Людям, совершившим попытку самоубийства, нужна особая психотерапия
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Попытка суицида - главный фактор риска для повторных попыток суицида и смерти вследствие самоубийства. Пока лишь немногие терапевтические программы успешно и эффективно снижают суицидальный риск людей после попытки. В статье утверждается, что традиционная медицинская модель суицидального поведения не помогает активной вовлечённости пациентов в лечение, и потому нам нужен иной подход к суицидальному пациенту. Наша исследовательская команда разработала и оценила новую, краткосрочную и весьма рентабельную терапевтическую программу (краткая программа интервенции после попытки самоубийства, ASSIP). В противоположность медицинской модели, которая понимает суицид как последствие психической болезни, модель ASSIP основана на понимании суицида как личного поступка, который можно внимательно изучить в сотрудничающем терапевтическом подходе. Подход с позиций теории поступка радикально центрирован на пациенте, он понимается как агент, деятель своего суицидального поступка. Подход поддерживает активную вовлечённость пациентов в терапию. Главный её элемент - собственный нарратив пациента, который помещает суицидальную попытку в биографический контекст. С помощью терапевта суицидальный кризис может быть понят, объяснён и переосмыслен. ASSIP была оценена в рандомизированном контролируемом исследовании с 120 участниками. После 24 месяцев врачебного наблюдения экспериментальная группа имела сниженный на 80% показатель повторных суицидальных попыток. Статья объясняет теоретические обоснования и развитие ASSIP, а также представляет обзор сессий ASSIP и обсуждение лечебных факторов терапевтического процесса.
Попытка суицида, превенция суицидов, психотерапия, терапевтический альянс, рандомизированное контролируемое исследование
Короткий адрес: https://sciup.org/140251020
IDR: 140251020 | УДК: 616.89-008 | DOI: 10.32878/suiciderus.20-11-02(39)-51-65
People who attempt suicide need a specific therapy
Attempted suicide is the main risk factor for repeated suicide attempts and death by suicide. So far there have only been very few therapy programs that have been successful in effectively reducing the suicide risk for suicide attempters. This article argues that the traditional medical model of suicide is not helpful for active treatment engagement of the patients, and that we need a different approach to the suicidal patient. Our research team developed and evaluated a novel, brief and very cost-effective therapy program (the Attempted Suicide Short Intervention Program ASSIP). In contrast to the medical model, which conceptualizes suicide as a consequence of a psychiatric illness, the ASSIP model is based on the concept of suicide as a personal action, which can be understood in a collaborative therapeutic approach. The action-theoretical approach is radically patient-centred, in that the patients are seen as the agents of their suicide actions. This approach fosters the patients’ active engagement in therapy. A central element is the patient’s self-narrative, which puts the suicide attempt in a biographical context. With the help of the therapist, the suicidal crisis can be understood, explained, and revised. ASSIP has been evaluated in a randomized controlled trial with 120 participants. At 24 months follow-up, the treatment group had a remarkable 80% reduced risk of reattempting suicide. The article explains the theoretical background and the development of ASSIP, followed by a summary of the ASSIP sessions and a discussion of the therapy process factors.
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