Psychological interventions for the suicidal adolescent.

Acute and chronic styles of suicidal behaviors require different psychotherapeutic approaches--the former needs a supportive-cognitive-focused approach, the latter (chronic or characterological) style needs an expressive insight-oriented psychotherapy with supportive elements to address the adolescent's developmental requirements for structure within the sessions. The psychotherapist needs to be appraised of the epidemiological, dynamic factors as well as the sources of external support the patient can count upon. It is interesting to note that psychodynamic factors alone or psychopathology alone are not sufficient to estimate the ebb and flow of the suicidal risk. A combination of all these factors must be taken into account in estimating suicidal risk at any point in treatment. It is advisable that an independent clinician's consultation be sought during treatment in the case of suicidal attempts as the therapist can easily overestimate or underestimate suicidal risks. Individual treatment requires family intervention from counseling to therapy. Particular problems addressed in the paper are countertransference reactions created by the suicidal behavior in the clinician such as rejection and withdrawal. The psychotherapy should address the resolution of aggressive, envious introjected images, issues of omnipotent control and interpersonal skills deficits. To transform suicidal behavior into reenactment of the aggression within the relationship to the therapist is the main immediate goal. A critical caveat; a patient who lies by commission or omission represents an obstacle for individual therapy on an outpatient basis as he will disguise his suicidal intentions and plans, excluding them from the therapeutic process.