Relational Explorative Art Therapy Intervention for Adults in Risk of Suicidality

This article introduces an innovative intervention manual developed by integrating relevant psychoanalytic methods, the interpersonal theory of suicide, and art therapy (AT). The Relational Explorative AT Intervention (REATI) manual is grounded in relational practice, highlighting core countertransference indicators of pre-suicidal mental states, and proposes nine themes to attend to when addressing suicidality. The authors use clinical material to demonstrate the intervention. The authors’ practice takes place within the National Health Service (NHS) in England, UK, in a secondary mental health service. The literature search and writing were conducted under the University of Exeter. Approach The AT sessions are based on the framework of Mentalisation-Based Treatment (MBT), and the practical exercises are primarily informed by psychoanalysis and the interpersonal theory of suicide. Outcomes AT offers tools to address suicidality, both directly and indirectly. When working with people experiencing suicidality, it is vital to identify the specific difficulties related to suicide risk that are causing distress. Exploring themes such as belongingness, burdensomeness, capability, urgency, hopelessness, entrapment, and concealment through process of “rising from the circle” in AT enables conversations about suicidality. Understanding these themes within the artwork helps to address suicidality both verbally and through art-making process. Understanding suicidality and the symbolic language related to the factors linked to suicide may help professionals intervene more effectively. However, measuring the impact of REATI is the next logical step in validating the anecdotal evidence emerging from the case studies presented in this paper. The manual may guide an intervention for suicide prevention, but this will need to be evaluated through research using a suitably sized sample. Plain-language summary In the theoretical part of this article, the authors introduce relational theories of suicidology and reflects on AT practice with suicidal patients as reported in the published literature. The authors propose paying attention to, and make use of, specific themes in AT practice when working with people at risk of suicide. The symbolic language of art-making as a way of addressing factors related to suicidality is also explored. Examples from the authors’ practice demonstrate how symbolic language can reveal important factors related to suicidality. The authors also suggest that the art-making process can stimulate actions that address these factors and provide several examples on how this can be applied in practice. • Combines psychoanalytic and interpersonal theories of suicide with art therapy (AT) interventions. • Introduces an innovative suicide prevention strategy within AT practice for individuals at risk. • Clinical material illustrates the therapeutic intervention and process of change. • AT sessions integrated into the framework of Mentalisation Based Treatment (MBT). • Interpersonal theory of suicide informs practical AT exercises. • Art therapy enables exploration of suicidality both directly and through symbolic expression. • Art making facilitates meaningful conversations about suicide and distress-related themes. • Highlights the need for larger-scale research to validate AT’s impact on suicide prevention.