Tony White is a registered psychologist in private practice in Perth, Australia. He is also a teacher and supervisor of Transactional Analysis psychotherapists.
Part 1. Understanding Suicide. 1. Introduction. 2. What is Suicide? 3. Transactional Analysis. 4. The Suicide Decision. 5. Modeling Suicidal Behavior. 6. Reactions to High Stress. 7. Suicide and Self-Harm. Part 2. Assessing Suicide Risk. 8. Quantitative Measures of Assessing Suicide Risk. 9. Qualitative Measures of Assessing Suicide Risk. Part 3. Supporting the Suicidal Individual. 10. The Suicide Secret and the Deliberate Suicide Risk. 11. Pseudo-Suicide, Suicide and Teenage Suicide. 12. Suicidal Ambivalence. 13. Suicidal Timelines. 14. The No-Suicide Contract. 15. Redecision Therapy. Epilogue. Appendix A: Stopper Analysis. References. Further Reading. Index.
This book is aimed at counsellors using transactional analysis (TA) as theirmethod of intervention. However, it is relevant to social workers given itsfocus on suicidality as a psychological state. The author introduces himself asa counsellor and psychologist, adding that his own teenage attempts atsuicide have afforded him a deeper understanding of the subject. Confidencein his therapeutic approach appears to be based on his recommendation thathe never had a client complete suicide'. The book is divided into three sections:Understanding suicide', Assessing suicidal risk' and Supporting the suicidalindividual'. In the first, White explains TA with reference to Berne's text TheGames People Play (1964), which proposes three aspects or ego states in thepersonality: the parent, adult and child. The author describes how each ofthese states is constituted and the importance of the transactions between theego states of different people, such as how parts of a parent's ego state relateto parts of a young child's ego state. In explaining the Suicidal Decision', heoutlines how, through transactions with an unsatisfactory parent figure, ayoung child can develop one of seven types of a Suicidal Decision', whichthen resides forever in the Child Ego State'. He argues that we can alsomake and retain a Suicide Decision' due to a transaction with a suicidalparent, which leads to a copying of parental suicidal tapes' in the child'sParent Ego State'. He further argues that, when a person is stressed, aflight' response of regression to the Suicide Decision' located in the ChildEgo State' occurs.Turning to assessment of risk and quantitative assessment', White suggeststhat an actuarial approach cannot predict individual suicides. Instead, hisfocus is assessing factors that increase the risk of suicide, such as substanceuse, mental illness and previous history of suicide attempts. White thenadvises on how to approach a risk assessment of a depressed or psychotic suicidalperson. The discussion of a qualitative assessment draws on the theoryBook Reviews 1615Downloaded from http://bjsw.oxfordjournals.org/ at Apollo Group on June 27, 2013of the Suicide Decision to suggest therapeutic techniques that can be used toassess the type of Suicide Decision that has been made.The section Supporting the suicidal individual' provides a discussion of theconcept of suicide ambivalence. White refers to suicidal ambivalence' inwhich the Free Child' wants to live and the Adapted Child wants to Die' sothat all suicidal people have some desire to stay alive, which creates an opportunityto give help. Through the therapists' engagement with both the FreeChild and Adapted Child Ego States, the person's self-awareness developsand the therapist can assess which is the most dominant. Next, the author introducesthe No Suicide Contract (NSC) based on the client's self-responsibility',which is used as a tool to buy time', though he emphasises by citing researchthat NSC does not in itself prevent suicide. The final discussion of RedecisionTherapy' involves a process of encouraging a rebellious child' to emerge andreject the modelling of parental suicidality held in the Adapted Child'.The section on support considers different groups such as teenage suicides, ofinterest to social workers, who regress more easily into their Child Ego State'and may engage in magical' and unrealistic' thinking that they will be aroundto watch how people respond to their death and do not comprehend death.White develops a psycho-dynamic discussion of self-mutilation and differentiatesthis group due to their low suicidal intent and he also discusses peoplewho make many failed attempts, often in contact with social workers, and stressesthat someone who makes many unsuccessful attempts may succeed.The author refers to case studies from male prisons, so there will be a particularinterest for social workers practising in a prison setting. The prisoners knownto be suicidal were on suicide watch' so that the therapy occurred in a controlledsetting. For an ordinary social worker encountering suicidality, thetext should probably be read for the added insights it gives rather than as arecipe for practice, since social workers are usually not trained in TA counselling,nor are they perhaps practising in a controlled setting.Linda de ChenuSenior Lecturer in Social Work, University of HertfordshirePsychologist Tony White delivers a commanding exposition in his guide to providingunderstanding, assessment and support in working with suicidal individuals. At theoutset, Tony describes his first hand experience of the associated affective stateby sharing that he twice attempted suicide as an adolescent. This was clearly aprofound personal experience and one that has enabled a unique inside view ofthe area of suicide and comes across particularly strong in the area of teenagesuicide in this book.The book is divided into three parts. Understanding suicide; assessing suicide riskand supporting the suicidal individual. Building his model around Eric Berne'stransactional analysis and supplementing this with attachment theory, he provides arobust framework with which to explore the varied and complex existential reasonswhy someone may seek suicide as a solution and to understand their motivations.This is an accessible model that will indeed be useful for frontline clinicians andpractitioners who will be able to conceptualise in more depth, the potentialpresenting influences that may be in the consulting room such as the nature ofhuman communication, transactions, the driving force of historical figures and theirrelationship to the unconscious.The mind here is conceptualised as a series of tapes that are laid down at keyareas of development throughout the life course. This is particularly helpful whenconsidering the assessment of the suicidal individual and offers clear paths to tailorintervention strategies accordingly. Moreover, the integration of both quantitativeand qualitative measures of risk, points the reader to a more comprehensive andindividualistic assessment. Chapter 14 on the no-suicide contract should proveparticularly powerful for frontline clinicians engaged in this emotionally chargedtask. There is clear guidance about theoretical framework behind this interventionand when and who it works well for. The no-suicide contract iceberg is a usefulshort-hand conceptualisation for understanding the complexities of contracting withvulnerable individuals. Case studies are woven throughout the text and capablydemonstrate the theory and the practice of this approach.In the therapy section a gestalt like or whole form approach is sought to defineprinciples of perception through the use of a two-chair technique to permitregression, in order to achieve the same emotional and physiological states ofarousal as occurred when the first set of state-dependent learning was achieved.The extra chair here, representing the critical parent ego state and the potential torework this and integrate into the adult self.Transactional analysis can have its limitations. Purist object relation theorists mayargue that from the standpoint of the ego, suicide is, first of all, an expression of thefact that the terrible tension the pressure of the superego induces has becomeunbearable. To have a desire to live evidently means to feel a certain self-esteem,to feel supported by the protective forces of the super ego. When this feelingvanishes, the original annihilation of the deserted hungry baby reappears.Tony White's dynamic psychology has the task of reconstructing, from certain givenmanifestations, the constellation of forces that produced the manifestations. Theclient work demonstrates significant effort to enable a more direct expression of itsdynamic foundations and will be essential reading for frontline practitioners andclinicians working with people at risk of suicide and harm in the neurodisability field.William HarperTeam Manager, Islington Assertive Outreach Team
