Psychotherapy outcomes for suicidality based on modality type

Individual, group, family therapy

There is an interesting article published yesterday, 07/02/25, in the Clinical Psychology and Psychotherapy Journal reporting on a meta analysis of the effectiveness of individual, group, and family therapy on suicidality.

The topic is of great interest to me because in my career of 56 years as a Psychiatric Social Worker I estimate I have done over 15,000 suicide evaluations, as many as 11 in one day when working as a Psychiatric Assignment Officer in a large urban hospital in Rochester, NY.

Based on my clinical experience and observation I already realized that a combination of modalities is the most effective treatment plan in most cases and in fact that is what the meta analysis found. When individual therapy was combined with group and/or family therapy outcomes were better.

This meta-analysis highlights that combined psychotherapy approaches, integrating individual sessions with group or family sessions, yields significantly higher effect sizes, reducing the risk of suicide attempts by 50%. These findings support the adoption of combined therapeutic strategies in clinical settings to effectively address suicidality. (https://onlinelibrary.wiley.com/doi/10.1002/cpp.70112?af=R, accessed on 07/03/25)

I am currently working with a family where the mother has been hospitalized twice in the last year for suicide attempts. I have used a combination of individual sessions with the four family members as well as combination sessions.

The therapeutic work has taken many twists and turns and what one might expect has turned out to not be accurate and what one might not expect emerged. Murray Bowen describes families where there is a schizophrenic member in which roles can change and the person labeled “schizophrenic” turns out to be one of the healthier members of the family whereas the “healthier appearing” family member starts showing signs of significant psychiatric symptoms.

Dr. Bowen’s teaching led to the appreciation of the system’s view of mental illness and contributed to an understanding of the strategic family therapy phrase, “What is the function of the symptom for the system?”

So what does suicidality in a family member indicate about the family system? Can the family system be ignored as we focus on the symptomatic member alone? If we ignore the social context of our client will we achieve as good an outcome ameliorating the suicidality of the identified patient? Now we have some research that validates practice wisdom which indicates that focusing on the individual’s suicidality alone will not get as good an outcome as taking into account the individual’s interpersonal relationships.

Lastly, and it's a whole other topic, how do we chart and bill for such work and how does compliance with a medical model and its practice hamper and constrain effective therapy?