[Promoting autonomy in the treatment of chronic suicidality and self-harm: a psychotherapeutic perspective]

In the Netherlands, autonomypromoting policy (APP) is increasingly applied to patients with chronic suicidality and self-harming behaviours for whom specialized psychotherapy for personality disorders is not yet feasible. A national clinical framework and a critical evaluation by MIND have recently highlighted the urgent need to articulate the psychotherapeutic principles underpinning APP. In this article we explore the practical implementation of APP, grounded in interventions from various evidence-based psychotherapeutic modalities for personality disorders that emphasize autonomy. Central to this approach is the delicate balance between containment and connection—setting clear boundaries while simultaneously preserving patient agency and choice.