ABSTRACT
This chapter examines the therapy of a late adolescent who presented with fears that he would suicide impulsively during an immobilizing depression. It focuses on the integration of the psychodynamic and the developmental, two equally important tasks if his treatment were to succeed. This requires an extended case presentation. One task was identifying and working through a distinctive psychodynamic formulation to relieve his symptoms. The other was managing the perennial problem of retaining adolescents in treatment when this conflicts with their developmental imperatives. The key to dealing with Will’s suicidal preoccupations was reducing his irrational survivor guilt by 'reality-testing' his omnipotence complex. This was the cognitive, interpretive feature of this process. The chapter overviews the recent research on adolescent suicide (which is primarily epidemiological) and adolescent mania (which is largely epidemiological and pharmacological), and focuses on findings that seem most relevant to clinical practice.
