Online IOP for College Students and Emerging Adults in MA in Network with Carelon

CE/CME Courses

Alliance-Based Intervention for Suicide

Instructor: Eric M. Plakun, MD, DLFAPA, FACPsych
In the last 25 years suicide has increased by 30% in the US, while a growing crisis in mental health is recognized in the post-pandemic world. Broadening training of clinicians to treat suicidal patients is an appropriate response. Although several manualized behavioral and psychodynamic therapies have been found to be efficacious in treatment of suicidal and self-destructive borderline patients, few clinicians achieve proficiency in even one of these. This workshop presents nine practical principles helpful in establishing and maintaining a therapeutic alliance in the psychodynamic psychotherapy of self-destructive borderline patients. The approach focuses on the therapeutic alliance, viewing suicide as an interpersonal event with meaning in the therapeutic relationship, and engages the patient’s negative transference as underlying suicidal and some self-destructive behavior. The principles are: (1) differentiate therapy from consultation, (2) differentiate lethal from non-lethal self-destructive behavior, (3) include the patient’s responsibility to stay alive as part of the therapeutic alliance, (4) contain and metabolize the countertransference, (5) engage affect, (6) non-punitively interpret the patient’s aggression in considering ending the therapy through suicide, (7) hold the patient responsible for preservation of the therapy, (8) search for the perceived injury from the therapist that may have precipitated the self-destructive behavior, and (9) provide an opportunity for repair. These principles are noted to be congruent with shared elements identified by an expert consensus panel review of behavioral and psychodynamic therapies for suicidal patients with borderline personality disorder. Case material will be used to illustrate the principles and create a space for highly interactive discussion. Workshop participants will also be encouraged to offer case examples from their own practices. The result will be a highly interactive opportunity to discuss and learn about this challenging and important clinical problem.