Interview With David A. Jobes
Interviewer [female voice]: In your book, Building a Therapeutic Alliance With the Suicidal Patient, you describe something called the Aeschi approach to clinical prevention of suicide. Can you explain the hallmarks of this approach?
David Jobes: The Aeschi approach is based on a think-tank that was originally started in a small village in Aeschi, Switzerland, by a group of clinical suicidologists. The Aeschi approach emphasizes an empathic approach to working with suicidal patients. An approach where we're interested in hearing the patient's story as to how they got into such dire straits, so that we're in a position to understand the nature of their struggle, to work with them in a very different kind of fashion than is typical in most mental health care settings.
Interviewer: Given the importance of the therapeutic alliance between clinician and suicidal patient, why do you think it has largely been ignored in both the literature and practice?
David Jobes: I think the alliance with the suicidal patient is unique, in that often what happens in many mental health settings, is a power struggle between whether the patient can kill themselves or not. In the Aeschi approach, we don't get into debate as to whether the patient can or can't kill themselves; clearly people do. The real question is, is it the best thing to do? And a skillful therapist can explore that discussion, offering alternatives, and avoid the power struggle.
We see in many settings clinicians basically trying to overpower the patient, that they can't do this, we'll hospitalize them should they feel imminently suicidal. We're mindful of the laws. We're also really trying to understand that for some suicidal people, this is a perfectly sensible thing to do. In their minds, it's a sensible thing to do. If we enter that relationship in a different kind of way than is typical, we're in a position to make a life-saving difference.
Interviewer: Now for a difficult question — how does the therapist help not only prevent suicide but help a patient re-discover purpose and meaning in life?
David Jobes: We all get to be dead for a long time, and one of the interventions that we think about a lot is the prospect of delaying the need to end your life just now. A skillful therapist that works with a suicidal patient where the alliance is strong may help persuade, convince, support them to understand that there are different ways to get their legitimate needs met, and in so doing, stabilize them such that they could actually imagine perhaps not just surviving, but entertain the notion that there might be a way in due course that they could thrive.
Interviewer: What do you see as the likely future path of suicide research?
David Jobes: What we're seeing in suicide research, from my bias, is a greater emphasis on the research and the evidence base of what actually works. We see psychotherapy and psychology moving to the forefront of treatments for suicide prevention, where it's not just a matter of getting someone not to kill themselves. It's more focused on what can you do to cope differently, to get legitimate needs met differently, and ultimately, how do you cultivate the ability to have a life that you want to live. That's the key to clinical suicide prevention going forward.