Theoretical Background

Traditional medical/psychiatric models approach the problem of suicidality from a variety of theoretical perspectives: biological, cognitive, psychodynamic, etc. However, practical interventions based on these theories often fail. Most suicidal persons, who admit to years of counseling, hospitalizations, and medication, say they will feel better for awhile but then feel twice as suicidal the next time they are in crisis. What this indicates is that the underlying problem, though changing form, never changes.

I have sought to understand the core experience of being suicidal by exploring the language of suicidal persons in the midst of suicidal crises. Through therapeutic processes with over 16,000 suicidal patients in 25 years on the mental health of a major public hospital, I find that suicidal persons universally communicate about an existence in a bifurcated state where who they are to us is not who they are to themselves. The suicidal person is trapped in unknowingly finding ways to sustain both “selves” and this unreal, painful, disconnected state leads to a lethal spiral downwards – in such a bifurcated state, a place of solace cannot be sustained. As therapists, we unknowingly participate in this bifurcation by comforting or “stabilizing” them. They are thereby validated for a state – for a “self” – that is really not stable inside them.

Reasoning, traditional cognitive-behavioral approaches and even medications may help for awhile but cannot really reach them. An indirect form of communication is needed to bypass the fierce intelligence and resistance which sustains this psychological and emotional trap. By utilizing metaphor and experiential methods, I have found ways to offer suicidal persons a stereoscopic perspective using metaphoric resonance to bypass the entrenched internal illogic that binds them.

I have integrated my learning and methods into a model of therapy derived from the suicidal persons' own voices, called Contextual-Conceptual Therapy (CCT): Guiding Suicidal Persons, Using Maps, Models, & Metaphors.