In this conversation, Dan chats with Dr. Matthew Large about his experiences in the field of mental health, his research on suicide prediction, and how Suicide Risk Assessment can often times be ineffective.

Dan and Dr. Large dive into a number of hard-hitting topics in this 7th episode: the challenges of balancing clinical work and research, the limitations of Suicide Risk Assessment, and more! Dr. Large shares personal stories on their career and what led to a life in medicine and psychiatry. They also touch on the progress and changes in the field of mental health, including the closure of asylums and the improvement in the treatment of mental illness. The conversation explores the limitations of suicide risk assessment and the over-reliance on categorizing patients as high or low risk. Dr. Large touches on how risk assessment tools have modest predictive abilities and that suicide is a complex and unpredictable phenomenon. Dan and Dr. Large suggest that clinicians should prioritize building rapport with patients and providing individualized care rather than relying solely on risk assessment.

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In this conversation, Dan speaks with Dr. Scott Miller about improving psychotherapy using feedback and using feedback to facilitate deliberate practice.

The conversation covers Scott's journey in the field of therapy, his experiences in different settings, and the development of feedback-informed treatment (FIT). FIT involves soliciting formal feedback from clients about their progress and engagement in therapy. The therapist uses this feedback to tailor the treatment to better fit the client's needs. The conversation also touches on the importance of monitoring outcomes and the challenges of implementing feedback-informed care. In this part of the conversation, Scott and Dan discuss the importance of measuring progress and using feedback to inform treatment decisions. They emphasize the need to consider adding or removing elements from the treatment plan if there is no progress after a certain number of sessions. They also discuss the concept of outcome-focused treatment and the importance of involving the client in the decision-making process. Scott shares an analogy from medicine to illustrate the need for a collaborative approach to treatment. They also discuss the challenges and objections to implementing measurement-based care, including concerns about burdening clients and the need for training and support for clinicians. They highlight the benefits of using feedback measures to facilitate conversations about termination and the potential for improving outcomes through deliberate practice.

Special Guest:
Dr. Scott Miller: Make sure to check out Scott's website which is full of useful resources!

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🎞️Video version of the show@PsychotherapyAppliedPsychology on YouTube
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In this conversation, Dr. David Klonsky dives deep into the Three-Step Theory of Suicide, explaining why some people consider suicide and some attempt suicide.

We begin the conversation with Dr. Klonsky talking about his side interest in combat sports and the psychology behind it. He shares his experience in martial arts and how it has influenced his understanding of the mental and emotional aspects of fighting. Dr. Klonsky also talks about his work as a consultant and analyst for combat sports, including his appearances on the Fight Network. He explains the importance of emotional readiness in combat sports and the role of approach-oriented emotions like excitement and anger. Dr. Klonsky emphasizes the need to overcome fear and interpret it as a natural response rather than a sign of unreadiness.

The main theme of the conversation is the study of suicide. The three-step theory is discussed, which includes the conditions under which people feel suicidal, the intensity of suicidal desire, and the capability to attempt suicide. Pain and hopelessness are identified as key factors in feeling suicidal, and the aversiveness of life is explored as a driving force behind suicidal ideation. The importance of understanding the distinction between suicidal ideation and suicide attempts is emphasized. The conversation explores the necessary conditions for suicidal desire, which include overwhelming pain, hopelessness, low connectedness, and capability. Pain and hopelessness are the primary motivators for suicidal desire, while connectedness acts as a pull towards life. Capability refers to the ability to overcome the barriers to suicide, which can be acquired through experience or dispositional factors. Mental illness, such as depression and post-traumatic stress disorder, can contribute to pain, hopelessness, and capability, increasing the risk of suicide. Understanding these factors can empower clinicians to intervene effectively and prevent suicide.

Special Guest:
E. David Klonsky

The following paper was referenced in the show:
The three-step theory of suicide: Description, evidence, and some useful points of clarification

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🎞️Video version of the show@PsychotherapyAppliedPsychology on YouTube
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📬TheAppliedPsychologyPodcast@gmail.com