This pilot study investigated the potential to utilize adaptive treatment strategies for treating moderate to severe suicidal risk among college students. This article will describe the unique study design and report on feasibility and acceptability findings. A 2-stage Sequential Multiple Assignment Randomized Trial (SMART) was conducted: In Stage 1, 62 suicidal college students were randomized to either a suicide-focused or a treatment-as-usual condition (4-8 weeks). Those deemed insufficient responders were re-randomized to one of two Stage 2 interventions-both suicide-focused but one comprehensive and multimodal and the other flexible and theoretically agnostic (4-16 additional weeks). Recruitment rates were high, treatment dropout levels were lower than expected for the setting, study dropouts were rare, and counselors were able to deliver suicide-focused approaches with fidelity. Treatment satisfaction was high among clients and moderately high among counselors. Findings from this pilot show that a SMART is highly feasible and acceptable to suicidal college students, counselors, and campuses.

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Functional Analytic Psychotherapy (FAP) is an interpersonal behavior therapy that relies on a therapist’s ability to contingently respond to in-session client behavior. Valued behavior change in clients results from the therapist shaping more effective client interpersonal behaviors by providing effective social reinforcement when these behaviors occur in or between sessions. One crucial discrimination for therapists to make is the distinction between the topography or physical form of their behavior versus how well or poorly it actually functions to shape client behavior. We notice that there are times when some therapists may focus too sharply on how similar their behavior is to that of a supervisor or prototypical therapist rather than focusing on how effectively their behavior functions as reinforcement. A review of some traditional psychotherapy adherence and competence literature suggests that therapists and supervisors may overly attend to the topography of behavior in assessing treatment fidelity. This paper will suggest strategies to minimize an over-reliance on topography, including shifting the focus from technique to principle.

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