Эмоциональный отклик клинициста на пациентов с суицидальным риском: обзор литературы

Эмоциональный отклик клинициста на пациентов с суицидальным риском: обзор литературы

Автор: Веспа Элисон, Галыткер Игорь, Чистопольская Ксения Анатольевна

Журнал: Суицидология @suicidology

Статья в выпуске: 1 (42) т.12, 2021 года.

Бесплатный доступ

Суицид - серьёзная проблема здравоохранения, которая занимает десятую строку среди ведущих причин смерти в США и ежегодно забирает в этой стране свыше 48 тысяч жизней. Во всём мире в 2016 году ежегодное количество смертей от суицида достигло 817 тысяч, а количество суицидальных попыток во всём мире достигает 25 миллионов каждый год. Хотя такие ошеломляющие показатели побуждают учёных и клиницистов искать предикторы и создавать диагностические инструменты, наша способность определять индивидов с высоким риском суицида и предсказывать возникновение суицидальных мыслей и действий (СМД) улучшилась незначительно, как и наша способность предсказывать, когда произойдёт суицидальное поведение. Соответственно, остаётся актуальной необходимость в улучшении краткосрочной оценки и превенции СМД, а также в создании и валидизации клинических инструментов в помощь этим задачам. Один из путей, которым идут попытки превенции, - это учёт ситуации в системе здравоохранения, точнее, непосредственно реакции специалистов в сфере психического здоровья. В самом деле, клиническое суждение остаётся одним из самых надёжных инструментов установления суицидального риска среди пациентов, поскольку ведущие признаки, симптомы и предшествующие события суицидального поведения всё ещё трудно определять. В этой статье мы исследуем тему клинического контрпереноса как потенциального индикатора СМД пациента: начнём с истории контрпереноса, продолжим разбирать этот феномен в психологическом ключе, исследуем разные типы контрпереноса, переживаемые клиницистами (позитивный, негативный, смешанный). Мы утверждаем, что присутствие смешанного ответа может стать подсказкой для суицидального поведения пациента в будущем. В то время как исследования в этой сфере ещё только зарождаются, данные наблюдения вызывают оптимизм, поскольку дальнейшие усилия можно направить на осознание таких ответов для предотвращения самоубийств.

Еще

Суицид, превенция суицида, контрперенос, клиническое суждение, психотерапевтический альянс, maris

Короткий адрес: https://sciup.org/140257623

IDR: 140257623   |   DOI: 10.32878/suiciderus.21-12-01(42)-47-63

Список литературы Эмоциональный отклик клинициста на пациентов с суицидальным риском: обзор литературы

