Psychodynamic psychotherapy with suicidal adolescents

Abstract

Although the treatment of suicidal adolescents is complex and may be daunting to many clinicians, it continues to play an important role in suicide prevention. In this paper, we use case material to address questions that arise in psychotherapy, including the contending priorities of understanding the suicidal act in order to prevent repetition, versus connecting emotionally with the patient in the therapeutic relationship; and the use of an evolving understanding of the complexity of suicide that develops over time as patient and therapist engage in a deepening relationship which fosters life-sustaining development and psychic change. We present a case description of a patient in later adolescence, who began intensive psychoanalytic psychotherapy after a suicide attempt and explore key components of therapeutic action. From this discussion we emphasise the relational aspects of the transference and countertransference that enables interpretation and increased therapeutic receptivity through collaborative interaction. We conclude that collaborative interaction is foundational for therapeutic action with suicidal adolescents.

Keywords::

• adolescent suicide
• countertransference
• therapeutic relationship
• implicit relational knowledge
• role responsiveness

Notes

^1. See Hawton et al. (2012) for a summary of factors associated with suicide and self-harm in adolescence.

^2. Names and other identifying features have been changed to preserve confidentiality. Some case material overlaps with a separate paper addressing issues of suicidal group dynamics (Goldblatt et al., 2015)

^3. The psychotherapy was conducted by one of the authors, and is described in the first person to increase immediacy.

^4. This discussion touches on an area of significant recent theoretical discussion, which includes different perspectives. In one of these, Fosshage (2011) for example, argues, unlike Stern and BCPSG, that there is a closer link to be made between the two dimensions of memory (declarative and procedural).