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and communicate with other treating clinicians.
Provide careful and adequate documentation,
including assessment of risk, communication with other clinicians,
the decision-making process, and the rationale for the treatment
Attend to problems in the transference and
countertransference and be alert for splitting.
Consider consultation with a colleague for
unusually high-risk patients, when a patient is not improving, or
when the best treatment approach is unclear.
Follow standard guidelines for terminating
Consider providing psychoeducation about
the disorder (e.g., risks of the disorder and uncertainties of treatment
Assess the risk of suicide; the potential
for angry, impulsive, or violent behavior; and the potential for
patient carefully for suicide risk and document these assessments.
Actively treat comorbid axis I disorders,
with particular attention to those that may contribute to or increase
the risk of suicide.
Take suicide threats seriously and address
them with the patient.
Consider consultation and/or hospitalization.
In the absence of acute risk, address chronic
suicidality in the therapy.
Consider involving the family when the patient
is either chronically or acutely suicidal.
Do not allow a "suicide contract" to
substitute for a careful and thorough clinical evaluation of the
patient carefully for impulsive or violent behavior.
Address abandonment/rejection issues,
anger, and impulsivity in the treatment, because they may be triggers
Arrange for adequate coverage when away;
carefully communicate plans for coverage to the patient and document
If threats toward others or threatening
behavior is present, action may be necessary to protect self or
and explore countertransference feelings toward the patient.
Be alert to deviations from the usual way
of practicing (e.g., appointments at unusual hours), which may be
signs of countertransference problems.
Avoid boundary violations such as the development
of a personal friendship outside the professional situation or a
sexual relationship with the patient.
Get a consultation if there are striking
deviations from the usual manner of practice.