وبلاگ خانه تبدیل شباهنگ مرکز تخصصی تبدیل صدا و تصویر
Non-prejudice contracts involve a commitment often signed by the customer that he will not do anything to hurt himself or someone else before a certain date. Often, this date is the next time the client and therapist meet, so the client can be re-evaluated and the contract can be reviewed and re-signed if necessary. Some contracts without prejudice contain specific measures that the customer must take before any harmful behavior. It may be that in the microcosm of suicide prevention, where all rational strategies and predictions dissolve in the face of the impulsivity, determination, prudence and perseverance that are the characteristics of severely suicidal people, and where the distinction between the serious and immediate suicidal person and the neurotically opportunistic parasubicide person with a hidden agenda is often impossible too divine, The non-suicide contract seems to provide an arena where personal connection and human connection make a difference. The non-suicide contract seems to deliver on the promise that the strength of a particular patient`s relationship with a particular clinician will make all the difference in preventing a person from taking the final steps in a long chain of visualized and possibly repeated self-destruction scenarios. In addition, during an initial assessment, especially in situations of high stress and concern for suicide, trying to get a promise of non-suicide from a patient you have just met has the high potential to backfire, as it lends itself to the perception that the clinician is more interested in legalistic self-protection than in understanding the patient`s desperate situation. This, in turn, raises the question of whether the non-suicide contract is relevant and useful only in situations where some sort of therapeutic relationship already exists. The psychiatric literature agrees that a non-suicide contract, when applied, cannot replace the careful and detailed assessment of suicide risk.2-5 It is dangerous to develop absolute diktats in psychiatric practice that go beyond the general understanding against patient exploitation. Assuming that the therapist`s intentions toward a patient are professionally benevolent, questions remain as to what is best for a particular patient in certain circumstances. In the absence of evidence-based practice guidelines – and most daily psychotherapeutic interactions fall into this category – it is impossible to say that a non-suicide contract should never be used.
This modesty of imperatives considers the notion of non-suicide contracts as one of the viable options that the clinician can consider when working with patients at risk of self-harm. There is no good statistical evidence that non-suicide contracts provide more benefits than harms, but the possibility that such negotiations may be useful to some clinicians in certain situations precludes an absolute recommendation against their use. A contract without prejudice is not a contract in the legally enforceable sense. If this client had indeed been injured, it is not as if my agency was suing the client for breach of contract. There is no way to hold anyone there in a meaningful way. With optimism, the refusal to accept a non-suicide contract can be conceived by the suicidal person as a communication with a serious intention to give the clinician the opportunity to intervene. In such a case, the clinician would be insensitive and even negligent if he did not respond to this advice to protect the patient. This is the best thing that can be said of a non-suicide contract as an assessment tool. The problem is how easy it is to understand that refusing to accept a contract without suicide can have many other meanings that focus on combat motives and personality styles, hostile or dependent engagement, victimization mentality, testing a relationship, and the need to raise the stakes and create excitement in one`s life. Conversely, accepting a non-suicide contract can be a dishonest attempt to avoid altering serious suicidal intentions.
The result is that accepting a non-suicide contract does not help assess suicide, and rejecting a non-suicide contract always leaves the clinician perplexed as to the meaning and extent of the rejection. Rudd and his colleagues,11 who start from a cognitive-behavioral model, wrote an interesting article criticizing the conceptual basis and practical benefits of non-suicide contracts. .
