Next Article in Journal
Hepatoprotective Effect of Melatonin in Toxic Liver Injury in Rats
Next Article in Special Issue
Suicide in Schizophrenia: An Educational Overview
Previous Article in Journal
Prognostic Impact of Canonical TGF-β Signaling in Urothelial Bladder Cancer
Previous Article in Special Issue
Suicidality in Borderline Personality Disorder
Article Menu
Issue 6 (June) cover image

Export Article

Open AccessOpinion

Psychotherapy with Suicidal Patients: The Integrative Psychodynamic Approach of the Boston Suicide Study Group

1
North Shore Medical Center, 81 Highland Avenue, Salem, MA 01970, USA
2
Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
3
McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA
*
Author to whom correspondence should be addressed.
Medicina 2019, 55(6), 303; https://doi.org/10.3390/medicina55060303
Received: 21 March 2019 / Revised: 6 June 2019 / Accepted: 13 June 2019 / Published: 24 June 2019
(This article belongs to the Special Issue Preventing Suicide in Patients with Mental Disorders)
  |  
PDF [314 KB, uploaded 26 June 2019]
  |  

Abstract

Psychotherapy with suicidal patients is inherently challenging. Psychodynamic psychotherapy focuses attention on the patient’s internal experience through the creation of a therapeutic space for an open-ended exploration of thoughts, fears, and fantasies as they emerge through interactive dialogue with an empathic therapist. The Boston Suicide Study Group (M.S., M.J.G., E.R., B.H.), has developed an integrative psychodynamic approach to psychotherapy with suicidal patients based on the authors’ extensive clinical work with suicidal patients (over 100 years combined). It is fundamentally psychodynamic in nature, with an emphasis on the therapeutic alliance, unconscious and implicit relational processes, and the power of the therapeutic relationship to facilitate change in a long-term exploratory treatment. It is also integrative, however, drawing extensively on ideas and techniques described in Dialectical Behavioral Therapy (DBT), Mentalization Based Treatment (MBT), Cognitive-Behavioral Therapy (CBT), as well on developmental and social psychology research. This is not meant to be a comprehensive review of psychodynamic treatment of suicidal patients, but rather a description of an integrative approach that synthesizes clinical experience and relevant theoretical contributions from the literature that support the authors’ reasoning. There are ten key aspects of this integrative psychodynamic treatment: 1. Approach to the patient in crisis; 2, instilling hope; 3. a focus on the patient’s internal affective experience; 4. attention to conscious and unconscious beliefs and fantasies; 5. improving affect tolerance; 6. development of narrative identity and modification of "relational scripts"; 7. facilitation of the emergence of the patient’s genuine capacities; 8. improving a sense of continuity and coherence; 9 attention to the therapeutic alliance; 10. attention to countertransference. The elements of treatment are overlapping and not meant to be sequential, but each is discussed separately as an essential aspect of the psychotherapeutic work. This integrative psychodynamic approach is a useful method for suicide prevention as it helps to instill hope, provides relational contact and engages the suicidal patient in a process that leads to positive internal change. The benefits of the psychotherapy go beyond crisis intervention, and include the potential for improved affect tolerance, more fulfilling relational experiences, emergence of previously warded off experience of genuine capacities, and a positive change in narrative identity. View Full-Text
Keywords: psychodynamic psychotherapy; integrative; suicide; therapeutic alliance; countertransference; hope psychodynamic psychotherapy; integrative; suicide; therapeutic alliance; countertransference; hope
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).
SciFeed

Share & Cite This Article

MDPI and ACS Style

Schechter, M.; Ronningstam, E.; Herbstman, B.; Goldblatt, M.J. Psychotherapy with Suicidal Patients: The Integrative Psychodynamic Approach of the Boston Suicide Study Group. Medicina 2019, 55, 303.

Show more citation formats Show less citations formats

Note that from the first issue of 2016, MDPI journals use article numbers instead of page numbers. See further details here.

Article Metrics

Article Access Statistics

1

Comments

[Return to top]
Medicina EISSN 1010-660X Published by MDPI AG, Basel, Switzerland RSS E-Mail Table of Contents Alert
Back to Top