To Live or Die: Working with Suicidal Ambivalence

Live Virtual Webinar
Eligible for (2) Continuing Education Suicide Credits

Register Now

Suicidal ambivalence – want to die/don’t want to die - is a common experience for many patients but can be a challenge for clinicians. Increasing attention has been given to this phenomenon over the past few years, with new empirical findings and a new clinical model being published. This workshop will provide a foundation for understanding suicidal ambivalence, its relationship to suicide risk, and interventions therapists can use to address it in treatment.

Learning Objectives

• Define suicidal ambivalence
• Discuss the relationship of age and gender to suicidal ambivalence
• Articulate three research findings on the relationship between ambivalence and risk
• Identify three phases of the suicidal process as posited by the Ambivalence Model of Suicidality
• Name four phase-specific therapeutic interventions based on the Ambivalence Model of Suicidality

About Kristen Davis-Coelho, PhD

Dr. Kristen Davis-Coelho, PhD, is a clinical psychologist in private practice, a faculty member in the University of Nevada-Reno School of Medicine, and an award-winning author and speaker. Committed to creating systemic solutions, she serves on NPA’s Legislative Committee and is vice-Chair of the Washoe Regional Behavioral Health Policy Board. She is author of the best-selling book, The Best Care for Those with the Least. Dr. Davis-Coelho is passionate about supporting vulnerable community members as well as empowering the dedicated professionals who serve them.

References

1. Bryan, C. J., Bozzay, M. L., Hay, J., Starkey, A., Tabares, J. V., & Baker, J. C. (2025). Changing temporal patterns in patient-reported wish to live and wish to die signal the imminent emergence and aftermath of suicide attempts: a dynamical systems analysis. BMC Psychiatry, 25(1), Article 884. https://doi.org/10.1186/s12888-025-07295-0
2. Ernst, M., Gemke, T. J., Olivi, L. J., & O’Connor, R. C. (2024). Ambulatory assessment of suicidal ambivalence: The temporal variability of the wish to live and the wish to die and their relevance in the concurrent and prospective prediction of suicidal desire. Suicide & Life-Threatening Behavior, 54(5), 831–843. https://doi.org/10.1111/sltb.13120
3. Ernst, M., Zwerenz, R., Michal, M., Wiltink, J., Tuin, I., & Beutel, M. E. (2023). Ambivalent toward life, ambivalent toward psychotherapy? An investigation of the helping alliance, motivation for treatment, and control expectancies in patients with suicidal ideation in inpatient psychotherapy. Suicide & Life-Threatening Behavior, 53(4), 557–571. https://doi.org/10.1111/sltb.12964
4. Fartacek, C., Fartacek, R., Schiepek, G. K., Sturm, J., Aichhorn, W., & Plöderl, M. (2024). Dynamic association between suicidal ambivalence and suicide risk among individuals with a history of suicide attempts. Suicide & Life-Threatening Behavior, 54(5), 860–868. https://doi.org/10.1111/sltb.13096
5. Gray, N., Hasking, P., & Boyes, M. E. (2021). The impact of ambivalence on recovery from non-suicidal self-injury: considerations for health professionals. Journal of Public Mental Health, 20(4), 251–258. https://doi.org/10.1108/JPMH-07-2020-0093
6. Höller, I., Forkmann, T., Glaesmer, H., Teismann, T., Spangenberg, L., Schreiber, D., Hallensleben, N., & Kraiss, J. (2024). Torn between living or dying—analyses of influencing factors on suicide ambivalence and its longitudinally impact on suicidal ideation and behavior in a high‐risk sample. Suicide & Life-Threatening Behavior, 54(5), 869–877. https://doi.org/10.1111/sltb.13091
7. Mitchell, S., Marvin, C., Mitaj, D., & Rogers, M. L. (2024). Identifying latent classes of suicidal ambivalence: Associations with suicide risk correlates and outcomes. Suicide & Life-Threatening Behavior, 54(5), 844–859. https://doi.org/10.1111/sltb.13111
8. Oakey-Frost, N., Moscardini, E. H., Cowan, T., Cohen, A., & Tucker, R. P. (2023). The Temporal Dynamics of Wish to Live, Wish to Die, and Their Short-Term Prospective Relationships With Suicidal Desire. Behavior Therapy, 54(3), 584–594. https://doi.org/10.1016/j.beth.2022.12.011
9. O’Connor, S. S., Jobes, D. A., Yeargin, M. K., FitzGerald, M. E., Rodríguez, V. M., Conrad, A. K., & Lineberry, T. W. (2012). A cross-sectional investigation of the suicidal spectrum: typologies of suicidality based on ambivalence about living and dying. Comprehensive Psychiatry, 53(5), 461–467. https://doi.org/10.1016/j.comppsych.2011.09.007
10. Palocz, E., Miklosi, A., Elek, L. P., Kacimi El Hassani, S., Hende, B., Rozsa, S., Szokolay, D., Balazs, M., Berdi, M., & Gonda, X. (2026). Wish to live, wish to die, and suicidal ambivalence: associations with clinical factors and suicide risk assessment in psychiatric inpatients. Neuroscience Applied, 5, Article 105658. https://doi.org/10.1016/j.nsa.2025.105658
11. Teismann, T., Britton, P. C., & kmann, T. (2024). Ambivalence model of suicidality ABS-model: an orientation model for the treatment of suicidal individuals. Frontiers in Psychiatry, 15, 1449565. https://doi.org/10.3389/fpsyt.2024.1449565
12. Teismann, T., Siebert, A. M., & Forkmann, T. (2024). Suicidal ambivalence: A scoping review. Suicide & Life-Threatening Behavior, 54(5), 802–813. https://doi.org/10.1111/sltb.13092
13. White, T. (2018). The Seven Suicide Decisions: Reassessing the Gouldings’ Work to Include Suicidal Ambivalence and the Homicide/Suicide Dimension. Transactional Analysis Journal, 48(1), 59–72. https://doi.org/10.1080/03621537.2018.1397972

Register Now