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Chronic Suicidality and Self-Destructive Behavior – Janina Fisher

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Chronically suicidal clients present a special kind of stress for therapists: there’s not only the emotional stress of working with their pain, but the additional burden of risk, responsibility, and anxiety.

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Chronically suicidal clients present a special kind of stress for therapists: there’s not only the emotional stress of working with their pain, but the additional burden of risk, responsibility, and anxiety.

When should we hospitalize a suicidal client?

How can we best assess when the level of suicidality is an immediate threat to life and safety?

What role should suicide contracts play in our work?

This workshop recording offers practical strategies for developing collaborative approaches with suicidal clients despite their resistance to help and transforming their relationships to self-destructive thoughts and impulses.


  1. Determine the somatic effects of suicidal ideation and impulses for the purposes of psychoeducation.
  2. Evaluate the role of suicidality in a client’s survival or adaptation to trauma.
  3. Determine the three basic steps of the Fisher risk assessment tool.
  4. Distinguish body-centered interventions that can increase the client’s sense of control over unbearable emotions.
  5. Develop collaborative solutions to high-risk situations.

The Challenges of Working with Suicidality and Self-Destructive Behavior

  • Association between suicidality/self-harm and a history of trauma
  • Suicidality as a survival strategy
  • The neurobiology of suicidality and self-harm

Evaluating Risk: Safe, Less Safe, and Not Safe

  • Ideation versus impulse
  • Relief versus punishment
  • Simple tools for risk assessment

Suicidality and Self-Destructive Behavior as Dissociative Symptoms

  • Using the Structural Dissociation model
  • Borderline personality and dissociative symptom
  • Increasing safety by working with suicidality as a part of the personality

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