Affective Constellations for Countertransference Awareness Following a Client's Suicide Attempt

The prevalence of suicides and attempted suicides in the United States illustrates the need for resources for counselors who serve suicidal clients. The Centers for Disease Control and Prevention (CDC; 2014) reported the most recent national suicide rate as 12.6 per 100,000. This rate yields an average of 111 suicides per day. In 2009, it was the second leading cause of death for 25- to 34-year-olds and the third leading cause of death for 10- to 14-year-olds and 15- to 24-year-olds (CDC, n.d.). Approximately 1 million U.S. adults per year make a suicide attempt (CDC, 2011). More than 6% of college students have seriously considered suicide in the past 12 months (American College Health Association, 2011). In 2009, approximately 14% of high school students seriously considered attempting suicide, whereas 10.9% made a plan and 6.3% made at least one attempt (CDC, 2010). Suicide and attempted suicide are continuing problems for youth and adults alike. Many counseling practitioners experience a client's suicide or suicide attempt. Almost one in four counselors has experienced the suicide of a client (McAdams & Foster, 2000). A previous suicide attempt is a risk factor and noteworthy suicide predictor (National Institute of Mental Health, 2007). The purpose of this article is to extend the suicide risk management literature by focusing on rebuilding the therapeutic alliance after a suicide attempt. The term suicide attempt has been acknowledged as problematic (Canetto, 1992; O'Carroll et al., 1996; Pompili, Innamorati, & Tatarelli, 2009). Similarly, terms such as failed attempt and successful suicide may unintentionally imply that a person is a failure for not dying or a success for achieving death (Crosby, Ortega, & Melanson, 2011). The term para-suicide has formerly served as an alternative for the phrase suicide attempt (Bille-Brahe et al., 1995). The World Health Organization (WHO; 2015) includes its use in the 10th version of the International Statistical Classification of Diseases and Related Health Problems, in which relevant codes "do not involve differentiation between attempted suicide and 'parasuicide,' since both are included in the general category of self-harm" (WHO, n.d., p. 101). However, in a list of unacceptable terms for describing self-directed violence, the CDC included parasuicide, noting that "the World Health Organization is now favoring the term suicide attempt" (Crosby et al., 2011, p. 23). In the first report on suicide prevention priorities within global public health issues, the WHO (2014) used the term suicide attempt, but not parasuicide. In this article, we use the term suicide attempt and its derivatives following the recommendations and definition provided by the CDC: "a non-fatal self-directed potentially injurious behavior with any intent to die as a result of the behavior" (Crosby et al., 2011, p. 21). The counseling literature on suicide is extensive and grounded in recognizing and assessing suicide risk (e.g., McGlothlin, 2008; Shea, 2002). An Institute of Medicine report (Goldsmith, Pellmar, Kleinman, & Bunney, 2002) on suicide outlined suicide risk and protective factors. Scales such as the SAD PERSONS scale (Patterson, Dohn, Bird, & Patterson, 1983) have been used for decades to help clinicians to identify and document risk factors. More recently, Jobes and Drozd (2004) introduced a collaborative approach to suicide risk assessment. The Collaborative Assessment and Management of Suicidality (CAMS) protocol was developed for outpatient mental health care as a problem-oriented way to focus on suicidality and involve the client in assessing and addressing such risk. The five steps of CAMS are (a) identify the risk, (b) assess the risk, (c) plan the treatment, (d) track the client's suicide status, and (e) resolve the risk (Jobes & Drozd, 2004). Throughout treatment, the clinician and client complete a Suicide Status Form together as a "joint assessment activity" (Jobes & Drozd, 2004, p. …