Jobes recommends rejecting the dynamic approach when working with suicidal adolescents. The suicidal adolescent, Laufer (1995) writes, "urgently needs skilled help and understanding, so that he feels less alone with his...determined belief that to be dead is the only answer...Unsuitable help or superficial caring is much more harmful than no help at all during the crisis period. No help, rather than inappropriate help, leaves open the hope that there may be a caring person nearby, but inappropriate help is experienced as confirmation that he can die, because nobody cares."
Symbolically sinking in quicksand, the adolescent will drown unless there is heroic intervention by the psychotherapist. Therapists who worry about the ramifications of disturbing the transference-countertransference formation must recognize that unless they intervene, death is absolute.
The most important countertransference task is to maintain therapeutic perspective when attempting to stabilize self-annihilative behavior. The therapist must remain a rational and responsible restraining force by questioning personal motives, e.g.: Do I become excessively angry when disappointed or disobeyed? Do I wish to punish when feeling frustrated? Do I hate or wish to replace parents? Do I feel I am owed respect, appreciation and compliance? Do I feel relief when the adolescent cancels an appointment? Do I hope the relationship ends?
Substance-abusing suicidal adolescents seek immediate gratification and relief. Consequently, they demand the psychotherapist produce results. Initially, the charisma of the mental health worker may be the primary reason to live because not infrequently everyone, including the adolescent, has conceded there is little hope for recovery. By conscious choices these adolescents have trapped themselves in a painful labyrinth where expectations of failure, rejection, mistrust, pain and loneliness become self-fulfilling prophesies. The youth may feel so overwhelmed and dejected that death may appear the most viable escape.
Joffee posits, "When adolescents feel...out of control, vulnerable and helpless, the idea of suicide gives them a sense of power over their...lives and a weapon to be used against others. It enables them to nurse a fantasy in which it is the parent or therapist who is seen to be-and, indeed, is made to feel-impotent and helpless."
The therapists' task is to instill hope in the future. After the treatment agent has been convinced by the adolescent that the threat of death has been diminished, an aggressive advocate stance helps to restore hope and decreases the chances of future suicidal acts. Expectations on the part of the patient for the psychotherapist to function as a personal advocate may be the initial motivation to enter into therapy. The act of advocacy permits the psychotherapist to maintain expectations for growth."
Finally, because some adolescents require more time before they begin to realize their potential, the credentialed professional must have an indefatigably optimistic and idealistic attitude never to give up or to quit.