Leenaars A A
University of Leiden, The Netherlands.
Psychiatry Clin Neurosci. 1995 May;49 Suppl 1:S61-8. doi: 10.1111/j.1440-1819.1995.tb01922.x.
Suicide risk assessment may well be the most complex clinical task that mental health professionals face. Tests have shown to be of little use. To confront this complexity, assessment and prediction are best seen as interwoven with understanding suicide, a multi-dimensional malaise. With the essential concepts of lethality and perturbation, a clinical theory of suicide is presented. Intrapsychic aspects (i.e., unbearable psychological pain, cognitive constriction, indirect expressions, inability to adjust, and ego) as well as interpersonal aspects (i.e., interpersonal relations, rejection-aggression, identification-egression), are outlined to aid in assessment. Transference and countertransference issues in assessment are noted. A case illustration to aid in clinical insight is provided. It is concluded that all assessment and prediction of suicide risk ultimately depends on the skill of the clinician.
自杀风险评估很可能是心理健康专业人员所面临的最复杂的临床任务。测试已证明用处不大。为应对这种复杂性，评估和预测最好被视为与理解自杀（一种多维度的不适）相互交织。借助致死性和扰动的基本概念，提出了一种自杀临床理论。概述了内心方面（即无法承受的心理痛苦、认知受限、间接表达、无法调整和自我）以及人际方面（即人际关系、拒绝 - 攻击、认同 - 退行），以协助评估。还指出了评估中的移情和反移情问题。提供了一个有助于临床洞察的案例说明。结论是，所有自杀风险的评估和预测最终都取决于临床医生的技能。
