ABSTRACT
This chapter outlines, in broad strokes, a practical approach for the management of chronic suicidality. It suggests overall guidelines for dealing with suicidal threats and attempts, as illustrated by the clinical examples. The chapter addresses three practical issues that define some of the structures of treatment: alliance building, the handling of suicidal crises, and the use of telephone contact. Suicidal crises usually emerge from problems with relationships. In addition to offering extra sessions, many therapists treating suicidal patients follow the practice of offering patients telephone contact in a crisis. The chapter presents three general principles to guide therapeutic interventions in chronically suicidal patients: helping patients regulate intense emotions, helping them learn to curb impulsivity, and helping them find a way to “get a life". Impulsivity is a separate dimension of personality that is only partly dependent on the emotional dysregulation.
