Treating Depressed and Suicidal Adolescents is a well organized and detailed description of a method to treat adolescent patients developed by the Services for Teens at Risk Center (STAR-Center) in Pittsburgh, Pennsylvania. This book presents a straightforward management recipe with a complete framework easily applicable to most treatment settings. However, despite providing a description of the success that the STAR-Center has had using this approach, the authors do not provide the data in this book to review the utility of this treatment paradigm.
The treatment method described by the team at the STAR-Center in this book draws on skills from many different treatment modalities including cognitive behavioural therapy, dialectical behavioural therapy, interpersonal therapy, family therapy and pharmacotherapy. One of the greater strengths of this book is the numerous case examples described throughout the text to clarify specific tools and skills introduced to follow this treatment method. Another strength of this text is the inclusion of numerous worksheets (some reproducible at the Guilford Press website for those who have unlimbered their wallets to obtain the book) with easy to follow guidelines for clinicians and patients to work through.
The book’s introduction involves a discussion of the evidence for current treatment approaches in the clinical care of depressed adolescents. The authors begin by describing a method for the assessment of adolescents presenting with low mood and/or suicidal ideation. Playing towards the strength of this book, it offers numerous examples and questions to assess the DSM-IV-TR criteria of depression and bipolar disorder. It also guides practitioners through questions related to other mental health diagnoses that may present differential diagnosis challenges including anxiety disorders, eating disorders and substance-use disorders.
The next section presents recommendations for a successful therapeutic environment. This section provides ample details of how to structure and carry out successful therapy sessions including safety planning, creating engagement to therapy, rapport building, psychoeducation and goal setting.
The authors go on to describe specific techniques to be used during therapy sessions with depressed and suicidal teens. One of the more useful techniques that the book describes is chain analysis. This technique enables both therapist and patient to identify the various factors leading up to a problematic behaviour such as a suicide attempt. The text then continues with a discussion of ways to intervene in areas of the chain to reduce the recurrence risk of similar behaviours. The book goes on to include discussion of other features of CBT that are integrated into this treatment method including behavioural activation and addressing negative core beliefs. In these chapters there are numerous worksheets for clinicians and patients including safety planning, chain analysis, treatment planning and the Emotions Thermometer to be used throughout therapy.
The consolidation phase of treatment described next covers the subsequent 3–6 months of treatment. During this phase the book also provides an approach to the treatment of residual symptoms such as sleep difficulty, fatigue and irritability. The authors conclude with a description of the maintenance phase of treatment and its utility to reduce relapse in the critical first year of remission from depression.
Also of utility to clinicians working in this field is the chapter on treatment-resistant depression. This chapter identifies features of treatment resistance and its clinical significance in the adolescent population. It also provides insight into identifying risk factors that may predispose patients to treatment resistance. The chapter concludes with suggestions for the management of specific predisposing factors associated with treatment-resistance.
We recommend this book as a valuable asset for clinicians who work with depressed and suicidal adolescents. Its user-friendly approach of incorporating psychotherapy and pharmacotherapy approaches makes it a handy quick reference to keep in the office. The emergency room mental health clinician will also likely benefit from the book’s review of safety plan development and implementation, which may be particularly beneficial in the management of patients being discharged from the emergency room.