We were very pleased to announce an impressive interview with Prof. Robert J. Gregory, who has just published an outstanding article in the International Journal of Environmental Research and Public Health (IJERPH, ISSN: 1660-4601). In this interview, we delve into the latest advancements, challenges, and future directions of his research.

Name: Prof. Robert J. Gregory

Affiliation: Department of Psychiatry and Behavioral Sciences, SUNY Upstate Medical University, Syracuse, NY 13210, USA

Interests: borderline personality disorder; suicide prevention; addictions; psychotherapy

Published Paper: “Dynamic Deconstructive Psychotherapy for Suicidal Adolescents: Effectiveness of Routine Care in an Outpatient Clinic”
by Rebecca J. Shields, Jessica P. Helfrich and Robert J. Gregory
Int. J. Environ. Res. Public Health 2024, 21(7), 929; https://doi.org/10.3390/ijerph21070929
Article Link: https://www.mdpi.com/1660-4601/21/7/929

The following is an interview with Prof. Robert J. Gregory:

I am a researcher, clinician, and teacher, and I was part of a regional youth mental health task force. Back in 2016, one of the recommendations from that task force was to improve care for suicidal individuals in our region. Since around 2007-2008, adolescents in the United States—and to some extent worldwide—have not been doing well. Even before the pandemic, there were rising rates of suicide and suicide attempts. In fact, during that time in the United States, there was a fivefold increase in adolescents coming to emergency rooms for suicide attempts or suicidal thoughts. The health system was overwhelmed, and we did not have adequate services for them. Frankly, we still do not have enough.

In 2017, I established a program called the Psychiatry High Risk Program, specifically for suicidal teens and young adults. The program utilizes an evidence-based psychotherapy that I developed about a decade earlier, called Deconstructive Dynamic Psychotherapy (DDP). Although DDP was well researched, it had not been used specifically for suicidal individuals. We decided to apply it to this population because it targets core vulnerabilities that lead to suicide—vulnerabilities such as impaired emotion processing, poor self-compassion, feelings of worthlessness, and a sense of alienation and isolation.

The goal of DDP is to address these core vulnerabilities over the course of up to a year, offering transformative healing rather than just helping people cope with their psychiatric disorders. Our recent study focused on adolescents aged 13 to 17 in our program. We looked at 65 consecutive adolescents who were highly suicidal, with a median of seven lifetime suicide attempts per person. Over six months, there was an 84% reduction in suicide attempts and a significant reduction in suicidal ideation. We also saw broad improvements in depression, anxiety, self-compassion, social functioning, and school performance, as well as a two-third reduction in emergency room visits and hospitalizations, saving an average of four hospital days per patient.

There is little research on adolescent suicide interventions, and our recovery-based approach seems to be working. I hope other institutions will consider adopting a similar model, as there is nothing about our program that cannot be replicated in other communities.

One of the challenges that we face is that this is a self-supporting program. We do not receive any state funding or other government support. We have received some donation money, which has been very helpful and has allowed us to conduct certain studies. One particularly helpful aspect was working with a few managed medical companies to secure slightly higher reimbursement rates. Unfortunately, the state did not cooperate, as they have a different, more short-term model in mind. However, the managed medical insurance companies were willing to work with us given our outcomes, especially since we were saving them a significant amount of money by reducing hospitalizations. This has allowed us to treat those patients who may not have private insurance or the means to afford it.

In terms of dissemination, I have found that it can be a significant challenge for any innovative treatment model. People are often skeptical of data unless they see patients improving with their own eyes. We have had some interest from different places around the world, and we have conducted training in Mexico and Israel and a residency program in North Carolina. We have also trained staff at a hospital in San Diego. However, progress is slow because of skepticism. Once people see the power of the method, especially in adolescents or young adults who have not responded to multiple other treatments, they become much more open to it.

Globally, the trend is moving in the opposite direction towards short-term interventions such as ten-session CBT or three-session approaches. While these have their benefits, particularly in helping people become less suicidal and get through a crisis, they also have limitations. Because these approaches are so short-term, they do not address the core vulnerabilities, which means that they do not break the cycle of chronicity. As a result, people may still be at risk when the next major stressor arises.

I hope it inspires them to see that there is another way—that they actually can make a difference. Many of the therapists I train, both regionally and internationally, are feeling burnt out. They feel like they are in a mill, trying to do the best they can, but no one is getting better, and clients keep cycling back into the clinic. This can be very discouraging. However, one thing that I have noticed with the training is that the morale of the therapists I train significantly improves. After initial skepticism, when they start seeing changes in their clients, they get really excited about it. Almost no therapist who begins training leaves; nearly all of them continue because they are inspired by the transformational changes they witness.

There is so much psychotherapy today that is ineffective, more akin to hand-holding and offering advice to get people through crises. Compared to 20 or 30 years ago, many have given up on psychotherapy as a solution. It can be hard to even get psychotherapy studies published, because not everyone realizes that not all therapy is the same. The counseling you might get in the community is very different from evidence-based, focused, structured psychotherapy. Many people are turning to quick solutions for their suicidality—a better drug, a new boyfriend or girlfriend—without realizing that more transformative healing is possible. They do not need to live the rest of their lives suffering from depression and suicidal thoughts.

Most of our clients have been struggling with suicidal thoughts since at least their early teens, and they are amazed and relieved when those thoughts finally go away for the first time in their lives. I have had clients tell me that they have been on their knees in their living room, with tears streaming down their faces. They are finally free from depression and suicidal thoughts. It is an incredibly gratifying treatment for the therapist as well. In most clinics, there is a lot of staff turnover, but we have almost zero turnover because therapists feel like they are finally making the kind of meaningful impact they hoped for when they entered the field.

I would say, contact me or email me at my email address. I am the corresponding author on the paper published. Email me to express an interest in collaboration. In fact, that is how the collaborations with Israel and Mexico started. Very often, it begins that way, and then we conduct research and publish together. It is about getting the word out. I love to collaborate, and it is definitely possible to do that.

I thought the process was a very good one. Publishing in IJERPH followed a rigorous scientific process. The peer reviews I received were objective and very helpful. We had two peer reviews as part of the manuscript submission process and were able to make the necessary changes. Once we had the final manuscript, the publication process went very quickly—within a week or two, we were able to publish it. I have been very impressed with the efforts towards dissemination and the partnership in that process. This interview is a good example of that. I definitely plan to make submissions to this journal in the future, as it has been a very positive experience thus far.

I think there has been a real transformation over the last 20 years in how knowledge is disseminated within the field of medicine more broadly, and also in psychiatry and mental health. Open access has clearly been the direction of the future, and indeed, the present, over the last 20 years. With search engines, it is now relatively easy to find the information you need, and the process of obtaining information out there through an open access journal is much faster. I am used to articles, once accepted, taking six months to a year before being published, rather than one to two weeks. The ability to have new findings disseminated quickly and make them available in search engines, where people can easily find them, is incredibly helpful.