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Relational Suicide Assessment

Risks, Resources, and Possibilities for Safety

3 May 2013


A relational approach to evaluating your suicidal clients.

Given the isolating nature of suicidal ideation and actions, it’s all too easy for clinicians conducting a suicide assessment to find themselves developing tunnel vision, becoming overly focused on the client’s individual risk factors. Although critically important to explore, these risks and the danger they pose can’t be fully appreciated without considering them in relation to the person’s resources for safely negotiating a pathway through his or her desperation. And, in turn, these intrapersonal risks and resources must be understood in context—in relation to the interpersonal risks and resources contributed by the client’s significant others.

In this book, Drs. Douglas Flemons and Leonard M. Gralnik, a family therapist and a psychiatrist, team up to provide a comprehensive relational approach to suicide assessment. The authors offer a Risk and Resource Interview Guide as a means of organizing assessment conversations with suicidal clients. Drawing on an extensive research literature, as well as their combined 50+ years of clinical experience, the authors distill relevant topics of inquiry arrayed within four domains of suicidal experience: disruptions and demands, suffering, troubling behaviors, and desperation.

Knowing what questions to ask a suicidal client is essential, but it is just as important to know how to ask questions and how to join through empathic statements. Beyond this, clinicians need to know how to make safety decisions, how to construct safety plans, and what to include in case note documentation. In the final chapter, an annotated transcript serves to tie together the ideas and methods offered throughout the book.

Relational Suicide Assessment provides the theoretical grounding, empirical data, and practical tools necessary for clinicians to feel prepared and confident when engaging in this most anxiety-provoking of clinical responsibilities.


"Flemons and Gralnik provide an excellent empirically grounded, therapeutically informed approach to suicide risk assessment. . . . [C]ould serve as the starting foundation for a practitioner new to suicide risk assessment and as a catalyst for practitioners who are more knowledgeable and experienced to refine their RSA." — Journal of Psychiatric Practice

"[A]n incredible reference book . . . . every page is filled with useful ideas. . . . I have wanted a book like this for a long time. The traditional methods of suicide assessment that I was taught were never as relational as I believed they needed to be. . . . This book offers a completely new and effective approach that is a combination of clinical wisdom and relevant research. . . . They offer therapists a way to forge ahead and make changes that can help, even while conducting the assessment. . . . I not only recommend this book to those new in the field, but also to experienced therapists who will find much to learn from Flemons and Gralnik. . . . [A] relevant resource book that will be a standard in libraries for years to come." — The Milton H. Erickson Foundation Newsletter

"[O]ffers a thoughtful and thoroughly systemic way of assessing a client’s risk of lethality, and features a tone reflective of the empathic, collaborative style it advocates. . . . [W]ell organized . . . . Well written and thoroughly referenced . . . . [A] valuable, comprehensive resource for all marriage and family therapists, as well as mental health professionals, and would be appropriate for graduate student audiences and beginning clinicians in training." — Journal of Marital and Family Therapy

"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. . . . [G]ives 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." — Journal of Nervous and Mental Disease

"[A] comprehensive book, which should be welcomed by systemic practitioners and clinicians who are routinely undertaking suicide assessments." — Contemporary Psychotherapy

"[A] thoughtful and well-rounded approach to suicide assessment . . . . [A] well organized and thoroughly referenced book. . . . This book is a valuable read for all mental health professionals involved in suicide assessment. . . . Douglas Flemons and Leonard M. Gralnik deserve recognition. . ." — Psychiatric Services

"Informed and informative . . . exceptionally well written, organized and presented, making it a critically important contribution to professional and academic library Psychology/Psychiatry reference collections and supplemental studies reading lists." — Midwest Book Review

"I recommend this book to any therapist who might find themselves dealing with potential suicide, and also to any therapist wanting to deepen and extend their clinical effectiveness. . . . [P]ractical, human ideas and approaches to this terrible dilemma." — Rob McNeilly, author of Healing the Whole Person: A Solution-Focused Approach to Using Empowering Language, Emotions, and Actions in Therapy

Also By: Douglas Flemons View all by author...



165 x 244 mm • 272 pages


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