作者: 《青少年抑郁症治疗手册》 / 5819次阅读 时间: 2020年5月22日
标签: 青少年抑郁 抑郁症

Anderson (2008) locates the suicidal behavior in young people in relation to the developmental demands of adolescence:

Anderson (2008) 将年轻人的自杀行为定位在青少年时期的发展需求之上:

The adolescent has to move from everything being orientated upwards towards the parents and the adult world, to becoming an adult who is capable of being a parent. This means that all the more disturbed parts of the personality have to be helped into the new situation. In those vulnerable adolescents the violent and murderous version of human relations which exists in all of us breaks out from its place of residence in the mind and can be played out in reality. [p. 71]


Anderson relates suicidal behaviour to Bion’s (1957) concept of the psychotic part of the personality which develops “when the degree of violent explosiveness is not contained for the baby” and is “dominated by a preference for projection and evacuation” (Anderson, 2008, pp. 66, 67). In understanding such behaviour, Bell (2008) argues that “suicide attempts never take place for the stated reason” (p. 48) and are often motivated by an unconscious desire to inflict pain on the parents or carers (p. 50).

Anderson将自杀行为与比昂(1957)关于人格中的精神病性部分的概念联系在一起, “当婴儿暴力性的爆发没有得到涵容的时候” 就会发展出来,并且“会被投射和释放的倾向所左右”(Anderson, 2008,pp.66-67)。在对自杀行为的理解上,Bell (2008)认为,“尝试自杀行为的原因永远都不是说出来的那些理由”,而是常常受到无意识想要给父母或照顾者带来痛苦的愿望所驱使。

Today’s young people are often keenly aware of the reality of mental illness, including among their peers. Suicidal thoughts are likely to occur in the treatment of many, particularly among older adolescents. It will be important for the therapist to be aware of this and to enquire specifically whether the young person is thinking about suicide if the material suggests this and if the young person does not mention it him/herself. The fact that the therapist can entertain the possibility of suicidal thoughts or actions can in itself provide substantial steadying. This may not be sufficient, however, even when the associated emotional constellations can be accurately assessed and interpreted, to ensure the patient’s safety. The therapist will in this case need to make clear to the young person that he or she (the therapist) has the obligation to consult other professionals, and possibly to inform the parents, in the interests of the young person’s safety, which in extremis takes precedence over the duty of confidentiality.


The professional network here would include the parent worker, the case manager, and the supervisor. There will also be instances where a psychiatric assessment is necessary and where the use of medication or hospitalization may need to be considered. This will be with the aim of keeping the young person safe in the immediate term, and this needs to be made explicit. In many cases, the knowledge that professionals are working together to respond to a communication that is taken seriously will in itself have a stabilizing effect. It is also important for the clinic team to establish good communication with the young person’s physician or GP from the start. Holidays may be a time in which suicidal impulses are exacerbated, and it needs to be made clear, both to the young person and to the parents, what cover arrangements are in place. The young person may also convey intense anxiety about suicidality to his or her parents, siblings, or friends. Families, and sometimes the school, will require support in managing these communications and in responding appropriately.


Apart from such crises, it is anticipated that a routine risk assessment in line with clinical governance requirements will be carried out once a term, in the context of preparing termly summaries. It is essential that any material suggesting suicidal ideation should be communicated to the case manager and recorded in the file.

除了这类危机之外,可以预期的是,每学期要做一次符合临床管理要求的常规风险评估,通常是在准备期末总结的时候。一项基本要求是, 任何提示自杀意念的材料都应该与个案经理沟通并记录在案。

TAG: 青少年抑郁 抑郁症
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