We studied therapeutic processes associated with improvement in suicidality in a naturalistic study of long-term dynamic psychotherapy.
In a naturalistic study of long-term dynamic psychotherapy (n = 53), 31 patients reported suicidal ideation, eight of whom also reported prior suicide attempts, while 22 were non-suicidal. Suicide ideation and attempts and components of therapy alliance were followed at 6 month intervals.
Suicidal patients had more psychiatric diagnoses, were treated longer and reported more negative reactions to treatment than non-suicidal patients. Alliance moderated (a) the relationship between negative reaction to treatment and improvement in suicidal ideation and (b) the relationship between quality of patient-therapist interaction and improvement.
Suicidal patients manifest hostility and negative reactions to treatment, indicating negative transference. Avoiding therapist errors emanating from negative countertransference improves the therapeutic interaction, which is followed by faster rate of improvement in suicidality.
[Show abstract][Hide abstract] ABSTRACT: Suicide seems to be increasing in young people in various countries and causes the greatest loss of years of life under the age of 65 in the Swedish population. Data from a national survey of 50,465 conscripts in Sweden were used in a prospective follow up study to assess personality and behavioural predictors of suicide in young men. Altogether 247 completed suicides occurred in the cohort during 13 years' follow up. Baseline data on social conditions, psychological assessments, and psychiatric diagnoses of the conscripts were entered into a Cox regression model with suicide as the outcome variable. Several early indicators of antisocial personality (poor emotional control, contact with a child welfare authority or the police, and lack of friends) were strongly predictive of suicide. None of the few conscripts who had a diagnosis of schizophrenia or affective psychosis committed suicide. A diagnosis of neurosis was associated with a twofold increase in the suicide rate and personality disorder with a threefold increase. Although the risk of suicide is difficult to assess in an unselected population owing to the low base rate of suicide, the predictors identified in the study may help to identify those at high risk in units where people with deviant behaviour and personality disorders cluster.
BMJ Clinical Research 08/1988; 297(6642):176-8. DOI:10.1136/bmj.297.6642.176 · 14.09 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This randomized controlled trial tested the effectiveness of an 18-month mentalization-based treatment (MBT) approach in an outpatient context against a structured clinical management (SCM) outpatient approach for treatment of borderline personality disorder.
Patients (N=134) consecutively referred to a specialist personality disorder treatment center and meeting selection criteria were randomly allocated to MBT or SCM. Eleven mental health professionals equal in years of experience and training served as therapists. Independent evaluators blind to treatment allocation conducted assessments every 6 months. The primary outcome was the occurrence of crisis events, a composite of suicidal and severe self-injurious behaviors and hospitalization. Secondary outcomes included social and interpersonal functioning and self-reported symptoms. Outcome measures, assessed at 6-month intervals, were analyzed using mixed effects logistic regressions for binary data, Poisson regression models for count data, and mixed effects linear growth curve models for self-report variables.
Substantial improvements were observed in both conditions across all outcome variables. Patients randomly assigned to MBT showed a steeper decline of both self-reported and clinically significant problems, including suicide attempts and hospitalization.
Structured treatments improve outcomes for individuals with borderline personality disorder. A focus on specific psychological processes brings additional benefits to structured clinical support. Mentalization-based treatment is relatively undemanding in terms of training so it may be useful for implementation into general mental health services. Further evaluations by independent research groups are now required.
American Journal of Psychiatry 10/2009; 166(12):1355-64. DOI:10.1176/appi.ajp.2009.09040539 · 12.30 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To determine if specific sets of dysfunctional attitudes were related to suicidal ideation, the 100-item Dysfunctional Attitude Scale (DAS) was administered to 908 psychiatric outpatients along with the Beck Depression Inventory (BDI), Hopelessness Scale (BHS), Self-Concept Test (BST), and Scale for Suicide Ideation (SSI). The SSI was used to classify the outpatients into 97 (10.7%) suicide ideators and 811 (89.3%) nonideators, and the DAS was scored for nine subscales described by Beck, Brown, Steer, and Weissman (1991). None of the DAS subscales discriminated the ideators and nonideators or was significantly related to SSI total scores of the suicide ideators after controlling for sex, age, diagnosis of a mood or panic disorder, comorbidity, presence of a personality disorder, a history of a past suicide attempt, the BDI, the BHS, and the BST. The contributions of sets of dysfunctional attitudes for identifying and explaining suicidal ideation were overshadowed by a history of a past suicide attempt and hopelessness.
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