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Through detailed analysis of case examples, this work seeks to provide valuable insights for clinicians wishing to explore suicidality with their patients in ways that are informed both by existential and attachment-based perspectives. Specific case studies are used to explore and illustrate areas of intersection around the topic of suicidality using Interpersonal Reconstructive Therapy (IRT) theory and Terror Management Theory (TMT) lenses together. Intersecting themes focus on meaning-making, attachment, and how these together inform how patients experiencing chronic suicidal ideation appear to overcome the evolutionary desire to survive. In this view, suicidality can be seen as a maladaptive attempt at adaptation, miscued by learning about perceived safety and threat signals derived from close attachment relationships. Implications for theory, research and practice are discussed.

Death anxiety and existential concerns among patients experiencing chronic or recurrent suicidal ideation in Interpersonal Reconstructive Therapy