Parasuicidality and Paradox: Breaking Through the Medical Model »

"This book describes parasuicidality from a different perspective, yet still within the framework of DBT. These concepts will be helpful to clinicians, who often spend much of their time dealing with these troubling behaviors .This book is well worth the price and the reader will not be disappointed." Score: 94, 4 stars

--Doody's

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Reviewer:Gary B Kaniuk, Psy.D.(Cermak Health Services)
Description:This book deals with the issue of parasuicidality using a dialectical behavior therapy (DBT) approach, but posits that clinical interactions aid and abet that specific behavior. It presents both theoretical and pragmatic ideas of how to deal with patients who often pose the greatest challenge to clinicians.
Purpose:According to the author, "this book is about people who repeatedly seek help from professionals for their suicidal or self-injurious behavior." Later, the author continues: "This book is my attempt to document what I've learned about individuals who engage in parasuicidal behavior and to suggest new strategies for working with them," describing the strategies as focusing "on the nexus between individuals with particular existential needs and medical institutions that fulfill these needs."
Audience:Although it's not stated, the book seems to target mental health professionals who see patients displaying parasuicidal behaviors, and clinicians would benefit most. Graduate students in psychology and social work would also gain much from this book, especially in the context of a cognitive-behavioral theory and/or practice course. Dr. Ellenhorn has a PhD in sociology and has worked for over 20 years in the field of mental health.
Features:This book addresses both theory and practice, patients and organizations. Dr. Ellenhorn begins with two caveats: he feels psychological issues are spiritual issues as well, and he is ambivalent about Western medicine, i.e., trying to solve all problems with medication. He discusses at length "patient careerism," the psychological and social factors that help maintain the patient's help seeking over years and even decades. In an interesting chapter titled "The Game," the author defines the game as "a process with specific demarcated goals that cannot be reached by any one strategy." That chapter is followed by a wonderful explanatory figure that highlights the game in the context of a clinical vignette. He presents an interesting technique he calls the hourglass, which is useful for organizing treatment planning meetings. There is also a nice section on risk management including liability, documentation, and supervision. Vignettes are used throughout the book, which is extremely helpful for the reader.
Assessment:This book describes parasuicidality from a different perspective, yet still within the framework of DBT. These concepts will be helpful to clinicians, who often spend much of their time dealing with these troubling behaviors. The vignettes are revealing and instructional. The author doesn't want to simply abandon the medical model, but notes that not everything is solved by psychopharmacology. This book is well worth the price and the reader will not be disappointed.

Foreword   Arthur Freeman     ix
Preface     xiii
Acknowledgments     xxiii
Introduction     xxv
A Theory of Patient Careerism
The Borderline Fallacies     3
The Dialectics of Failure     15
The Patient Career     29
The Practice of The Game
The Game: Treating the Problem of Treatment Seeking     61
The Attitudinal Conditions for The Game     75
Relationship     105
Clinician's Authorship     115
Motivation and Change     129
Organizational Considerations
Deinstitutionalizing Institutions     151
Conclusion: Alienation, Dehumanization, Conformity, and Their Influence on Parasuicidal Behavior     179
References     185
Index     191