Share this article on:

Relational Suicide Assessment: Risks, Resources, and Possibilities for SafetyDouglas Flemons, PhD and Leonard M. Gralnik, PhD (2013) New York W.W. Norton & Company, Inc. 272 pp.

Ganança, Licínia MD; Oquendo, Maria A. MD, PhD

The Journal of Nervous and Mental Disease: February 2014 - Volume 202 - Issue 2 - p 179
doi: 10.1097/NMD.0000000000000089
Book Reviews

Postdoctoral Fellow Columbia University New York

Professor and Vice Chair Columbia University New York and New York State Psychiatric Institute New York

Suicide is the most dreaded outcome mental health care providers face. Every year, approximately 1 million people die by their own hand. Given the estimates that there are 50 suicide attempts for each suicide death, the morbidity and mortality due to suicidal behavior are staggering. As such, identifying those at risk is imperative. Research has helped us delineate some of the risk factors of suicidal behavior: mood disorders, aggression, impulsivity, hopelessness, and past suicidal behavior are all key predictors. However, we still have much work to do in terms of developing strategies for finding and treating suicidal individuals. Although some instruments can help identify who is at risk, thus far, there is no instrument that can tell us with precision who will ultimately commit suicide. Thus, a structured, documented assessment strategy becomes vitally important to clinicians.

In this book, Relational Suicide Assessment, the authors offer the reader the results of a 6-year project focused on assessing and providing treatment to suicidal students. An assessment method was developed that combined the authors’ different professional backgrounds and perspectives, psychiatry, and psychology, conferring a solid and holistic approach to suicide prevention.

The authors start by providing a description of the general therapeutic principles that guide relationships with patients, with emphasis on empathy, to help establish the framework from which relational suicide assessments can take place. Descriptions of these principles are extensive, at times drifting into therapeutic challenges other than those directly relevant to suicidal behavior. The first step in this method consists of exploring the client’s risks and resources, following an interview guide that comprises well-known variables distributed into four groups: disruptions and demands, suffering, troubling behaviors, and desperation. After qualitatively establishing risk for suicide, the next steps focus on safety, coming to a decision about how to proceed and finally working on a safety plan. The relational assessment takes into account not only the intrapersonal dimensions of risk and protective factors but also the interpersonal dimensions concerning relationships with significant others and possibilities for safety and therapeutic change. Clinical vignettes and practical examples and suggestions can be found throughout the book, helping the reader to relate the principles described to different scenarios in clinical practice. A final chapter illustrates an entire relational suicide assessment based on a real case.

This book describes basic strategies for managing suicidal patients that, rather than being novel, adhere to concepts developed throughout years of research and broadly used in clinical practice. It gives an account of essential steps that constitute a complete assessment of suicidal behaviors and provides guidance for the novice clinician starting a career in mental health. Experienced clinicians may appreciate the authors’ poignancy, practical suggestions, and empathic perspective central to improving the care required by suicidal individuals.

Now more than ever, our field needs empirically based diagnostic and treatment strategies to tackle this problem. Research to develop and implement tried-and-true treatment for this serious medical outcome is essential to the well-being of our patients. Only in this way will we be able to save lives.

Licínia Ganança, MD

Postdoctoral Fellow

Columbia University

New York

Maria A. Oquendo, MD, PhD

Professor and Vice Chair

Columbia University

New York

and New York State Psychiatric Institute

New York

Back to Top | Article Outline


Dr. Oquendo receives royalties for use of the Columbia Suicide Severity Rating Scale and received financial compensation from Pfizer for the safety evaluation of a clinical facility, unrelated to this study. She has received unrestricted educational grants and/or lecture fees from Astra-Zeneca, Bristol Myers Squibb, Eli Lilly, Janssen, Otsuko, Pfizer, Sanofi-Aventis, and Shire. Her family owns stock in Bristol Myers Squibb.

© 2014 by Lippincott Williams & Wilkins