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Assessing the Meaning of Suicidal Risk Behavior in Adolescents: Three Exercises for Clinicians

NCJ Number
214399
Journal
Journal of the American Academy of Child & Adolescent Psychiatry Volume: 45 Issue: 6 Dated: June 2006 Pages: 745-748
Author(s)
Matthew R. Galvin M.D.; Jerry Fletcher M.D.; Barbara M. Stilwell M.D.
Date Published
June 2006
Length
4 pages
Annotation
This article describes three exercises that the authors have found to be clinically useful with young suicidal patients as a means of revealing conscience-related psychodynamic issues that support or protect against suicide.
Abstract
One exercise, called the "moral genogram," focuses on the domain of conscience known as "moralization of attachment" (Stilwell et al., 1997), which pertains to moral values developed through cumulative experiences of caring, empathy, and moral expectations in interaction with attachment figures. Such experiences instill a sense of moral obligation between a child and caring family members. The exercise exposes the character of relationships within the family and how they may promote or protect against a troubled child's suicidal tendencies. The second exercise, called the "suicide walk," is designed to elicit a patient's fantasies about the impact of an accomplished suicide on significant family members and friends. The critical question is whether the child feels his/her death will have a more powerful influence over other family members than he/she has under current interactions with family members. In addition to examining the "moral attachment" domain of conscience that is the focus of the moral genogram, the "suicide walk" taps into the domain of conscience known as "moral volition" (Stilwell et al., 1998). This domain pertains to the exercise of autonomy and willpower through suicide in fantasies regarding how significant others will value them more after they are gone. The third exercise, called the "value matrix," is designed to help a patient analyze his/her motivation for complying with or violating the dictates of his/her conscience regarding the prohibition against suicide. 7 references

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