A brief overview of safety planning in interpersonal reconstructive therapy.

Abstract

Most research to date with Interpersonal Reconstructive Therapy (IRT: Benjamin, 2006) involves application with patients who qualify for the acronym "CORDS": Comorbid, Often Rehospitalized, Dysfunctional, and Suicidal. A case formulation (CF) based on interpersonal copy process theory defines links between presenting symptoms and patterns of affect, cognition, and behavior that invoke safety or threat and were learned and internalized in close relationships. The "gift of love" (GOL) hypothesis is that the wish to receive love and acceptance from specific internalized attachment figures organizes and propels problem patterns and their associated symptoms. Through a series of steps, IRT seeks to help patients become aware of and learn about their copied patterns, including where they were learned, the role they play in maintaining connection with internalized attachment figures, and their functions in the present. The goal is to help a patient differentiate from their "family in the head" and pursue healthy behaviors and self-concepts. With awareness and differentiation comes the possibility of letting go of problematic quests for love and acceptance from the internalized attachments and to choose healthy alternatives instead. As an integrative method, safety planning in IRT shares much with other approaches. What is unique is how therapists utilize the CF to guard against unsafe behavior as an ongoing part of the treatment process with patients with suicidality. This article provides an overview and illustration emphasizing these unique aspects of the IRT approach to safety planning in the context of individual psychotherapy with adults.Clinical Impact Statement Question: The article describes how safety planning and crisis management are implemented in Interpersonal Reconstructive Therapy (IRT: Benjamin, 2006, 2018. Findings: IRT emphasizes tailored intervention based on a case formulation that links current problems and symptoms to messages about safety and threat internalized in close attachment relationships. Meaning: A clinical case example is used to illustrate helpful application of the approach. Next Steps: Ongoing work is underway to validate IRT principles and train their use.

The essentials of creating effective safety planning-type interventions for suicidal patients.

“…Psychotherapists can use SPTIs as part of a comprehensive intervention. For example, Bryan and Rudd (2018) used crisis response plans as part of their cognitive behavioral treatment program for suicidal patients, Jobes (2016) included a stabilization plan as part of his Collaborative Assessment and Management of Suicide (CAMS) program, Weinstein et al (2021) used an empowerment plan as part of Acceptance and Commitment Therapy, and Critchfield et al (2022) used safety plans in interpersonal reconstructive therapy. Also, crisis intervention programs, emergency departments, or psychiatric hospitals can use SPTIs as a stand-alone intervention or as part of a discharge plan.…”

Introduction to the special section on suicide and crisis management in clinical practice: Theoretical and practical integration.

“…A second set of articles demonstrates the application of the Stanley and Brown Safety Planning Intervention in a juvenile detention setting (Rudd et al, 2021) and through alliance-focused training (Barzilay & Bloch-Elkouby, 2021). The final collection of articles shows the unique application of three theoretical models to enhance standardized methods of suicide and crisis assessment and management including dialectical behavior therapy (Alba et al, 2022), interpersonal reconstructive therapy (Critchfield et al, 2021), and motivational interviewing (Micol et al, 2021).…”