests the risk for a suicide attempt may be higher than first assessed. 
Documentation of clinical status, including the results of a mental status examination, together with a detailed suicide risk assessment are the best evidence that due clinical diligence was undertaken. Care planning, level of monitoring, frequency of visits, and similar interventions hinge on the quality of the initial and subsequent reassessment of suicide risk. For the most recent literature review, please see Lisa McConnell Lewis, LCSW’s “No-Harm Contracts: A Review of What We Know, Suicide and Life-Threatening Behavior, vol. 7, #`, February, 2007.

The QPR Institute ( provides Online Advanced Suicide Prevention Courses for a wide range of professionals including: Mental health professionals, school counselors, crisis line workers, substance abuse professionals, EMS/firefighters, law enforcement, primary care providers, nurses and correctional workers.

For more information please visit our full library of advanced courses!


  Paul Quinnett, PhD., Founder & CEO QPR Institute,



Self-Care | Social Work | Suicide Bereavement | Suicide Prevention

Heros and the Heat of the Game

by Rosemary De Faria Wednesday, July 17, 2013

There has been a lot of buzz with the play-offs lately.  One has to live under a rock to avoid being affected by it in one form or another.

Not being a sports fan I decided to take a walk on the wild side by accepting an invitation to dinner at a local bar where the final game would be played on every screen in the place.

My immersion experience began with the driver of the shuttle who took us to the bar.  He recounted the story of the previous evening’s game, sharing with emotion how he had been close to tears when it looked like his beloved team may lose.     His voice, hoarse from all the screaming, now had a lilt in it as he spoke of the team’s dramatic win.  They had managed to turn things around and to listen to him; it had been close to a spiritual experience.

In the restaurant people were already seated in the front row.   Dressed in their Heat attire, they were screaming and throwing their hands up to clap for a play which brought the team a little closer to winning.   

I began thinking of the role these sportsmen played for people, young and old from all walks of life and I found myself wondering : “Who do we make our heroes and why? “

When I think of my heroes, the people that come to mind are rarely those with celebrity.  Oh, I admit, Oprah holds a special place for me as I’m sure she does for many, but I think instead, of Sister Mendonca my fifth grade teacher who had the kindest, most loving heart.   She made some difficult times a bit easier to bear and I have never forgotten her for it.  

Now in middle age, I think of my father as another hero.  This surprises me at first, but it is a good choice nonetheless.   He was a tough, scary man, but he modeled some of the most important principles in life for which I am very grateful.  The best parts of me are all as a result of having him as my father. 

I sometimes sit across from my clients and wonder, am I a hero for them?    If so, I hope I can be like my heroes, who in very humble and unassuming ways gave me so much. 

Take the time to seek out your heroes.   They often go unnoticed, flying under the radar with little or no awareness of their own magnificence, but they are heroes nonetheless.

Let them know how they have impacted you.  Then, think about how you can be a hero for someone else and do it.  You may just change a life in unexpected ways.   Unleash the hero within you.  I promise you it’s there …ready and waiting to get into the heat of the game.

Rosemary De Faria, LCSW has a psycho-spiritual psychotherapy practice in Miami, Florida.  With over 20 years experience she uses both traditional and alternative therapies in working with her clients.  To read more about Rosemary or to read more of her articles, please visit Mention this blog article for a complementary phone consultation: 954-966-3446.

Tags: , ,

relationships, friendships | Self-Care | Social Work | Therapeutic Relationship

Friendship, Love and Marriage

by Gil Shepard Thursday, April 18, 2013


When someone says, “She (or he) is just a friend,” this generally means the relationship is not romantic, not sexual and not too intimate. It is also understood to mean, “You need not take this too seriously.”

On the other hand we sometimes hear someone say in a reverent way about a spouse, or a partner, “He (or she) is my best friend.” This is saying, “Yes, lots of people are married, lots of people have sex and live together, but what we share is a special trust, support and a rich love.”

What does it take to have this rich enviable friendship? For a start it takes risking being open about one’s feelings, being gently honest about what one thinks and does, being able to deal with disagreements in a relatively calm manner and being able to negotiate differences.

Unfortunately these skills are rarely taught in childhood. Instead many of us learned not to trust because we found caregivers not safe, not trustworthy and it was not smart to trust. Suspicion and fear are often survival skills in childhood but as an adult they can impede love. To learn how to be a true friend and how to choose someone trustworthy may take relearning in a safe environment.

In effective relationship therapy you may learn techniques, like how to let another person know that you heard what they said by repeating what you think you heard back to them and checking to see if you are correct. You may learn certain "no-no's" like telling someone they "should" do or be a different way. That is a sure way to create distance in a relationship very quickly, almost as fast as by telling someone they are stupid. These things certainly do not gain intimacy.

But most effective may be observing the therapist's style and emotional tone. Or you may notice that the therapist may see things very differently from the way you have seen them and wonder what he sees that you don't. You may explore why your partner's comments are so upsetting to you. What does it remind you of in your history? It can be very helpful to have a wise and experienced guide to do this and feel safe.