  • Centers for Disease Control and Prevention. CDC WISQARS: Leading causes of death reports, 1981–2018. Available from: https://webappa.cdc.gov/sasweb/ncipc/leadcause.html
  • Hedegaard H., Curtin S.C., Warner, M. (2018). Suicide mortality in the United States, 1999–2017.
  • Centers for Disease Control and Prevention [CDC]. (2018). WISQARS: Web-based inquiry statistics query and reporting system. http://www.cdc.gov/ncipc/wisqars/default.htm
  • Ahrnsbrak R., Bose J., Hedden S., et al. Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration: Rockville, MD, USA, 2017.
  • World Health Organization. Comprehensive mental health action plan 2013-2020. World Health Organization, 2013.
  • Naghavi M. Global, regional, and national burden of suicide mortality 1990 to 2016: Systematic analysis for the global burden of disease study 2016. BMJ: British Medical Journal (Online). 2019, № 364.
  • Crosby A., Gfroerer J., Han B., Ortega L., Parks S.E. Suicidal thoughts and behaviors among adults aged ≥18 Years – United States, 2008–2009. Washington, DC: US Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.
  • Franklin J.C., Ribeiro J.D., Fox K.R., Bentley K.H., Kleiman E.M., Huang X., Nock M.K. Risk factors for suicidal thoughts and behaviors: a meta-analysis of 50 years of research. Psychological Bulletin. 2017; 143 (2): 187.
  • Glenn C.R., Nock M.K. Improving the short-term prediction of suicidal behavior. American Journal of Preventive Medicine. 2014; 47 (3): 176-180.
  • National Action Alliance for Suicide Prevention: Research Prioritization Task Force. A prioritized research agenda for suicide prevention: An action plan to save lives, 2014.
  • Schaffer A., Sinyor M., Kurdyak P., Vigod S., Sareen J., Reis C., Green D., Bolton J., Rhodes A., Grigoriadis S., Cairney J. Population‐ based analysis of health care contacts among suicide decedents: identifying opportunities for more targeted suicide prevention strategies. World Psychiatry. 2016; 15 (2): 135-145.
  • Schmitz Jr.W.M., Allen M.H., Feldman B.N., Gutin N.J., Jahn
  • D.R., Kleespies P.M., Quinnett P., Simpson S. Preventing suicide through improved training in suicide risk assessment and care: An American Association of Suicidology Task Force report addressing serious gaps in US mental health training. Suicide and Life‐Threatening Behavior. 2012; 42: 292-304.
  • Chemtob C.M., Hamada R.S., Bauer G., Kinney B., Torigoe R.Y. Patients‘ suicides: frequency and impact on psychiatrists. American Journal of Psychiatry. 1988; 145: 224–228.
  • American Association of Suicidology, Clinician Survivor Task Force. (2002). Therapists as survivors of suicide: Basic information. Retrieved Februrary 28, 2020, from http://www.iusb.edu/~jmcintos/basicinfo.html
  • Chemtob C.M., Bauer G.B., Hamada R.S., Pelowski S.R., Muraoka M.Y. Patient suicide: Occupational hazard for psychologists and psychiatrists. Professional Psychology: Research and Practice. 1989; 20: 294.
  • Deutsch C.J. Self-reported sources of stress among psychotherapists.
  • Professional Psychology: Research and Practice. 1984; 15: 833.
  • Collins J.M. Impact of Patient Suicide on Clinicians. Journal of the American Psychiatric Nurses Association. 2003; 9 (5): 159-162.
  • Hendin H., Lipschitz A., Maltsberger J.T., Haas A.P., Wynecoop S. Therapists‘ reactions to patients‘ suicides. American Journal of Psychiatry. 2000; 157: 2022–2027.
  • Goode E. (2001). Patient suicide brings therapists lasting pain. New York Times. Retrieved January 18, 2001, from http://www. nytimes.com.
  • Menninger W.W. Patient suicide and it impact on the psychotherapist. Bulletin of the Menninger Clinic. 1991; 55: 216-227.
  • Calati R., Cohen L.J., Schuck A., Levy D., Bloch-Elkouby S., Barzilay S., Rosenfield P.J., Galynker I. The Modular Assessment of Risk for Imminent Suicide (MARIS): A validation study of a novel tool for suicide risk assessment. Journal of Affective Disorders. 2020; 263: 121-128.
  • Barzilay S., Yaseen Z.S., Hawes M., et al. Emotional responses to suicidal patients: Factor structure, construct, and Predictive Validity of the Therapist response Questionnaire-suicide Form. Frontiers in Psychiatry. 2018; 9: 104.
  • Betan E., Heim A.K., Zittel Conklin C., Westen, D. Countertransference phenomena and personality pathology in clinical practice: An empirical investigation. American Journal of Psychiatry. 2005; 162: 890-898.
  • Bruck E., Winston A., Aderholt S., Muran J.C. Predictive validity of patient and therapist attachment and introject styles. American Journal of Psychotherapy. 2006; 60 (4): 393-406.
