Gegenübertragungsdiagnostik in der Psychotherapie suizidaler Männer

The diagnosis of suicidality is an important challenge in psychotherapy: The threat of life has to be determined, decisions in differential therapy must be made and the therapeutical relationship must be established. The psychoanalytical contribution to the diagnostics of suicidality is the analysis of transference and countertransference phenomena, of "scenic" actions and of enactments between patient and therapist. By a systematic qualitative research method ("forming ideal types by understanding") 5 prototypical transference-/countertransference situations at the beginning of outpatient psychodynamic psychotherapy of suicidal men are identified and out of them 3 ideal types are constructed. The object-alienated ideal type with an avoidant transference and "weak", e.g. unemotional complementary countertransference appears to be a special problem. If aggression and strong attachment wishes toward the object come into the therapeutic relationship, this often is an indicator for the contacts’strength and can lead to deactualisation of suicidality. The results are discussed with and supported by methodically different publications on object relations orientated aspects of suicidality.     

Near-Death Experiences and Attempted Suicide

ABSTRACT: Attempted suicide is correlated with an increase subsequent risk of committed suicide. However, preliminary data and psychodynamic hypotheses suggest that serious suicide attempts followed by transcendental near-death experiences (NDEs) may decrease rather than increase subsequent overt suicide risk, despite the NDEs’ apparent “romanticization” of death. Studies of NDEs and of their influence on suicidal ideation are proposed which may yield greater understanding of self-destructive urges and new strategies of suicide prevention.     

The association between homelessness and suicidal ideation and behaviors: results of a cross-sectional survey

This study was carried out with three goals: (1) to determine the prevalence of suicidal ideation and suicide attempts among the homeless; (2) to determine what aspects of homelessness predict suicidality, and (3) to determine which aspects remain predictive after controlling for key covariates, such as mental illness. A sample of 330 homeless adults were interviewed. Sixty-one percent of the study sample reported suicidal ideation and 34% had attempted suicide. Fifty-six percent of the men and 78% of the women reported prior suicidal ideation, while 28 percent of the men and 57% of the women had attempted suicide. Childhood homelessness of at least 1 week without family members and periods of homelessness longer than 6 months were found to be associated with suicidal ideation. Psychiatric diagnoses were also associated with suicidality in this sample.     

Suicidal women and their relationships with husbands, boyfriends, and lovers

This study describes the specific conflicts which suicidal women experience in their intimate relationships with men. Fifty women who had made suicide attempts were studied with a focus on the contributing role of their relationships with men to the genesis of the suicidal acts. Four major themes were found in the relationships: "smothering love", infidelity, battering, and denial of affection. The women experienced these conflicts as major precipitants in their suicidal behaviors. Examples of the four themes are described and analyzed.     

Moral Objections and Fear of Hell: An Important Barrier to Suicidality

This review explores the literature to test the hypothesis that ‘moral objections to suicide (MOS), especially the conviction of going to hell after committing suicide, exert a restraining effect on suicide and suicidality.’ Medline and PsycInfo were searched using all relevant search terms; all relevant articles were selected, rated and reviewed. Fifteen cross-sectional studies were available on this topic, and raise sufficient evidence to confirm a restraining effect of MOS, and sparse data on fear of hell. MOS seem to counteract especially the development of suicidal intent and attempts, and possibly the lethality of suicidal attempts. A differential pattern of influence of MOS on the suicidal continuum is suggested.     

Personal and professional factors and suicide intervention skills

This research investigated the relationship of professional and personal factors to the ability of counselors to respond appropriately to suicidal verbalizations using the Suicide Intervention Response Inventory (SIRI). Level of training, experience with suicidal clients, and death acceptance were positively related to suicide intervention competencies. A personal history of suicidality and a belief that suicide is a personal right were negatively related to such skills. Regression analysis revealed that personal history of suicidality and attitude toward suicide as a personal right accounted for a modest, but significant, percentage of the variance in SIRI scores, beyond that accounted for by professional factors. Post hoc analysis indicated that the negative relationship between personal history of suicidal behaviors and suicide counseling skills was significant in the professionally trained participants. These results highlight the importance of attitudes toward suicide and personal history of suicidality, as well as training and experience, in effectively counseling potentially suicidal clients.     

