Impact of Psychotherapy on Rational Suicide

Abstract

Suicidality is one of the most challenging issues in clinical work. Often, it demands greater urgency than other targets of intervention, and it involves more specific legal and ethical obligations. Patient death by suicide is one of the most stressful, distressing occurrences for clinicians, in part because it feels like one has failed one's patient by not taking sufficient clinical or environmental steps to prevent their death. In this chapter, we take the view that an individual is responsible for their own life, and that it is valuable to explore a range of alternatives before choosing death because it is irreversible. Cultural, philosophical, and legal views of suicidality influence providers' obligations and approaches to care, and these are often based on a framework that considers hastened death to always be harmful and the provider's responsibility to always be preventing death. However, openly exploring patients' and one's own values around life and death is likely to improve patient outcomes, such as reduced distress and increased existential coherence, and to reduce the emotional burden on providers by emphasizing patients' responsibility for their own lives. Furthermore, clinical discussion of suicidality with patients actually helps to reduce the likelihood of death by suicide. This open, direct approach underpins the clinical approaches reviewed and recommended here. (PsycInfo Database Record (c) 2020 APA, all rights reserved)