Psychotherapy outcomes for suicidality based on modality type

There is an interesting article published, 07/02/25, in the Clinical Psychology and Psychotherapy Journal reporting on a meta analysis of the effectiveness of individual, group, and family therapy on suicidality.

The topic is of great interest to me because in my career of 56 years as a Psychiatric Social Worker I estimate I have done over 15,000 suicide evaluations, as many as 11 in one day when working as a Psychiatric Assignment Officer in a large urban hospital in Rochester, NY.

Based on my clinical experience and observation I already realized that a combination of modalities is the most effective treatment plan in most cases and in fact that is what the meta analysis found. When individual therapy was combined with group and/or family therapy outcomes were better.

This meta-analysis highlights that combined psychotherapy approaches, integrating individual sessions with group or family sessions, yields significantly higher effect sizes, reducing the risk of suicide attempts by 50%. These findings support the adoption of combined therapeutic strategies in clinical settings to effectively address suicidality. (https://onlinelibrary.wiley.com/doi/10.1002/cpp.70112?af=R, accessed on 07/03/25)

I am currently working with a family where the mother has been hospitalized twice in the last year for suicide attempts. I have used a combination of individual sessions with the four family members as well as combination sessions.

The therapeutic work has taken many twists and turns and what one might expect has turned out to not be accurate and what one might not expect emerged. Murray Bowen describes families where there is a schizophrenic member in which roles can change and the person labeled “schizophrenic” turns out to be one of the healthier members of the family whereas the “healthier appearing” family member starts showing signs of significant psychiatric symptoms.

Dr. Bowen’s teaching led to the appreciation of the system’s view of mental illness and contributed to an understanding of the strategic family therapy phrase, “What is the function of the symptom for the system?”

So what does suicidality in a family member indicate about the family system? Can the family system be ignored as we focus on the symptomatic member alone? If we ignore the social context of our client will we achieve as good an outcome ameliorating the suicidality of the identified patient? Now we have some research that validates practice wisdom which indicates that focusing on the individual’s suicidality alone will not get as good an outcome as taking into account the individual’s interpersonal relationships.

Lastly, and it's a whole other topic, how do we chart and bill for such work and how does compliance with a medical model and its practice hamper and constrain effective therapy?

Should psychological fitness be a standard for holding public office?

People who would be red-flagged for employment at my agency were elected to the two top positions in the American government which makes me question the mental health of the American public as well.

When people with mental illness reach high levels of public office and have concomitant power to make policy and engage in actions which affect millions of people, it would seem that psychological fitness might be a standard to use in the selection process. Police officers in major cities go through more psychological evaluation for their jobs than politicians who make policy to govern the police officers' actions.

Could a standard of psychological fitness be politicized and misused and abused? Yes, there is a huge potential there, and yet if we see psychological standards being increasingly used in other human service professions in criminal justice, ministry, counseling and mental health, education, would it be too much to ask that our political leaders also be subjected to such evaluations?

The argument that voters will decide is not reliable judge of fitness because most voters are naive when it comes to a candidates psychological fitness.

For more click here.

Longer term psychotherapy works according to a study published in JAMA

A study which appeared in the October 1, 2008 issue of the Journal of the American Medical Association which found that long term psychodynamic psychotherapy works. Here is a snippet from the article:

People with complex mental disorders or personality disorders would benefit from long-term psychodynamic psychotherapy that lasts at least a year or longer, according to new research.

Published in the Oct. 1 issue of the Journal of the American Medical Association, the German study found that compared to the more commonly used short-term therapy, long-term psychotherapy left people better off. In fact, the number of therapy sessions the patients had was directly correlated to improvements in symptoms.

"Long-term psychodynamic psychotherapy was significantly superior to shorter forms of psychotherapy applied in the control groups. This was true with regard to overall effectiveness, target problems, and personality functioning," said the study's lead author, Falk Leichsenring, a professor of psychotherapy research in the department of psychosomatic medicine and psychotherapy at the University of Giessen in Germany.

"With regard to overall effectiveness, on average, patients with complex mental disorders were better off after treatment with long-term psychodynamic psychotherapy than 96 percent of the patients in the comparison groups. Thus, this meta-analysis provides evidence that long-term psychodynamic psychotherapy is an effective treatment for complex mental disorders," said Leichsenring.

"This study provides a great value for doctors and for patients, and one would hope could have an influence on policy decisions," added Dr. Charles Goodstein, a clinical professor of psychiatry at the New York University School of Medicine and Langone Medical Center in New York City.

