Restoring Hope for the Future: Mentalization-Based Therapy in the Treatment of a Suicidal Adolescent

ABSTRACT

Suicide is the gravest outcome facing patients, families, and clinicians. Clinicians treating adolescent patients and their families face these life-and-death realities with justifiable fear. The effective assessment and management of suicidality in children and adolescents is critical and complex for even the most seasoned clinician. Helping the adolescent overcome emotional suffering and suicidal despair is the primary task for those of us clinicians who undertake such treatments. In this paper, we focus on the treatment of a suicidal adolescent using a mentalization-based approach. We believe a mentalizing approach opens up nonsuicidal pathways for enduring and dealing with suffering, while supporting the adolescents’ developmental needs. We highlight the challenges and benefits of making mentalizing a core focus of therapy with a suicidal adolescent and reflect on its usefulness in the context of dynamic and psychoanalytic approaches to suicidal patients. In the pages to follow, we take stock of the sobering risks of the adolescent epoch, link the adolescent suicidal crisis to Maltsberger’s (2004) psychodynamic formulation of the suicidal crisis, articulate how a mentalizing treatment frame addresses the primary problem of the adolescent suicide crisis, and provide a case example to link theory to practice.

KEYWORDS:

• Adolescent
• suicide
• mentalization-based therapy

Acknowledgment

The author would like to thank Jon Allen, PhD for his generous feedback on an earlier draft of this paper.

Notes

1. John is a fictional name. Heavy disguise with minimal details were instituted to protect confidentiality.

Additional information

Notes on contributors

Shweta Sharma

Shweta Sharma, PsyD is an Assistant Professor of Psychiatry in the Menninger Department of Psychiatry and Behavioral Science at Baylor College of Medicine. She is a senior staff psychologist at The Menninger Clinic and a clinical candidate in adult studies in psychoanalysis at the Center for Psychoanalytic Studies in Houston, Texas. Her clinical work focuses on the assessment and treatment of young adults.

J. Christopher Fowler

J. Christopher Fowler, PhD is a Professor in the Menninger Department of Psychiatry and Behavioral Science at Baylor College of Medicine. He is the Director of Psychology and Director of Clinical Research at The Menninger Clinic. His clinical work focuses on the assessment and treatment of professionals in crisis, helping physicians, lawyers, and entrepreneurs return to full functioning. As a researcher, he has more than 100 publications in the areas of personality disorders, suicide, neuroimaging, and treatment outcome. He is an internationally recognized personality researcher and currently serves as the editor for The Bulletin of the Menninger Clinic.