ABSTRACT
This chapter will focus on the role of efficacy and agency selfobject experiences in the prevention of suicide. Selfobject experiences mostly have in common that they refer to the self as recipient of some action of the selfobject. Wolf (1988) described another kind of phenomena that proceed in the opposite direction, that is, phenomena characterized by the self as actor and the selfobject as acted upon. The essence of these phenomena is the self’s experience of being an effective agent in influencing the object that Wolf defined as efficacy experiences. Exploring the self-state of suicidal patients, the therapist is confronted with their loss of agency in a state of despair and deep feelings of helplessness. When suicidal patients experience being an effective agent in influencing the object, their selves become more cohesive and the suicidal ideation is less imminent. Some borderline patients try to manipulate their surroundings. Other suicidal patients are found to act on the therapist by attacking him (Milch, 1990b). These attacks are not meant to destroy the therapist but, rather, aim at making contact with him and, by doing so, experiencing personal agency. When these attacks are unconscious, the neediness of the patient is split off (vertical split). In the countertransference, the manipulating behavior and the attacks of the patients provoke defensiveness in the therapist, who might feel insulted and acted upon. The patient’s wish to make contact and to sense his own agency via hidden or open attacks is often experienced as so hurtful by the therapist that he himself might wish to get rid of the patient or even that the patient might die. On the other hand, the patient often expects to be rejected (see case vignettes later) as a protection against disappointment and therefore loses his last hope. This whole course of events is, in our view, a kind of pathological accommodation (Brandchaft, 1998).
