Psychotherapeutic considerations in the management of the suicidal patient

The management of the suicidal patient is complicated by (1) the emotions expressed and the demands made by the patient, (2) the therapist's own responses, and (3) the influence of significant others. The therapist may be required to make himself available and to become personally involved to a greater extent than is usual. The suicidal patient has a tendency to involve himself in symbiotic relationships from which it is difficult for either partner to become detached without generating anxiety in the other. The degree to which the therapist indulges the patient in his dependency needs or encourages him to act responsibly is a matter of fine clinical judgment. The unwillingness of the suicidal individual to entrust himself to others causes him to become ambivalent towards both the therapist and life itself. The hostile, even murderous attitude of family members may require his temporary removal from them and necessitate their involvement in his treatment.