Do you mean the secondary gain from their suicidal ideation? Are they depressed? Have you addressed their possible depression, substance abuse, or relationship issues?

Are they actually suicidal or "simply" self-mutilating? We need more information to be of help.

It is extremely difficult to make a helpful comment with the scanty information you give. Should one congratulate you for keeping them alive (for weeks or months?) or conclude that your  specific approach is really stuck?  To my knowledge, the available research so far offers us no conclusive answer about what works best with persisting suicidality. In you place, first of all I would be practical: are these two people at high risk? Second I would try to adress their suicidal thinking directly. Cognitive Behaviour Therapy seems to me the most promising treatment approach. If you are not familiar with it, John D Matthews from Harvard has written a very good review entitled Cognitive Behaviour Therapy Approach for Suicidal Thinking and Behaviours. Good luck.  

V.E. Frankl was specialized in preventing suicides in concentration camps where the temptation to escape the suffering by touching the electric wire was great. He helped the client to discover even very short-term reasons to live: an old mother still alive, a book still unwritten, a relative stioll inneed of help, someone's whose life would be forever disturbed by this suicide an so on. By asking and milking ideas from the patient or client he revived the desire to survive. Also by drawing on the responsibility to fulfill certain  obligations towards life- it is not what you ask to get from the life- it is what life asks from you - to fulfill your special gift. Normally all persons have a certain gift better than anyone else's in a certain field, drawing upon this unique gift to be fulfilled is one of the ideas to keep persons alive. Have you tried ECT?  You should not at all think about secondary gain in these cases.

Neuropsychiatr. 2012;26(3):111-20. [Suicide and suicide prevention in Vienna from 1938 to 1945].

[Article in German]

Sonneck G, Hirnsperger H, Mundschütz R.

This is in German so it is easy for you to read it. There is also a homepage with everything Frankl has written.

They are depressive sober alcoholics, who have compensate the depression by Alcohol.Now they use the therapeutical contact. I am not shure, if it is secodary gain, which is given by never ending therapy.

Thank you for the suggestions and proposals. I will look again to Frankl and I'll take care of CAMS.

If they could "act out" their need for dependence in weekly AA peer groups, they could probably endure a more distant relationship to you

There are studies about psychodynamic psychotherapy for suicidality. For overview look at the works from Therapie-Zentrum für Suizidgefährdete, UKE, Hamburg:

Lindner, R. (2006). Suizidale Männer in der psychoanalytisch orientierten Psychotherapie. Eine systematische qualitative Studie. Psychosozial-Verlag, Gießen.

Lindner, R. (2006). Suicidality in men in psychoanalytic psychotherapy. Psychoanalytic Psychotherapy 20: 197 – 217.

Gerisch, B.; Fiedler, G.; Gans, I.; Götze, P.; Lindner, R.; Richter, M. (2000): "Ich sehe dieses Elendes kein Ende als das Grab": Zur psychoanalytischen Konzeption und der Behandlung Suizidgefährdeter. In: Kimmerle, G. (Hrsg.): Zeichen des Todes in der psychoanalytischen Erfahrung. Reihe Anschlüsse, Bd. 4. edition diskord, Tübingen, S. 9-64

Thank You for yor hint!

Hello Andreas Dieckmann,

I think that beside working on prevention of suicidality a focus could be on positive aspects of life. We use a DBT approach to work both with adolescents and adults with suiidality and deliberate self harm. Like you wrote your patients had a hard time with depression and alcohol. I use a pro/contra approach together with empowering patients with mindfullnes to challenge aspects of suicidality and focusing on positive (often 'little') things that make life worth living.

Linehan, 2006. DBT der Borderline-Persönlichkeitsstörung.

Thank you, Florian Hammerle, for your hints and advices. It gives me the motivation to continue the work with nevertheless everlasting doubts about the side effects of long term therapy.

DBT is a behavioral form of the "psychoanalytisch-interaktionelle Methode" of Heigl-Evers,A, which I am familiar with.

Best regards

Andreas Dieckmann

I would always address the underlying issues and remain person centered.