Suicidality Among Gay and Bisexual Men in Taiwan: Its Relationships with Sexuality and Gender Role Characteristics,Homophobic Bullying Victimization,and Social Support

This study aimed to examine the associations of suicidality in emerging adulthood with time of coming out, gender role nonconformity, sexual orientation, traditional and cyber homophobic bullying victimization, and family and peer support during childhood in gay and bisexual men in Taiwan. The frequency of “experiencing suicide ideation” and “attempting suicide” in the past year among 500 gay or bisexual men was examined. The participants’ time of coming out, level of subjective masculinity, sexual orientation, experiences of traditional and cyber homophobic bullying victimization, and levels of family and peer support during childhood were also evaluated. In total, 31% (n = 155) of participants reported experiencing suicide ideation (n = 82) or attempting suicide (n = 73). Early coming out, traditional homophobic bullying victimization, and low family support during childhood increased the risk of suicidality in emerging adulthood; by contrast, family support did not moderate the association of early coming out or traditional bullying victimization with current suicidality. A high proportion of participants reported experiencing suicide ideation and attempt in emerging adulthood. Hence, effective suicide prevention is required for gay and bisexual men. Suicide prevention programs should consider time of coming out, traditional homophobic bullying victimization, and level of family support.     

The Impact of Participating in Suicide Research Online

The impact of participation in online mixed‐methods suicide research was investigated. Participants, who described feeling suicidal, completed an 18‐item questionnaire before and after taking part (n = 103), and answered open‐ended questions about participation (n = 97). Overall, participation reduced negative experiences and had no effect on positive experiences. Feelings of calm increased, but participants felt less supported. Some participants did experience distress, but some also reported this distress to be manageable. Anonymously sharing experiences of suicidality was viewed as important, had therapeutic benefits, and engendered hopes for recovery. The findings suggest a need to ensure vulnerable participants in online studies are well supported while protecting their anonymity.     

Risk and Protective Factors that Distinguish Adolescents Who Attempt Suicide from Those Who Only Consider Suicide in the Past Year

Data from the 2010 Minnesota Student Survey was analyzed to identify risk and protective factors that distinguished adolescents across three groups: no suicidality, suicidal ideation only, and suicide attempt. The population‐based sample included 70,022 students in grades 9 and 12. Hopelessness and depressive symptoms emerged as important risk factors to distinguish youth who reported suicidal ideation or behavior from those without a history of suicidality. However, these factors were not as important in differentiating adolescents who attempted suicidal from those who considered suicide but did not act on their thoughts. Instead, for both genders, self‐injury represented the most important factor to distinguish these youth. Other risk factors that differentiated the latter groups, but not the former groups, for males were dating violence victimization and cigarette smoking, and for females was a same‐sex sexual experience. Running away from home also seemed to increase the risk of a suicide attempt among youth in this study. Parent connectedness and academic achievement emerged as important protective factors to differentiate all the groups, yet neighborhood safety appeared to protect against the transition from suicidal thoughts to behavior. Findings from this study suggest risk and protective factors practitioners should target in clinical assessments and intervention programs to help prevent suicidal behavior among youth at greatest risk.     

Gender identity conflicts in adolescents as motivation for suicide

One of the motivational factors for suicide in adolescents is examined in light of gender identity issues and conflicts. It is proposed that difficulties in the formation of a cohesive gender identity are related to the adolescent's motivation to attempt suicide. This paper makes use of Fast's (1984) distinction between "event-centered" and "self-centered" experiences in order to explore problems in the formation of gender identity with reference to regression to earlier stages of psychosexual development. Physiological changes and regressive pull may lead the adolescent to the "event-centered" mode of experience. Thus one minor event may become the focus of the adolescent's gender and self identities. The adolescent may then have regressive omnipotent fantasies of being able to change gender identity through suicidal acts.     

