ABSTRACT
Assumptions therapists make about the value of life are challenged when a patient proclaims the wish or the intention to be dead, or expresses bitter resentment for not having had a choice about being born. Even when suicidal ideation or planning is not present, a patient with a traumatic developmental history may often be devaluing life less explicitly. He is going on living against underlying currents of apathy, self-denigration, and despair. A very persistent part of him holds traumatic experiences, at some level of dissociation, of having felt negated: unrecognized, annihilated, hated, abandoned – maybe all of the above. The part of him that wants to go on living repeatedly collapses into a belief that the hope of sustaining any sense of goodness is all in vain. This kind of self-alienation, with or without overt suicidality, is ubiquitous. Its recognition and treatment are central to the therapeutic project. The therapist's role in supporting the patient to develop self-reflective and self-regulating capacities is crucial in helping patients make use of their internal healing and self-consoling resources.
