Some experience in psychotherapy with suicidal patients.

Changes in actual relationships and self-esteem are of particular importance. The therapist must be more direct, personal and interrogating than is the case with other types of patients, especially with regard to the suicidal fantasies and acts, i.e., plans and methods. The author emphasizes the importance of identifying hateful countertransference reactions in the therapist, and points out just how these can be controlled, and used constructively as means of understanding the more subconscious aggressive feelings of the patient, which are projected on to the therapist. There is often a fragile balance between trust, realistic agreement and the availability of the therapist with regard to out-patients, and limit-setting of admission to emergency wards. An important aspect with regard to consultations with hospitalized patients is always to ask questions and employ direct communication about suicidal intentions and risks; further, no secrecy or vagueness about these matters should be permitted at ward meetings or in group work. The therapist must be open and direct, informing the patient as to just how he looks upon suicide as a mindless act, which once and for all destroys totally the interests and goals of the patient. It is also essential to work all the time on countertransference reaction in the staff, both the anxiety and the hate. The post mortem work after a successful suicide must include fellow patients, staff members and the family.