  • Gelso C.J., Hayes J.A. Countertransference and the innerworld of the psychotherapist: Perils and possibilities. Mahwah, NJ: Erlbaum, 2007.
  • Marcinko D., Skocic M., Saric M., Popovic-Knapic V., Tentor B., Rudan V. Countertransference in the therapy of suicidal patients – an important part of integrative treatment. Psychiatria Danubina. 2008; 20 (3): 402-405.
  • Barzilay S., Yaseen Z.S., Hawes M., Kopeykina I., Ardalan F., Rosenfield P., Murrough J., Galynker I. Determinants and predictive value of clinician assessment of short‐term suicide risk. Suicide and Life‐Threatening Behavior. 2018; 49 (2): 614-626.
  • Barzilay S., Schuck A., Bloch‐Elkouby S., Yaseen Z.S., Hawes M., Rosenfield P., Foster A., Galynker I. Associations between clinicians‘ emotional responses, therapeutic alliance, and patient suicidal ideation. Depression and Anxiety. 2020; 37: 214–223. DOI: 10.1002/da.22973
  • Hawes M., Yaseen Z., Briggs J., Galynker I. The Modular Assessment of Risk for Imminent Suicide (MARIS): A proof of concept for a multi-informant tool for evaluation of short-term suicide risk. Comprehensive Psychiatry. 2017; 72: 88-96.
  • Posner K., Brown G.K., Stanley B., et al. The Columbia-Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. The American Journal of Psychiatry. 2011; 168 (12): 1266–1277.
  • Yaseen Z.S., Briggs J., Kopeykina I., Orchard K.M., Silberlicht J., Bhingradia H., Galynker I.I. Distinctive emotional responses of clinicians to suicide-attempting patients-a comparative study. BMC Psychiatry. 2013; 13: 230.
  • Hayes J.A., Gelso C.J., Hummel A.M. Managing countertransference. Psychotherapy. 2011; 48 (1): 88–97.
  • Cartwright C. Transference, countertransference, and reflective practice in cognitive therapy. Clinical Psychologist. 2011; 15 (3): 112–120.
  • Leahy R.L. Overcoming resistance in cognitive therapy. New York, NY: Guilford Press, 2001.
  • Prasko J., Diveky T., Grambal A., Kamaradova D., Mozny P., Sigmundova Z., Vyskocilova J. Transference and countertransference in cognitive behavioral therapy. Biomedical Papers. 2010; 154 (3): 189–197.
  • Little M. Countertransference and the patient‘s response to it. International Journal of Psychoanalysis. 1951; 32: 32–40.
  • Levenson H. Time-limited dynamic psychotherapy. New York: Basic Books, 1995.
  • Racker H. The meanings and uses of countertransference. The Psychoanalytic Quarterly. 1957; 26 (3): 303-357.
  • Mitchell S.A. Hope and dread in psychoanalysis. New York, NY: Basic Books, 1993.
  • Zittel, Conklin, C., Westen D. The therapist response questionnaire. Departments of Psychology and Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia, 2003.
  • Strack S., Coyne J.C. Social confirmation of dysphoria: shared and private reactions to depression. Journal of Personality and Social Psychology. 1983; 44 (4): 798–806.
  • Coyne J.C. Depression and the response of others. Journal of Abnormal Psychology. 1976; 85 (2): 186-193.
  • Maltsberger J.T., Buie D.H. Countertransference hate in the treatment of suicidal patients. Archives of General Psychiatry. 1974; 30: 625-633.
  • Pompili M. Our Empathetic Brain and Suicidal Individuals. Crisis. 2015; 36 (4): 227-230.
  • Чистопольская К.А., Ениколопов С.Н., Чубина С.А. Специфика отношений к жизни и смерти у пациентов в остром постсуициде и у врачей-психиатров. Суицидология. 2019; 10 (2): 56-71 [Chistopolskaya K.A., Enikolopov S.N., Chubina S.A. Specifics of life and death attitudes in patients in acute postsuicide and psychiatrists. Suicidology. 2019; 10 (2): 56-71] (In Russ / Engl) DOI: 10.32878/suiciderus.19-10-02(35)-56-71
  • Birtchnell J. Psychotherapeutic considerations in the management of the suicidal patient. American Journal of Psychotherapy. 1983; 37: 24-36.
  • Dressler D.M., Prusoff B., Mark H.A.L., Shapiro D. Clinician attitudes toward the suicide attempter. Journal of Nervous and Mental Disease. 1975.
  • Varghese F.T., Kelly B. Countertransference and assisted suicide. In Countertransference issues in psychiatric treatment. Edited by Gabbard GO. Washington DC: American Psychiatric Press, 1999. РР. 85–116.
  • Michaud L., Ligier F., Bourquin C., Corbeil S., Saraga M., Stiefel F., Richard-Devantoy S. Differences and similarities in instant countertransference towards patients with suicidal ideation and personality disorders. Journal of Affective Disorders. 2019.
  • Gurrister L., Kane R.A. How therapists perceive and treat suicidal patients. Community Mental Health Journal. 1978; 14: 3-13.
  • Modestin J. Counter‐transference reactions contributing to completed suicide. British Journal of Medical Psychology. 1987; 60: 379-385.
