What Works? Building on What We Know to Develop Practice Principles
In this chapter, I propose a series of practice principles for therapeutic talk about suicide. These principles are based on several ways of knowing:
1. The context of clinical experience-what clients teach us about what works
2. The hard-earned wisdom of survivors (people who have been bereaved by suicide) and first voices (people who have lived and struggled with their own suicidal thoughts and actions)
3. The application of solution-focused brief therapy (SFBT) methods, as developed by Insoo Kim Berg, Steve de Shazer, and their colleagues at the Brief Family Therapy Center in Milwaukee (e.g., Berg & de Shazer, 1994; Berg & Dolan, 2001; De Jong & Berg, 2002; de Shazer, 1985, 1988a, 1991a, 1994; de Shazer et al., 2007)
4. What the available literature tells us about what works (see Appendix B for a discussion of the evidence base)
These principles are not rules, guidelines, theories, or “best practices.” “Best practice” in solution-focused therapy is simply what works for a particular client-therapist system. And the current state of empirical knowledge about helpful treatment in suicide intervention is still so limited (Comtois & Linehan, 2006; Hawton, 2000; Heard, 2000; Linehan, 1999a, 2004; Rudd, Joiner, & Rajab, 2001) that our best practice guidelines or standards of care must be regarded as highly tentative works-in-progress. We must be prepared to “take action with imperfect knowledge” (White, 2004). These practice princi-
ples are a description of how I take action-how I approach and work with the most critical resources for helping clients who are struggling with suicidal thoughts or behaviors: their own knowledge, capacities, and communications.