Suicide in old age: psychotherapeutic intervention.

Psychotherapy with suicidal patients can best be planned and conducted after the specific narcissistic incapacities of the patient have been identified through an examination of the clinical history. To which of the suicide-inviting affects (worthlessness, aloneness, murderous rage) is the patient vulnerable? On what exterior sustaining supports has the patient relied in the past to ward them off? What exterior sustaining supports have been lost, and which remain available in the present? What maneuvers must the psychotherapist undertake in order to offset the narcissistic deficiencies of the patient? These questions are addressed as they bear on psychotherapeutic interventions with older patients, and specific problems of countertransference are reviewed.