A review of patient satisfaction with the Attempted Suicide Short Intervention Program

Article in Review: Ring, M and Gysin-Maillart, A (2020) Patients’ Satisfaction with the Therapeutic Relationship and Therapeutic Outcome is related to the Suicidal Ideation in the Attempted Suicide Short Intervention Program (ASSIP). Crisis, 41(5), 337-343

Summary: This article reviews research undertaken into the outcomes for the ASSIP program, a brief psychotherapeutic intervention for suicidality.

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There is a growing body of evidence that suggests that psychosocial interventions are effective in reducing repeated suicidal behavior and long-term suicide risk. However, in many cases, it proves difficult for patients to obtain a high treatment adherence to long-term therapies. This could be because patients do not believe that they need ongoing support. Or, it could be because patients find themselves in what they feel to be a hopeless situation.

Psychotherapy has now been acknowledged as one key element of therapeutic suicide support in numerous studies. In 1979 Bordin investigated the contributing factors that would help establish a good working alliance between the patient and the therapist. To establish this relationship, Bordin recommended that the patient and therapist reach an agreement about the goal and tasks of the therapy, as well as forming a personal and affective bond.

Later research has reinforced the importance of the patient-therapist bond. This relationship is key to a successful treatment, this bond much be created before the commencement of the

• real relationship
• creation of expectations through an explanation of the disorder and treatments
• enactment of health promoting actions.

A good therapeutic relationship can mean less conflict between patient and therapist, as they work together towards goals.

ASSIP Session structure
The Attempted Suicide Short Intervention Program (ASSIP) is a highly structured program for working with individuals who have attempted suicide. In comparison to longer term strategies, ASSIP is brief- a structured three sessions of therapy, with the offer of ongoing contact once the program is completed. This model seems to enable patients to develop a better understanding of acute suicidality, enabling an improved sense of control at any future crisis.

• In the first session, patients are filmed as they tell the story of their suicide attempt in their own words.
• In the second session, patients review the video in order to identify tolerance issues and triggers.
• In the third session, the case is conceptualised and personal safety strategies are revised.

This is followed by regular semi-standardised letters over the course of two years.

Satisfaction with ASSIP
This study by Ring and Gysin-Maillart (2020) was to better understand patient satisfaction and outcomes for those completing the ASSIP model of treatment. A total of 120 participants who had attempted suicide were involved in the study, 66 females and 54 males. Participants had to fit study criteria, namely, that had presented to the study hospital following a suicide attempt. Exclusion criteria included insufficient language, severe cognitive impairment, current psychotic disorders, or antisocial personality disorders.

After the first session, there were no significant differences in patient satisfaction between the control group and the ASSIP group. However, the ASSIP group was more satisfied with the therapeutic relationship and the outcome from the first session to the third.

At one and two years after participation in the program, the higher patient satisfaction with the therapeutic relationship and the program outcomes were both associated with lower suicide ideation.

The high degree of structure in the ASSIP program is thought to have helped patients and therapists create authentic and patient-centered collaborative approaches to participants in this study. Both the relationship between the therapist and patient, and the structure offered by the ASSIP model are recognised as contributors to a reduction of suicide ideation in this study