A date with death: management of time-based and contingent suicidal intent.
OBJECTIVE
The patient who voices suicidal intent in terms of the future or in terms of certain life contingencies presents special difficulties for the therapist. The authors outline the challenges posed by this problem for assessment, clinical management, and risk management.


METHODS
The authors examined and analyzed case examples from both clinical and risk-management aspects.


RESULTS
Problematic cases can be grouped into categories that offer insight as to management. The authors discuss this area and offer suggestions for appropriate clinical responses to this challenge.


CONCLUSIONS
The authors recommend that therapists 1) treat the expressed "date with death" as a communication to be explored, 2) explore the problem of helplessness while monitoring their own countertransference responses, 3) assess the patient's competence to inform clinicians about suicidal state, and 4) readily use involuntary commitment.
Gutheil
T G
TG
Department of Psychiatry, Harvard Medical School, Boston, USA.
Schetky
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D000328:Adult; D003134:Commitment of Persons with Psychiatric Disorders; D003379:Countertransference; D004992:Ethics, Medical; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology* / Q000628:therapy; D008875:Middle Aged; D008960:Models, Psychological; D010817:Physician-Patient Relations; D011570:Psychiatry; D011613:Psychotherapy; D012308:Risk Management; D013405:Suicide / Q000523:psychology*; D000092864:Suicide Prevention