J Am Psychoanal Assoc. 2022 Feb;70(1):103-137. doi: 10.1177/00030651221086622.
Psychodynamic psychotherapy has an important role in suicide prevention. The psychoanalytic study of suicide has taught us a great deal about the human experience and the process of suicidality. There is also much to be learned from other fields of study and from empirical research that can be integrated into psychoanalytic therapies. Central to the psychoanalytic approach to suicide has been understanding the patient's internal subjective experience of unbearable emotional or psychic pain and the urgent need for relief. Emotional pain can include intense affects such as shame, humiliation, self-hate, and rage. Factors that can increase vulnerability to suicidal states include problems with early attunement, dissociation and deficits in bodily love and protection, conscious and unconscious fantasy, and certain character traits and dynamics. Empirical research has confirmed many basic psychoanalytic concepts about suicide, including escape from unbearable pain as the primary driver of suicidal behavior, the role of dissociation in increasing risk of bodily attack, and the importance of unconscious processes. Further research into implicit processes and their role in the suicidal process holds potential to improve suicide risk assessment and to enhance psychotherapy by bringing otherwise inaccessible material into the treatment.
动力性心理治疗在预防自杀方面起着重要作用。对自杀的精神分析研究让我们深入了解了人类的体验和自杀过程。我们还可以从其他研究领域和实证研究中学习很多知识，并将其融入精神分析治疗中。精神分析方法关注的核心是理解患者内心无法承受的情绪或心理痛苦的主观体验，以及对缓解痛苦的迫切需求。情绪痛苦可能包括强烈的情感，如羞耻、屈辱、自我仇恨和愤怒。增加自杀状态脆弱性的因素包括早期调谐问题、解离以及身体爱护和保护的缺陷、有意识和无意识的幻想，以及某些性格特征和动态。实证研究证实了许多关于自杀的基本精神分析概念，包括将逃避无法忍受的痛苦作为自杀行为的主要驱动力、解离在增加身体攻击风险中的作用，以及无意识过程的重要性。进一步研究潜意识过程及其在自杀过程中的作用，有可能通过将原本无法触及的材料带入治疗中，来提高自杀风险评估和增强心理治疗。
