Drs. Gutheil and Schetky Reply

To the Editor: We greatly appreciate—and find ourselves largely in agreement with—the dynamic insights of our French colleagues, Dr. Chabrol et al. We, too, have observed the splitting phenomenon, wherein suicide is an attempt to destroy the bad parts of the self rather than simply to die.

We were attempting to counsel therapists to avoid power struggles (e.g., by acknowledging realistic limits on the ability to prevent suicide) more than to convey an attitude of helplessness that, as the letter notes, may promote another of the patient’s attempts to control the therapist (or other persons or fate itself) through a projective identification mechanism. We did imply that the patient’s feeling of helplessness may lead him or her to resort to this defense.

Finally, we are grateful for the letter writers’ obviously close and thoughtful reading of our article.