THE PHILOSOPHY BEHIND ASSIP
In ASSIP, suicide is conceptualized within the frame of action theory (1). Actions are goal-directed and are related to higher-order goal-directed systems. Actions include cognitive and emotional processes, such as planning, steering, control, regulation, monitoring, and decision-making.
In relation to suicide, three basic aspects can be distinguished:
- Action theory encompasses the way we communicate and explain our actions in everyday life, or how we make sense of actions in others. Suicide attempters in general have an impressive narrative competence. However, to foster the patient in the development of their narratives, the interviewer must respect the patient as the expert of his or her own actions. This requires a definition of the roles of patient and professional helper that radically differs from roles typically seen in the biomedical treatment model.
- Patients explain their suicide action as a part of higher-order systems, which includes “life career” aspects and projects that are goal-oriented and meaningful to the patient. Suicide thus appears as a (usually temporary) goal, a possible solution, when a person’s long-term goals and projects are seriously threatened.
- The immediate goal of suicidal action is to escape from an unbearable state of mind dominated by psychic pain, which may amount to a state of extreme stress, dissociation, automatisms and analgesia, secondary to negative and often humiliating experiences.
A further tenet in ASSIP is the emphasis on collaborative therapeutic processes and the development of a therapeutic alliance between therapist and patient. The starting point is the narrative interview with the suicidal patient. The interviewer respects the patient as the expert of his or her own actions. This requires a definition of the roles of patient and professional helper that radically differs from the biomedical treatment model.
ASSIP IN CLINICAL PRACTICE
ASSIP has been designed as a brief and specific follow-up therapy for patients who attempt suicide.
ASSIP is administered in three (to four) sessions, followed by regular letters. ASSIP should be understood as an add-on therapy to the usual clinical management.
ASSIP can be administered in out-patient or in-patient health care settings, or, in some cases, a combination of both.
Patients should receive a brief outline of the ASSIP sessions before the first appointment.
ASSIP sessions are ideally administered in weekly intervals.
ASSIP sessions typically have a duration of 60 mins face-to-face with the patient, plus 30 min for record keeping and preparation of the next session.
Clinicians and therapists involved in the treatment are informed about ASSIP and the personal safety strategies with the patients’ consent.
(1) Action Theory: References
Valach L, Young R, & Michel K. (2010). Understanding Suicide as an Action. In: Michel K. & Jobes D.A. (Eds.). Building a Therapeutic Alliance with the Suicidal Patient. American Psychological Association APA Books, Washington DC, p.129-148.
Valach L, Michel K, Young RA, Dey P (2006) Suicide attempts as social goal-directed systems of joint careers, projects, and actions. Suicide and Life-Threatening Behavior 36(6): p.651-660.
Valach L, Michel K, Young RA, & Dey P. (2006). Linking life and suicide related goal directed systems. Journal of Mental Health Counseling, 28(4): p.353-372.
Valach L, Young RA, & Lynam MJ (2002). Action theory. A primer for applied research in the social sciences. Westport, CT: Praeger.
Michel K, Valach L. (1997). Suicide as goal-directed action. Archives of Suicide Research 3, p.213-221.