Gil Shepard is a licensed Marriage and Family Therapist in Walnut Creek, California


Tags: , , , , , ,

Social Work | Therapeutic Relationship | relationships, friendships | marriage

The Social Worker's Role in Major Mental Illness

by Joan E. Shapiro LCSW BCD Wednesday, June 29, 2011

Maze of Mental Illness


After receiving a diagnosis of schizophrenia, bipolar disorder, or a personality disorder, one can become overwhelmed with the seemingly disastrous news. Fear and anxiety may creep in and take over, but it is important to gain knowledge and learn how best to cope with the news. By learning about these disorders, one can come to terms with the diagnosis and move toward seeking appropriate treatment. 

Schizophrenia, bipolar disorder (previously known as Manic-Depressive Illness), and the personality disorders are all treatable conditions. While they each have distinct characteristics, they can also have overlapping symptoms, making proper diagnosis challenging. 

Schizophrenia and bipolar disorder are two major mental illnesses. Schizophrenia is primarily a thinking disorder. Bipolar disorder is primarily a modd disorder. Both conditions can cause the person to lose touch with reality. 

Personality disorders refer to enduring patterns of being, which are maladaptive, and interfere with an individual's attainment of contentment, stability, safety, and integration into society. A personality disorder often supports symptoms that trouble the individual such as anxiety, depression, eating disorders, and substance abuse. 

The most talked about personality disorder is borderline personality disorder, distinguished as the personality disorder that may require specialized treatment for its behavioral aspects. One one personality disorder, antisocial personality disorder, is not considered to be treatable with medication or psychotherapy techniques currently available. 


Schizophrenia commonly starts in late adolescence. The young person with an emerging schizophrenia may suffer from unrealistic, compelling ideas (called "delusions"), perceptual disturbances such as hearing voices, social withdrawal, and difficulty putting thoughts together. 

Early intervention with psychotropic medications is always indicated in stabilizing the individual before symptoms become flagrant and disruptive to the person's life. Sometimes hospitalization is needed to accomplish this goal. Psychotherapy and group therapy centers are important adjuncts of the treatment for this illness in many cases. 

Social workers play an important role in providing psycho-education for patients and families, and making appropriate referrals for services specially designed for helping people with this illness. Clinical social workers directly deliver psychotherapy for the conditions of mental illnesses. People with schizophrenia often lack the consistency of judgment to cope alone in the world, can show deterioration over time, and may need lifelong help in sustaining themselves in the world.

Bipolar Disorder

Bipolar disorder is expressed in people who have episodes of serious depression (characterized by symptoms such as lack of appetite, withdrawal, pessimism, lack of energy and disinterest in normal activities), coupled with episodes of mania or elation (characterized by such symptoms as sleeplessness, high energy, distractibility, irritability and excessiveness of sexuality, spending, talking, and self-importance. 

As with schizophrenia, medication is essential to stabilize mood. In the case of bipolar disorder, psychotherapy is also essential for the person's overall understanding of, and coping with, their condition over their lifetime. Sometimes people resist believing they have a mental problem. Disbelief can lead to repeated involuntary hospitalizations for the safety of the person and others. Therapists who are social workers can be especially well equipped to look for and be sensitive to cultural attitudes which may impede the acquiring of appropriate mental health services.

Personality Disorders 

Personality disorders provide fertile soil for the maintenance of uncomfortable and sometimes behavioral symptoms. While medications may temporarily help with symptoms that are supported by the particular disorder (depression, anxiety, insomnia), the ultimate help comes with the psychotherapy that treats the underlying personality disorder. 

Psychotherapy for personality disorders often requires a commitment to meeting with an experienced therapist frequently and regularly over a long period of time to obtain a significant result. Those people whose condition includes seriously self-destructive behaviors do best with DBT (Dialectical Behavioral Therapy), a therapy which specifically focuses on curtailing these behaviors. As with major mental illnesses, hospitalization can be required at times. 

After Diagnosis

Post-diagnosis can be a confusing time and with a clinical social worker specializing in mental health issues can clarify the path to begin the process of obtaining help. An expert can help wade through the numerous types and modalities of therapies offered and find the best treatment available. 

Joan E. Shapiro LCSWJoan E. Shapiro LCSW, BCD is a Lecturer in Social Work for the North Shore University Hospital's Department of Psychiatry. She is in full time private practice on Long Island, N.Y. Ms. Shapiro earned her MSW from Smith College School for Social Work in Northampton, MA and attended the Institute for Psychoanalytic Training and Research in New York City. Ms. Shapiro has trained at New York Hospital Westchester Division, Bronx Municipal Hospital Center, and The Clifford Beers Guidance Clinic in New Haven. She was a staff social worker at North Shore University Hospital Department of Psychiatry's Out Patient Department for twenty five years.

*Photo Credit - Williamsburg Hedge Maze

Tags: , , ,

Social Work | Therapeutic Relationship


<<  February 2020  >>

View posts in large calendar

Page List

    Month List