The Longitudinal Association of Being Bullied and Gender with Suicide Ideations,Self‐Harm,and Suicide Attempts from Adolescence to Young Adulthood: A Cohort Study

Longitudinal associations between being bullied during adolescence and suicide ideations, self‐harm, and suicide attempts into young adulthood were examined. A large representative sample was examined in 1998 (N  = 2,464, MA 13.7), 1999/2000, and 2012 to reassess the outcome measures. At all ages, bullied participants showed more suicide ideation, self‐harm, and suicide attempts, regardless of gender. Bullied females showed a decrease in suicide ideation from adolescence to adulthood, while bullied males showed an increase in suicide attempts in the same time period. Being bullied in adolescence strongly predicts suicidal behavior and self‐harm. Preventive efforts might reduce the risk of later suicidality.     

Digital lives in psychotherapy: ‘the other in the room’

Within the broader area of digital risk, there has been concern over the phenomena of ‘cyber suicide’, a completed or attempted suicide influenced by the internet. We propose a theoretical explanation of the ‘ambivalent self’ in people who go online searching for suicide, by introducing the concept of an inner split between the ‘suicidal part’ (SP) and ‘non-suicidal part’ (NSP) within the personality structure of the individual which struggle for domination of the inner life and external relationships and decisions of the suicidal person. This is grounded in psychoanalytic theory and draws upon a broader conceptualisation of the psyche of the self as split between rival parts, and differing states of mind, competing for control of the vulnerable individual and their capacity to tolerate and manage emotional pain and reality. The recognition and awareness of an inner split between the SP and NSP of the person who goes online, and how this influences virtual relationships, as well as external relationships, such as in psychotherapy, is an important understanding for contemporary psychotherapy and risk management in the digital age.     

The Course of Post‐Crisis Suicidal Symptoms: How and for Whom Is Suicide “Cathartic”?

We investigated suicide "catharsis" as evidenced by decreased suicidality following a suicide attempt. Past research has examined this issue with mixed results (Bronisch, 1992; Davis, 1990; van Praag & Plutchik, 1985). In the present study, we examined Modified Scale for Suicide Ideation (MSSI) scores for 198 suicidal men during suicidal crisis, prior to entry into a treatment study, and again at 1-month and 12-month follow-ups. Patients were divided into ideators, single attempters, and multiple attempters. We found evidence for decreased suicidality, but interpreted it as the gradual action of interpersonal support, rather than as emotional catharsis. Also, multiple attempt status affected the long-term course of post-crisis suicidality.     

Intentional infection with the AIDS virus as a means of suicide

This brief paper describes a case study in which a woman attempted to commit suicide by deliberately trying to become infected with HIV. A psychodynamic perspective is developed. A ‘death wish’ of this kind should be taken into consideration in evaluating health education and in the management of some suicidal people.     

Adolescent Suicidal Trajectories through Young Adulthood: Prospective Assessment of Religiosity and Psychosocial Factors among a Population‐Based Sample in the United States

The main objective was to identify distinct patterns of suicidal behaviors over the life course from adolescence to young adulthood and to determine influences of religiosity and other contextual factors on subgroup membership. Semiparametric growth mixture models were used to identify distinct clusters of suicide ideation and suicide attempt trajectories, and generalized estimating equations were used to assess individual and contextual characteristics predicting suicidal behaviors in adolescence and in young adulthood. Distinct trajectories of suicide ideation and suicide attempt were identified for the total sample and for the gender groups. Results showed marked gender differences in the trajectory of suicide ideation and attempt patterns. Religiosity effects on suicidality were prominent in adolescence but not in young adulthood. Analysis showed that an important window of opportunity for preventing the escalation of suicidality exists during the early adolescent period, an opportunity that should be emphasized in interventions on adolescence suicide prevention.     

