1. Suicide: From Chronic Illness to a Recovery Perspective

2. Introduction to Dynamic Deconstructive Psychotherapy

II. Dilemmas

- Dilemma 1. “I’m just here because of my parents, spouse, etc.” (for clients who are unmotivated to start treatment)

- Dilemma 2. “I just need to be put on the right medication for my ADHD, bipolar, etc.” (for clients who are seeking a quick fix instead of psychotherapy)

- Dilemma 3. “I don’t want to recover; I just want to die.” (for clients who are expressing suicidal intent in session)

- Dilemma 4. “I don’t have anything to talk about.” (for clients who are not actively participating in the treatment)

- Dilemma 5. “You are not qualified to be my therapist.” (for clients who have narcissistic or paranoid personality traits)

- Dilemma 6. “Nothing can help me; I need more help!” (for clients who are hopeless and desperate)

- Dilemma 7. “You don’t really care about me; it’s just your job!” (for clients who have antisocial or dependent personality traits)

- Dilemma 8. “Cannabis is the only thing that helps me.” (for clients who are using substances)

- Dilemma 9. “I want to work toward recovery, but I have a secret stash just in case.” (for clients who are holding onto suicide as a backup option)

- Dilemma 10. “I was too depressed to attend my appointment or do the things you wanted me to.” (for clients who are ambivalent about treatment or recovery)

- Dilemma 11. “I’m coming every week but nothing’s working.” (for clients who feel hopeless that they can get better well into treatment)

- Dilemma 12. “I’m not sure I can keep myself safe, but going to the hospital will just make things worse.” (for clients who feel unsafe but refuse to go to the hospital)

- Dilemma 13. Your client is in the emergency department after taking an overdose. (for clients who recently attempted suicide)

- Dilemma 14. “Why are you so rigid when people may need extra help?” (for clients who violate your boundaries)

- Dilemma 15. “How can you understand me when you haven’t gone through what I have?” (for clients who want a therapist with a similar race, ethnicity, gender, values, or background)

- Dilemma 16. “I thought I was getting better, but now I realize that I’m no better than when we started treatment.” (for clients who were progressing in treatment but are now regressing)

- Dilemma 17. “If you discharge me, I’m going to kill myself.” (for clients who are disengaged from treatment but are threatening suicide if you discharge them)

- Dilemma 18. “I am pregnant!” (for clients or therapists who become pregnant during the course of treatment)

III. Conclusion

Final Reflections

References

Index