Solution-focused therapy in an Emergency Room setting: Increasing hope in persons presenting with suicidal ideation

Summary: One-third or more of persons presenting to Emergency Rooms (ER)/Accident and Emergency departments in psychiatric emergencies report experiencing suicidal ideations. A critical task for hospital-based practitioners is to assess the lethality of the situation to determine whether the person should be hospitalized. Practitioners often employ standardized assessment instruments to assist in determining the suicidal risk factors, yet such measures often fail to recognize or consider the following: 1) the relative importance of the therapeutic process in creating meaningful therapeutic change; 2) the quality of the therapeutic encounter in the ER; and 3) follow-through with the community referral process. Findings: This article proposes the use of the actual ER encounter between client and practitioner to work with suicidal risk factors that are amenable to immediate therapeutic change. Using a therapy approach that can positively impact a client’s level of hopelessness and allow for the assessment of suicide risk can work to ensure that an appropriate hospitalization disposition is reached. Application: This article details how the use of solution-focused therapy provides one avenue for assessing suicide risk and how the therapeutic intervention, which has not been subjected to the scrutiny of empirical research, can serve as an opportunity for increasing hope.