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Suicide is a significant potential risk in patients with depressive disorders. In this chapter, we describe how psychodynamic psychotherapy can aid in understanding and alleviating the psychological sources of suicidal thoughts. Although an understanding of dynamics is helpful in management of suicidality, we do not focus on management issues. Initial efforts with suicidal patients should focus on ensuring their safety by way of appropriate evaluation of any suicidal ideas or behavior, possible use of medication, and consideration of the need for hospitalization. For further discussion of these practical management issues, we recommend Blumenthal and Kupfer (1990) and Ellison (2001). In some instances, practical management issues supersede psychodynamic exploration. Nevertheless, where possible, the clinician can maintain the inquiring stance consistent with psychodynamic treatment or explore psychodynamic factors alongside implementing practical interventions.
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