As a reader, I often find myself skipping over much of a book's Foreword, so let me get straight to the point. With the publication of this book, there is now no better guide for learning about and clinically assessing the phenomenology of suicidal states. Penned with compelling elegance and charm, The Practical Art of Suicide Assessment is brimming with clinical wisdom, enlightening case illustrations, and a vibrant sense of compassion. Writers of Forewords have a tendency to proclaim that the book in hand is a "must-read" for every clinician. This time it is actually true.
Shea has an almost unparalleled way of making sense out of the complex interplay of the biopsychosocial and philosophical forces that lead a human to take his or her own life. What at first glance seemed senseless, murky, and intangible becomes palpably real to the beginning clinician. Shea then offers a practical, commonsense, and accessible approach to systematically assessing the nuances and essentials of suicidal thoughts, plans, and behaviors. He walks the student through this process step by step, offering numerous examples of useful questions and fascinating excerpts of clinical dialogue.
For the seasoned clinician, this book is no less valuable. The most daunting and complicated clinical scenarios are dealt with plainly and with a no-nonsense approach, from emergency-room assessments of psychotic patients to borderline "suicide talk" at 2:00 A.M. Controversial topics such as the usefulness or uselessness of safety contracts and the role of the clinician's own thoughts and biases toward the topic of suicide are discussed head-on and with a refreshing candor. Shea never talks down to his readers; rather, he shares himself and his techniques with matter-of-fact openness.
He reminds us of the inherent challenges and rewards that are central to the life-and-death arena of clinical work with suicidal patients. As the seasoned clinician reads, old facts are suddenly seen with a new light. Seemingly disparate clinical encounters garnered over years of clinical experience become connected by underlying principles that can be immediately applied to the next clinic day. There is an earnest quality to the writing. Shea's sharing of his clinical vignettes highlights the importance of timing, patience, technique, and the acceptance of our own mistakes and failures.
No less would be expected from this author. This same sense of an always-welcome "beginner's mind" was one of the irresistible qualities of his first book, Psychiatric Interviewing: The Art of Understanding, now in its second edition. That classic text was my original introduction to Shea. As a teacher of graduate students in clinical psychology and counseling, I was delighted when I discovered it. The book is rich with case presentations, vivid clinical dialogues, theoretical eclecticism, empirical underpinnings, literary style, personal wit, clinical acumen, and undeniable readability. I can't think of any other book that my graduate students enjoy as much, or talk about with more enthusiasm. In my view, Psychiatric Interviewing: The Art of Understanding is unequivocally the best beginning text for mental health professionals, no matter what their discipline. I am delighted to say that the present effort is a worthy successor to this previous work.
As a career suicidologist, I marvel at Shea's almost uncanny ability to grasp, embrace, and extend what we know about effective clinical work with suicidal patients. While plainly a master clinician, Shea is nevertheless a relative newcomer to the subspecialization of clinical suicidology. The freshness and vitality of his approach take us to a new level of clinical understanding.
His most striking contribution to the practical assessment of risk is his innovative interview strategy for eliciting suicidal ideation itself, a strategy he calls the Chronological Assessment of Suicide Events (the CASE Approach). The CASE Approach is a remarkably pragmatic and systematic interview strategy that enables clinicians to flexibly and comprehensively assess the nooks and crannies, the ins and outs, of different suicidal states. The CASE Approach moves the clinician almost imperceptibly into the secret internal workings of the mind and soul of a patient tormented by suicidal ideation. From this shared phenomenological exploration, the client's immediate risk becomes much clearer. I believe that the CASE Approach is a remarkable conceptual and clinical contribution to the field of suicidology. It should be routinely taught to any frontline clinician. It has the power to meaningfully save lives.
Shea's work complements other recent work by leading clinical suicidologists who are increasingly emphasizing the importance of understanding the power and seduction of suicide for those who are experiencing unbearable pain and despair. Shea wisely walks us through a nonjudgmental, systematic, thoughtful approach to appreciating the attraction of suicide as an apparently viable solution to ending this pain. In so doing, he helps us understand how we can help a patient to seek alternative solutions. This searchnot always, but oftenleads to hope, renewal, and the choice of life over death.
In the last analysis, this is a very human book about the very human struggles of people who find themselves standing at the precipice of eternity. Shea helps us to understand their exquisite pain, and that understanding gives us the capacity to reach out to those who are at this precipice. I have no doubt that the reader will find herein the skills and the confidence to enter the world of these acutely suicidal patients, to sensitively yet tenaciously ask the right questions at the right times, and to enter their world of suicidality with as little pre-judgment, fear, or bias as one can manage. The gentle wisdom of this book allows us to discover within ourselves the capacity and courage to help such patients make seemingly unlivable lives once again livable, creating new life and new hopean important, if not noble pursuit.
DAVID A. JOBES, PhD
President, American Association of Suicidology Associate Professor of Psychology
The Catholic University of America, Washington, DC