Working with the suicidal patient in general practice

Probably the most difficult patient to provide therapy to is the one who is chronically suicidal. We worry about many aspects of their care, because a patient committing suicide is one of the worst things we can face. First, and foremost, we want to help our patients, and a completed suicide is the most concrete manifestation that we haven’t.

Not only do we feel we failed them, but we are likely to question our own competence, and the rest of the world is likely to question our competence and the therapy we delivered. This includes family and friends of the patient, our colleagues, the public, and the legal system. This underlying anxiety when working with the chronically suicidal patient has a powerful effect on the therapeutic process.

Not only do we feel we failed them, but we are likely to question our own competence, and the rest of the world is likely to question our competence and the therapy we delivered. This includes family and friends of the patient, our colleagues, the public, and the legal system. This underlying anxiety when working with the chronically suicidal patient has a powerful effect on the therapeutic process.

In the webcast I will provide some didactic information about suicidality, and then explore why patients become suicidal, and what the function of suicidal thoughts and urges are. I will develop a general psychodynamic hypothesis about the origins of suicidal thoughts, and the relationship between deliberate self harm and suicidal thoughts. I will differentiate between acute suicidality and chronic suicidality, and briefly outline the different treatment needs of each group.
 
An important topic is how the fear of suicide structures the therapy, and influences the therapist’s response. Finally, some important prevailing myths about suicide prediction, assessment and prevention will be described.