Academic journal article American Journal of Psychotherapy

Therapeutic Empathy with the Suicidal Wish: Principles of Therapy with Suicidal Individuals

Academic journal article American Journal of Psychotherapy

Therapeutic Empathy with the Suicidal Wish: Principles of Therapy with Suicidal Individuals

Article excerpt

Therapeutic Empathy with the Suicidal Wish:

Principles of Therapy with Suicidal Individuals*

Several principles of therapeutic work with suicidal individuals are described. These principles represent different aspects of therapeutic empathy with the suicidal wish. They are based on a theoretical model that presents suicide as an end result of unbearable mental pain. Mental pain is believed to emerge from reciprocal interactions between biochemical imbalances, life stress, personality factors, pain-producing inner patterns (e.g., self-hate, sense of being dispensable), and facilitators and inhibitors of self-destructive behavior. The therapeutic approach is characterized by an empathic experiential encounter with the death wish, the pain-producing inner patterns, self-destructive tendencies, and the exploration of the most dreadful and frightening inner experiences. An empathic attitude toward the wish to die, coupled by an uncompromised confrontation of self-destructiveness, can provide the hope of discovering a path of compromise with life's difficulties.

Every therapeutic approach must be based on a theoretical conceptualization as a departure point for its therapeutic principles. I will first present a concise summary of my theoretical approach to understanding suicide. Next, I will describe some of the therapeutic principles stemming from this approach.

Following Shneidman (1), I believe that suicide is an outcome of unbearable mental pain (psychache). Mental pain, according to Shneidman, is the immediate consequence of frustration of one's "most important needs." These most important needs are unique to each individual, and their fulfillment provides meaning and happiness in one's life. Frustration produces mental pain in the form of extreme negative emotions, such as guilt, shame, anguish, depression, humiliation, and the like. However, an empirical-phenomenological scrutiny of mental pain (2) has shown that the definition of mental pain is of a wider scope of experience than frustration and extreme negative emotions. On the basis of a narrative analysis, mental pain was defined as the perception of extreme negative changes in the way the "self" was previously being experienced and in the way it functions. Accordingly, in addition to negative emotions, mental pain constitutes experiential aspects, such as a sense of loss of control, emotional freezing and estrangement, emotional flooding, a sense of irreversibility of pain, and a sense of being abandoned. Mental pain also includes action tendencies, such as wishes for escape, withdrawal from people, and yearning for support.

To understand the relationship between mental pain and self-destructive behavior, it is necessary to place it in a wider context that includes other important factors and processes related to suicidal behavior, such as constitutional and biochemical factors, stressful life events, personality, and facilitators and inhibitors of suicidal behavior (3).

The sequence leading to self-destruction is believed to begin with biochemical and constitutional factors (such as the level of serotonin [41) that reciprocally interact with extremely negative and stressful life events, as well as personality traits and factors that may exacerbate self-destructive behavior. One personality factor that may play a central role in the suicidal process is emotional regulation. Effective modes of regulation of emotions can mitigate negative feelings caused by stress and in the long run reduce or prevent mental pain, whereas ineffective regulation can increase mental pain. Indeed, some studies (5) have empirically demonstrated that suicidal youngsters as compared with nonsuicidal ones have difficulties in regulating negative affect. It is my theoretical assertion that unbalanced biochemical processes interacting with prolonged life stress and maladaptive personality factors and processes will in time create persistent patterns of inner experiences that produce mental pain. …

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