Presenter: J. Christopher Fowler, PhD

Description: We are acutely aware of the fear and dread of losing a patient to suicide. Unlike other medical crises, there are no biologic tests to accurately determine the level of suicide risk, nor metrics for determining when a suicidal crisis may occur (Fowler, 2012; Franklin et al., 2017). It should be no surprise then, that when our patients speak of suicide, we are anxious and eager to discern if the thought is a fleeting fantasy, a declarative statement of imminent purpose, or something else. In this zone of the unknown, countertransference fears can disrupt clinician’s capacity to mentalize our patients and can lead to precipitous unilateral crisis management before we have a chance to understand our patient’s communication and the emerging dynamic. While it is always necessary to intervene in a suicidal crisis, the most impactful intervention is curiosity and interest in the individual’s inner experience. In this roundtable discussion we will focus on 3 core principles in reducing the acute and long-term risk of suicide: 1. Engaging our radical curiosity (via mentalizing) to help patients feel understood and joined, 2. Reducing emotion dysregulation by focusing on the affective experiences driving suicidal ideation, and 3. Restoring effective mentalizing in order to reduce suicidal risk. In time our mentalizing interventions aim is to build epistemic trust (Fonagy & Campbell, 2017). An extended clinical vignette will highlight specific mentalizing interventions in the treatment.