Symbolic threat leads to faulty generalizations out of touch with reality

Across six studies, we found that people commonly exaggerate the presence of certain groups – including ethnic and sexual minorities – simply because they are perceived as ideologically threatening. Psychologists call this feeling – that groups hold different values and worldviews from the mainstream, thereby jeopardizing the status quo – “symbolic threat.”

From an article on The Conversation on 06/09/2022 entitled "People overestimate groups they find threatening- when "sizing up others," bias creeps in.

"They're eating the cats! They're eating the dogs!" Donald Trump in presidential debate with Kamala Harris in 2024.

How crazy are your beliefs? Are you aware of them? Can you manage them realistically? Being self aware is one of the first skills of spiritual intelligence. Socrates said an unexamined life is not worth living, and the humorist said an unlived life is not worth examining.

AI psychosis can lead to suicide

The parents of a teenager who died by suicide have filed a wrongful death suit against ChatGPT owner OpenAI, saying the chatbot discussed ways he could end his life after he expressed suicidal thoughts. The lawsuit comes amid reports of people developing distorted thoughts after interacting with AI chatbots, a phenomenon dubbed “AI psychosis.” John Yang speaks with Dr. Joseph Pierre to learn more.

For more click here.

AI had taken over health care

Peter Simons writes in his article "Doctors: Patients Don't Want You To Use AI" on 08/18/25 on the Mad In America website:

There’s a deep divide between how patients and doctors view the use of artificial intelligence (AI). Doctors are overwhelmingly in favor of using AI: two-thirds of doctors have already incorporated it into their practice. But patients are concerned about AI’s tendency to make up false information and fear AI use may further reduce an already dismissive and unsympathetic medical interaction to something completely robotic.

This divide exists in other fields too, where corporate executives believe that AI has improved customer service, but actual customers disagree, with 88% preferring human interaction, and almost half say “their biggest frustration has been not being able to reach a human.”

The back room jargon in the health care field is the importance of treating the record and not the patient. Modern health care has turned into disease management and less on patient care.

How to manage this poor patient care? Limit your interactions with health care professionals which are increasingly being recorded and be careful about the information you share. Find other resources for understanding and support.

Book Review - The Book Of Ruth by Jane Hamilton

While it's not a self-help book, reading Jane Hamilton's The Book of Ruth can offer several psychotherapeutic benefits, primarily by fostering empathy and providing a powerful narrative for exploring themes of trauma, resilience, and personal growth. The novel is not a manual for therapy, but it can serve as a catalyst for self-reflection and understanding.

Here are some of the potential psychotherapeutic benefits of reading The Book of Ruth:

• Empathy and Understanding of Trauma: The novel provides a deeply personal and raw account of a character, Ruth, who endures a life of hardship and emotional abuse. By immersing yourself in her perspective, you can develop a deeper sense of empathy for individuals who have experienced trauma, particularly those from marginalized or difficult backgrounds. Ruth's story challenges the reader to look beyond surface judgments and understand the complex reasons behind her choices and struggles.

• Exploring Family Dynamics and Cycles of Abuse: The book's central conflict revolves around the toxic and abusive relationship between Ruth and her mother, May. By witnessing this dynamic, readers can gain insight into the destructive nature of family dysfunction and the ways in which trauma can be passed down through generations. This can be particularly therapeutic for readers who have their own difficult family histories, as it may provide a framework for understanding and processing their experiences.

• The Power of Resilience: Despite the immense suffering she endures, Ruth demonstrates a quiet yet profound resilience. She finds solace and strength in unexpected places, such as her correspondence with her aunt and her love for literature. Her journey from passivity to a form of self-rescue highlights the human capacity to survive and even grow in the face of overwhelming adversity. This can be a source of hope and inspiration for readers facing their own challenges.

• The Quest for Identity and Self-Worth: A major theme of the novel is Ruth's struggle to define herself outside of the expectations and labels placed upon her by her family and community. She is constantly told she is a "loser" and is overshadowed by her "brilliant" brother. Her journey of self-discovery, from a timid and passive young woman to someone who can piece together her own story, is a powerful narrative about finding one's voice and recognizing one's own value.

• The Role of Narrative in Healing: The novel is revealed to be a story that Ruth herself has written. This framing device suggests that the act of telling one's own story can be a form of therapy and a path to forgiveness. By creating her own narrative, Ruth is able to process her trauma and take ownership of her life. This can be a powerful lesson for readers about the importance of giving voice to their own experiences.

In summary, The Book of Ruth offers a harrowing but ultimately hopeful look at the human spirit. While it's a work of fiction, its exploration of themes like trauma, family relationships, and resilience can serve as a valuable tool for introspection and empathy, providing a unique form of psychotherapeutic benefit.