J Am Psychoanal Assoc. 2022 Feb;70(1):139-166. doi: 10.1177/00030651221087158.
In Part I contemporary psychoanalytic concepts about suicide were synthesized with other theories and empirical research findings. Here the focus is on applying those principles and describing an integrative psychodynamic approach to treatment, one emphasizing the therapeutic alliance, unconscious and implicit processes, exploration of fantasy, and use of the therapeutic relationship as an implicitly interpretive vehicle for change. It is "integrative" because it draws on ideas and techniques described in dialectical behavioral therapy (DBT) and cognitive-behavioral therapy (CBT), as well on developmental and social psychology research. Psychotherapy with suicidal patients is inherently challenging, requiring the therapist to bear intense emotional pain while attending to potentially derailing countertransference pressures. The therapist plays an active role in helping the patient navigate affect storms and counter harsh self-attack, and instilling hope that treatment can lead to meaningful change. The integrative psychodynamic approach offers a pathway to a lessening of harsh self-judgment, greater connection with the body, improvement in continuity of experience, positive changes in narrative identity, emergence of the patient's genuine capacities, and more satisfying interpersonal relationships. These changes promote affect tolerance, improve life satisfaction, and decrease the likelihood of suicidal behavior.
在第一部分中，当代精神分析关于自杀的概念与其他理论和实证研究结果进行了综合。这里的重点是应用这些原则，并描述一种综合的心理动力学治疗方法，强调治疗联盟、无意识和内隐过程、幻想的探索，以及利用治疗关系作为一种隐含的解释性变化载体。它是“综合的”，因为它借鉴了辩证行为疗法（DBT）和认知行为疗法（CBT）中描述的思想和技术，以及发展心理学和社会心理学的研究成果。对有自杀倾向的患者进行心理治疗具有内在的挑战性，要求治疗师在关注可能脱轨的反移情压力的同时承受强烈的情绪痛苦。治疗师在帮助患者驾驭情绪风暴和对抗严厉的自我攻击，以及灌输治疗可以带来有意义的改变的希望方面发挥着积极的作用。综合心理动力学方法提供了一条途径，可以减轻严厉的自我评判，增强与身体的联系，改善体验的连续性，叙事认同的积极变化，患者真正能力的出现，以及更令人满意的人际关系。这些变化促进了情绪容忍度，提高了生活满意度，降低了自杀行为的可能性。