Suicide risk in the detachment from reality: failures in the quest for love that saves

Suicide is among the leading causes of death worldwide, accounting for almost one million annual deaths globally. The author presents an exploration into the suicidal mind using Freud's cathexis and decathexis theory. This model describes the patient’s withdrawal from reality and the need to gratify libidinal and aggressive drives in the internal world. Theories and beliefs of other authors are used to introduce the importance of early disturbed relationships with parental figures. Working with the particular subtype of suicidal patient described in this essay may be a challenge for clinicians. A psychodynamic approach may help in the understanding of the patient’s complex and private world of psychological pain. If unresolved, the patient’s conflicts may precipitate suicide.     

Building Models for the Relationship Between Attitudes Toward Suicide and Suicidal Behavior: Based on Data from General Population Surveys in Sweden,Norway, and Russia

Our aim was to build a model delineating the relationship between attitudes toward suicide and suicidal behavior and to assess equivalence by applying the model on data from different countries. Representative samples from the general population were approached in Sweden, Norway, and Russia with the Attitudes Toward Suicide (ATTS) questionnaire. Data on experience of suicidal behavior among significant others and self‐reported suicidal expressions were also collected. Structural equation modeling resulted in gender and country specific models where experience of suicidal behavior among significant others and self‐reported suicidal expressions earlier in life predicted attitudes, and attitudes predicted current suicidal expressions. The models included the attitude factors acceptance of suicide, condemnation, and preventability; age and level of education were also incorporated. The different models reveal possible ways to better understand gender and culture‐specific paths between attitudes and suicidal behaviors, and their relevance in a suicide prevention context is considered.     

The Internal Suicide Debate Hypothesis: Exploring the Life versus Death Struggle

Researchers and theorists (e.g., Shneidman, Stengel, Kovacs, and Beck) hyothesized that suicidal people engage in an internal debate, or struggle, over whether to live or die, but few studies have tested its tenability. This study introduces direct assessment of a suicidal debate, revealing new aspects of suicidal ideation. Results, from an online survey (N = 1,016), showed nearly all suicide‐risk respondents engaged in the debate. In addition, debate frequency accounted for 54% of the variance in suicidality scores, and showed significant associations with other indicators of suicide risk. Likely factors of the debate, reasons for living and dying, showed significant differences by suicidality, and most suicide‐risk participants reported going online for such purposes, demonstrating a behavioral component of the debate.     

Characteristics of Suicidality Among Adolescents

The identification of high-risk adolescent suicide attempters in a population of depressed and suicidal adolescents is of crucial importance. This retrospective study examined characteristics of suicidality (recent and lifetime, active and passive) and psychopathology (depression, aggression, impulsivity, stressful life events, SCL-90 dimensions) among four groups of depressed adolescent outpatients: (1) suicide attempters who required medical treatment (n = 84), (2) suicide attempters who did not require medical treatment (n = 57), (3) suicidal ideators who had never made a suicide attempt (n = 40), and (4) nonsuicidal patients (n = 44). Results indicate that the nonsuicidal group could be differentiated from the three suicidal groups on the basis of suicidality and psychopathology, and that the three suicidal groups could be differentiated from one another on the basis of suicidality but not psychopathology. These findings are discussed in terms of the usefulness of certain self-report measures of suicidality for identifying suicidal adolescents and for differentiating among them. Furthermore, the findings suggest that psychopathological factors do not determine which suicidal adolescents make a medically dangerous suicide attempt and which do not.     

Psychosocial treatment of depression and suicidality in adolescents

Depression is a common disorder among adolescents and is associated with a high risk of suicide. Suicide is the third leading cause of death among adolescents in the United States. Currently, there are only two evidence-based psychotherapies for adolescence depression: cognitive-behavioral therapy and interpersonal psychotherapy. Furthermore, psychosocial interventions that specifically target suicidal behavior in adolescents are even fewer in number than treatments for depression. This article will review the psychosocial interventions for depression and suicidality in adolescents and will describe a recently developed treatment that is under study for depressed suicidal adolescents.