TreaTing DepresseD anD suiciDal aDolescenTs TreaTing DepresseD anD suiciDal aDolescenTs A CliniCiAn’s Guide DaviD a. Brent KimBerly D. Poling tina r. golDstein THe guilForD press new York london © 2011 The Guilford Press A Division of Guilford Publications, Inc. 72 Spring Street, New York, NY 10012 www.guilford.com All rights reserved Except as indicated, no part of this book may be reproduced, translated, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the publisher. Printed in the United States of America This book is printed on acid-free paper. Last digit is print number: 9 8 7 6 5 4 3 2 1 LIMITED PHOTOCOPY LICENSE These materials are intended for use only by qualified mental health professionals. The publisher grants to individual purchasers of this book nonassignable permission to reproduce all materials for which photocopying permission is specifically granted in a footnote. This license is limited to you, the individual purchaser, for personal use or use with individual clients. This license does not grant the right to reproduce these materials for resale, redistribution, electronic display, or any other purposes (including but not limited to books, pamphlets, articles, video- or audiotapes, blogs, file- sharing sites, Internet or intranet sites, and handouts or slides for lectures, workshops, webinars, or therapy groups, whether or not a fee is charged). Permission to reproduce these materials for these and any other purposes must be obtained in writing from the Permissions Department of Guilford Publications. The authors have checked with sources believed to be reliable in their efforts to provide infor- mation that is complete and generally in accord with the standards of practice that are accepted at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the authors, nor the editor and publisher, nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they are not responsible for any errors or omissions or the results obtained from the use of such information. Readers are encouraged to confirm the information contained in this book with other sources. Library of Congress Cataloging-in- Publication Data Brent, David A. Treating depressed and suicidal adolescents: a clinician’s guide / David A. Brent, Kimberly D. Poling, and Tina R. Goldstein. p. ; cm. Includes bibliographical references and index. ISBN 978-1-60623-957-5 (hardcover: alk. paper) 1. Depression in adolescence—Treatment. 2. Adolescent psychotherapy. 3. Teenagers—Suicidal behavior. I. Poling, Kimberly D. II. Goldstein, Tina R. III. Title. [DNLM: 1. Depressive Disorder—psychology. 2. Depressive Disorder— therapy. 3. Adolescent Behavior—psychology. 4. Adolescent Psychology. 5. Suicide—prevention & control. 6. Suicide—psychology. WM 171] RJ506.D4B74 2011 616.85′2700835—dc22 2010028727 Whoever destroys a single life, it is as if he destroyed an entire world. And whoever saves a single life, it is as if he saved an entire world, because each person is a unique creation. Therefore every single person is obligated to say, “The world was created for me.” (Paraphrased from Mishna Sanhedrin 4:5) about the authors David A. Brent, MD, is Academic Chief of Child and Adolescent Psy- chiatry at the University of Pittsburgh School of Medicine and holds an Endowed Chair in Suicide Studies. He is Director of Services for Teens at Risk (STAR-Center), a clinical service for depressed and sui- cidal teens. Dr. Brent has conducted some of the most important work on the risk factors for depression and suicidal behavior in adolescents, and has successfully translated that work into the development and test- ing of effective pharmacological and psychotherapeutic interventions for depressed and suicidal adolescents. He has received wide recogni- tion for his contributions on the assessment and treatment of depressed and suicidal adolescents, including research awards from the American Foundation for Suicide Prevention, the American Association of Sui- cidology, the National Alliance for Research on Schizophrenia and Depression, the American Academy of Child and Adolescent Psychiatry, and the American Psychiatric Association. Kimberly D. Poling, LCSW, is Clinical Program Manager at the STAR- Center, which she initially joined as a therapist in 1987. She has been involved in developing and implementing treatment protocols, training, and supervising cognitive therapists, both in Pittsburgh and throughout the country, and is an expert in the areas of cognitive therapy, diag- nostic assessment, and suicide risk assessment. She has also served as a faculty member at the Center for Cognitive Therapy at the University vii viii About the Authors of Pittsburgh Medical Center and in the Department of Psychology and Education of the University of Pittsburgh. Tina R. Goldstein, PhD, a clinical psychologist, is Assistant Professor in the Department of Child and Adolescent Psychiatry at the University of Pittsburgh School of Medicine. Her clinical and research interests focus on the development and testing of psychosocial interventions for chil- dren and adolescents with and at risk for mood disorders, as well as the prevention and treatment of suicidal behavior in youth. Dr. Goldstein is the recipient of multiple foundation and federal grants for which she conducts, trains, and supervises psychosocial treatment protocols for youth. She has expertise in cognitive- behavioral therapy and dialectical behavior therapy. acknowledgments We gratefully acknowledge all those who have had a critical role in help- ing us find our way. First, we are indebted to Dr. Aaron Beck, the founder of cognitive- behavioral therapy (CBT), for providing the foundation for the treat- ment we have developed. Dr. Robert Berchick and, more recently, Dr. Greg Brown have further helped hone our thinking on the application of CBT for suicidal teens. We appreciate the commitment of all of the Services for Teens At Risk (STAR-Center) faculty and staff, too numerous to list. Several core clinicians at the STAR-Center provided critical contributions to the development of the treatment approach we describe herein: Boris Birmaher, MD Charles Bonner, PhD Mary Beth Boylan, PhD Maureen Maher- Bridge, LCSW Charles Goldstein, LCSW Mary Margaret Kerr, EdD Brian McKain, MSN Grace Moritz, LCSW Mary Wartella, LCSW Susan Wesner, MSN ix
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