Moving towards a psychoanalytic formulation when assessing the risk of suicide in adolescents in crisis

Adolescents frequently present to mental health services in acute crisis, making the assessment and interpretation of suicide risk particularly complex. This chapter introduces the ‘Threefold Insight for Evaluating Risk’ (TIER) model – a psychoanalytically informed framework developed by the author for the dynamic assessment of suicide risk in young people. A psychoanalytic formulation is positioned as central to both diagnosis and treatment planning, offering a lens through which to understand the meaning of the crisis, the adolescent’s underlying anxieties, self-perception, and defensive strategies – both maladaptive and adaptive – employed to manage emotional distress. The model also takes into account the adolescent’s capacity for emotional regulation and communication. These factors are examined in relation to personality structure, with attention to clinical indicators that may suggest elevated suicide risk. Such an approach is crucial given the unique developmental vulnerabilities and transitions that define adolescence.