Y

The Aeschi Working Group

MEETING THE SUICIDAL PERSON

The therapeutic approach to the suicidal patient

 
 
     

Joining the patient

 
 
FUTURE EVENTS
 
THE BOOK:
BUILDING A THERAPEUTIC ALLIANCE WITH THE SUICIDAL PATIENT
 
THE GUIDELINES FOR CLINICIANS
 
PAST EVENTS
1st Aeschi Conference
2nd Aeschi Conference
3rd Aeschi Conference
4th Aeschi Conference
5th Aeschi Conference
6th Aeschi Conference
7th Aeschi Conference (Aeschi West)
8th Aeschi Conference (Aeschi 8)
9th Aeschi Conference (Aeschi 9) 
 
PROBLEMS IN CLINICAL
PRACTICE
The usual clinical practice
Clinicians' attitudes
Patients' dissatisfaction
Non-attendance in aftercare
Treatment failures
 
A PATIENT-ORIENTED
APPROACH
New perspectives
Patients' narratives
Patients' inner experiences
Joining the patient
CAMS
The Narrative Action
Theoretical (NAT) approach
Mental Pain
 
INFORMATIONS
The Aeschi Group
Publications
Links

Sonnenalp Resort

Hotel Aeschi Park
Destination Aeschi
 
Download main text as pdf here
Download Guidelines for Clinicians as pdf here
Home
 

The need for a shared understanding of the patient's suicidality has been stressed by a number of authors (Leenaars 1991, Eddins and Jobes 1994, Jobes 2000; Orbach, in press). Indeed, difficulties in establishing a working relationship with suicidal patients may be the main reason for the sobering results of treatment evaluations (Hawton et al. 1998). In fact, the first encounter with a health professional largely determines patient adherence to subsequent therapy. Psychotherapy research has established that the patient's early evaluation of the relationship with the therapist determines compliance to psychotherapy (Dyck et al. 1984, Luborsky et al. 1985, Gerstley et al. 1989). Morgan et al. (1982) indicated that a good working relationship is possible in a first session. Therapeutic alliance in psychotherapy has been found to be related to the quality of therapist interventions (Crits-Christoph et al. 1988, Horvath and Luborsky 1993, Silberschatz et al. 1986). In particular, therapeutic alliance is associated with the accuracy of therapist interventions in relation to central issues in a person's life (Luborsky and Crits-Christoph 1990, Crits-Christoph et al. 1993).

In suicidal patients, accuracy of therapist interventions is particularly relevant because the suicidal mind is characterized by a total collapse of self-esteem (Baumeister 1990, Maltsberger 1997). Suicidal patients are very vulnerable, and therefore, the clinician's primary goal must be to establish a trusting relationship that allows patients to share their inner experiences of extreme pain and shame.

Michel et al (2004) in study on interviews with suicide attempters were able to show that working alliance in interviews with suicide attempters can be improved when the interviewer uses a narrative approach aimed at an understanding of the patient's suicidality in the context of emotional life career issues (abstract)

References

Leenaars A.A. (1991) Suicide notes and their implications for intervention, Crisis 12/1, 1-20.

Eddins CL, Jobes AJ (1994) Do you see what I see? Patient and clinician perceptions of underlying dimensions of suicidality. Suicide and Life-Threatening Behavior, 24, 170-173.

Jobes D: Collaborating to prevent suicide: A clinical research perspective. Suicide and Life Threatening Behavior 2000; 30(1):8-17.

Orbach l: Therapeutic empathy with the suicidal wish: Principles of therapy with suicidal individuals. Submitted for publication,

Hawton K, Arensman E, Townsend E, Bremner S, Feldman E, Goldney R, Gunnell D, Hazell P, van Herringen K, House A, Owens D, Sakinofsky I, Träskman-Bendz L: Deliberate self-harm: systematic review of efficacy of psychological and pharmacological treatments in preventing repetition. BM J, 317: 441-7, 1998.

Dyck R.J, Joyce A.S., Azim H.F.A. (1984) Treatment noncompliance as a function of therapist attributes and social support. Canadian Journal of Psychiatry, 29: 212-216.

Luborsky L., McLellan A.T., Woody G.E., O'Brien C.P., Auerbach A. (1985) Therapist success and its determinants. Arch Gen Psychiatry 42,602-611.

Gerstley L., McLellan A.T., Alterman A.L., Woody G.E., Luborsky L, Prout M. (1989) Ability to form an alliance with the therapist: a possible marker of prognosis for patients with antisocial personality disorder. American Journal of Psychiatry 146,508-512.

Morgan R., Luborsky L., Crits-Christoph P, Curtis H., Solomon J. (1982) Predicting outcomes of psychotherapy by the Penn helping alliance rating method. Archives of General Psychiatry, 39, 397-402.

Crits-Christoph P., Cooper A., & Luborsky L. (1988) The accuracy of therapists' interpretations and the outcome of dynamic psychotherapy. Journal of Consulting and Clinical Psychology, 56, 490-495.

Horvath AO & Luborsky L (1993) The role of the therapeutic alliance in psychotherapy. Journal of Consulting and Clinical Psychology 64, 561-573.

Silberschatz G., Fretter P., Curtis J (1986) How do interpretations influence the process of psychotherapy? Journal of Consulting and Clinical Psychology 54, 646-652.

Luborsky L. & Crits-Christoph P. (1990) Understanding transference. The CCRT method. New York: Basic Books.

Crits-Christoph P, Barber J.P., Kurcias J.S. (1993) The accuracy of therapist's interpretations and the development of the alliance. Psychotherapy Research 3, 25-35.

Michel K, Dey P, Stadler K, Valach L: Therapist sensitivity towards emotional life career issues and the working alliance with suicide attempters. Archives of Suicide Research 2004, 8,203-213.

TOP

 
The Guidelines for Clinicians 1st Aeschi Conference 2nd Aeschi Conference 3rd Aeschi Conference 4th Aeschi Conference 5th Aeschi Conference 6th Aeschi Conference
The usual clinical practice Clinicians' attitudes Patients' dissatisfaction Non-attendance in aftercare Treatment failures New perspectives Patients' narratives
Patients' inner experiences Joining the patient CAMS The Narrative Action
Theoretical (NAT) approach
Mental pain The Aeschi Group Publications
Links Hotel Aeschi Park Destination Aeschi THE BOOK