A treatment approach is presented for monitoring suicidal potential in borderline and psychotic patients within the context of psychotherapy. The approach seeks to prevent, or at least to minimize, the gap in communication which almost always develops between thehapist and suicidal patient within the context of traditional psychotherapy and which contibutes to the sense of alienation characteristically associated with suicidal action. The approach recommends that the therapist, whenever in the slightest doubt concerning the patient's suicidal potential, make the issue of the patient's suicidal potential and/or preoccupation a principal explicit focus of the therapy; insist on a joint meeting with important family and professional figures to communicate suicidal potential; actively center the psychotherapy around explicit discussion of the patient's object relations and whether he believes his life situation has become irrevocably ungratifying; and discuss with the patient the ways in which his (pathological) convictions concerning his life situation are related to his actively considering suicide. In addition to its goal of fostering communication and object relatedness, the approach attempts to objectify the issues relevant to suicidal preoccupation and thereby to permit the patient to apperceive the relevant thoughts and feelings as comprising problems to be examined rather than as unquestioned parts of being. The exploration and objectification of the patient's depressive convictions about reality becomes the central focus for therapy until his reality testing has improved sufficiently in these areas so that he no longer feels helpless or hopeless. In order to facilitate consideration of the potentially suicidal patient's internalized assessment of his external reality, the authors formulate a conception of reality conclusion" which relates the psychic state of the potentially suicidal person and his interpersonal and social situation. Three case examples are presented to illustrate types of clinical situations in which the monitoring approach can be useful. Advantages and limitations of the approach are discussed and certain precautions are emphasized as necessary in its application. © 1969."
