who repeatedly attempt suicide. A controlled trial Cognitive-behavioural problem solving in the treatment of patients

condition.The grouppractisingproblemsolvingimprovedsignificantlymorethan controlson ratingsof depression,hopelessness,suicidalideationandtarget problemsat the endoftreatment and at follow-upof up to one year, andthere was evidenceof an effect on theratesof repetitionover the six monthsafter treatment.There is a need for “?moreresearch. . . to establishthe most effective patterns of care for patients whodeliberately harm themselves, while at the same timemaking better use of scarce resourcesâ€s (Departmentof Health and SocialSecurity,1984).Methodologicaldifficulties involved in carrying out such researchhave been well summarised by Hawton (1989). Selfharm occurs in a wide range of clinical conditions,and is not uncommon among those without anyformal psychiatric diagnosis (Hawton & Catalan,1987). This suggests that pharmacotherapy forrepeated suicide attempters may be of questionablevalue, and that psychological treatment is moreappropriate. Furthermore, there is evidence thatdrug treatments are ineffective (Morgan, 1979);moreover many patients attempt suicide usingprescribed psychotropic medication. For a psychosocial intervention to be useful in self-harm patients,it must be brief, flexible, and relevant to a wide rangeof difficulties and diagnoses. Recent experimentalstudies of patients who have attempted suicide haveshown specific deficits in problem-solving abilities(e.g. Linehan et al, 1987; Schotte & Clum, 1987),consistent with the hypothesis that attempted suicidemay relate to failures of problem solving at timesof crisis.Taking all of these factors into account, thecognitive-behavioural approach to problem solvingshould be a useful short-term treatment, and it hasmet with some limited success when applied to the