  • Richards B.M. Impact upon therapy and the therapist when working with suicidal patients: some transference and countertransference aspects. British Journal of Guidance & Counselling. 2000; 28: 325-337.
  • Soulié T., Bell E., Jenkin G., et al. Systematic Exploration of Countertransference Phenomena in the Treatment of Patients at Risk for Suicide. Archives of Suicide Research. 2018; 1: 23.
  • Yaseen Z.S., Galynker I.I., Cohen L.J., Briggs J. Clinicians' conflicting emotional responses to high suicide-risk patients – Association with short-term suicide behaviors: A prospective pilot study. Comprehensive Psychiatry. 2017; 76: 69-78.
  • Galynker I. The suicidal crisis: clinical guide to the assessment of imminent suicide risk. Oxford University Press, 2017.
  • Soulié T., Levack W., Jenkin G., Collings S., Bell E. Learning from clinicians‘ positive inclination to suicidal patients: A grounded theory model. Death Studies, 2020. DOI: 10.1080/07481187.2020.1744201
  • Kernberg O. Notes on countertransferences. Journal of the American Psychoanalytic Association. 1965; 13 (1): 38-56.
  • Dattilo G. The role of attachment style on clinician self-efficacy and empathy. La Salle University, 2005.
  • Khodabakhsh M. Attachment styles as predictors of empathy in nursing students. Journal of Medical Ethics and History of Medicine. 2012; 5.
  • Bedics J.D., Atkins D.C., Harned M.S., Linehan M.M. The therapeutic alliance as a predictor of outcome in dialectical behavior therapy versus nonbehavioral psychotherapy by experts for borderline personality disorder. Psychotherapy. 2015; 52 (1): 67–77.
  • Dunster-Page C., Haddock G., Wainwright L., Berry K. The relationship between therapeutic alliance and patient‘s suicidal thoughts, self-harming behaviours and suicide attempts: A systematic review. Journal of Affective Disorders. 2017; 223: 165–174.
  • Jobes D.A., Ballard E. The therapist and the suicidal patient, 2011.
  • Joiner Jr.T.E., Van Orden K.A., Witte T.K., Rudd M.D. The interpersonal theory of suicide: Guidance for working with suicidal clients. Washington, DC: American Psychological Association, 2009.
  • Borodin E.S. The Generalizability Of The Psychoanalytic Concept Of The Working Alliance. Psychotherapy, Theory, Research and Practice. 1976; 16: 252-260.
  • Flückiger C., Del Re A.C., Wampold B.E., Horvath A.O. The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy. 2018; 55 (4): 316.
  • Maltsberger J.T., Weinberg I. Psychoanalytic perspectives on the treatment of an acute suicidal crisis. Journal of Clinical Psychology. 2006; 62 (2): 223-234.
  • Schechter M.A., Goldblatt M.J. Psychodynamic therapy and the therapeutic alliance: Validation, empathy, and genuine relatedness. 2011.
  • Schechter M., Goldblatt M., Maltsberger J.T. The therapeutic alliance and suicide: When words are not enough. British Journal of Psychotherapy. 2013; 29 (3): 315-328.
  • Beck A.T., Brown G.K., Berchick R.J., Stewart B.L., Steer R.A. Relationship between hopelessness and ultimate suicide: A replication with psychiatric patients. American Journal of Psychiatry. 1990; 147: 190-195.
  • Van Orden K.A., Witte T.K., Cukrowicz K.C., Braithwaite S.R., Selby E.A., Joiner Jr.T.E. The interpersonal theory of suicide. Psychological Review. 2010; 117 (2): 575.
  • Hutchinson M., Jackson D. Hostile clinician behaviours in the nursing work environment and implications for patient care: a mixed-methods systematic review. BMC Nursing. 2013; 12 (1): 25.
  • Safran J.D., Kraus J. Alliance ruptures, impasses, and enactments: A relational perspective. Psychotherapy. 2014; 51 (3): 381-387.
  • Perry J.C., Bond M., Presniak M.D. Alliance, reactions to treatment, and counter-transference in the process of recovery from suicidal phenomena in long-term dynamic psychotherapy. Psychotherapy Research. 2013; 23 (5): 592-605.
  • Van Wagoner S.L., Gelso C.J, Hayes J.A., Diemer R.A. Countertransference and the reputedly excellent therapist. Psychotherapy Theory Research Practice and Training. 1991; 28 (3): 411-421.
  • Blanchard M., Farber B.A. ―It is never okay to talk about suicide‖: Patients‘ reasons for concealing suicidal ideation in psychotherapy. Psychotherapy Research. 2020; 30 (1): 124-136.
  • Blanchard M., Farber B.A. Lying in psychotherapy: Why and what clients don‘t tell their therapist about therapy and their relationship. Counselling Psychology Quarterly. 2016; 1: 90-112.
Еще
Статья научная
QR-код для установки приложения SciUp Наведите камеру и скачайте бесплатное приложение SciUp