Therapeutic Interventions in Life‐threatening Situations*

Abstract

Therapists who encounter life‐threatening behavior in their clinical practice are at risk in providing interventions which do not take into account the systemic effects of their interventions. Specifically, therapists are likely to engage in “more of the same” behavior with clients who present with suicidal or homicidal threats. This paper presents two case studies that employed therapeutic methods derived from the systemic therapy of the Palo Alto group. In these case studies, the author illustrates the importance of the therapist's ability to speak the client's language in formulating an intervention that has the potential for reducing the likelihood of actual violence. The first case illustrates the use of the client's world view about her situation to assist her in dealing with domestic violence. The second case presented describes the use of systemic interventions in the case of a young woman known to have made homicidal threats. The author discusses the appropriateness, as well as the ethical issues, of the techniques described. Also offered, is a discussion clarifying the theoretical underpinnings of the clinical work presented and an amplification of some of the ideas originally presented by the Palo Alto group.

Strategies for Managing Difficult Clinical Situations in Between Sessions

“…Conceptualizing crises within the family context and process allows a therapist to not be debilitated by content of an unexpected therapeutic event. A firm systemic grasp on the homeostatic nature of family events and the feedback mechanisms within them provides a reframe of crises that ensures a map for the therapist on how to proceed (Bobele, 1987: Everstine and Everstine, 1983). Case consultation after crisis-involved sessions is often very useful.…”

Systemic Thinking in a Linear World: Issues in the Application of Interactional Counseling

“…From the systemic point of view, spouse abuse is a relationship problem (Bobele, 1987;Margolin, 1979;Nichols, 1986;Straus et al, 1980). The "perpetrator" and the "victim" have co-created a system in which the events leading to and including the violent act have a unique meaning that can be understood only within the context of the relationship.…”

“…To illustrate the issues inherent in the implementation of systemic approaches, spouse abuse is used as an example throughout this article. Although systemic approaches have been successfully used in such cases (Bobele, 1987;Margolin, 1979;Nichols, 1986;Straus, Gelles, & Steinmetz, 1980), the purpose here is not to suggest that the systemic approach should be the treatment of choice or to debate the relative merits of various treatment approaches to this problem. Instead, couple violence is used to illustrate the unique challenges involved in the application of interactional approaches.…”

Disarming People With Words: Strategies of Interactional Communication That Crisis (Hostage) Negotiators Share With Systemic Clinicians

“…I believe that considering the context of behavior is particularly important when intervening in life-threatening situations. Ignoring the interactional context of threatening behavior risks the likelihood of increasing it (Bobele, 1987).As a systemically trained therapist, I strive for the flexibility to establish meaningful conversations in unlikely, intense, unpredictable circumstances. I am trained to manage the intense dialogue that occurs between family members in a session.…”

“…I believe that considering the context of behavior is particularly important when intervening in life-threatening situations. Ignoring the interactional context of threatening behavior risks the likelihood of increasing it (Bobele, 1987).…”