Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.


Date of Graduation


Document Type


Degree Name

Doctor of Psychology (PsyD)


Department of Graduate Psychology


Ken Critchfield

Anne Stewart

Cara Meixner

Lora Henderson Smith


Suicide is among the leading causes of death in the U.S. and it is imperative to improve prevention efforts (CDC, 2021). Previous research has demonstrated a strong association between adverse childhood experiences (ACEs) and suicide risk (e.g. Felitti et al., 1998; Hughes et al., 2017), and the need for deeper understanding of these associations utilizing developmental and relational perspectives (e.g. Angelakis et al., 2019; Hjelmeland and Knizek, 2020). This study investigated the associations between ACEs, interpersonal learning history in early attachment relationships, and suicidality using an explanatory sequential mixed methods design. The Structural Analysis of Social Behavior (SASB; Benjamin, 1979) is a widely used dyadic model that characterizes interpersonal patterns, and Interpersonal Reconstructive Therapy (IRT; Benjamin, 2003/2006) is an integrative, interpersonal and intrapersonal psychotherapy built from clinical observations using this model. The goals of this study were to (1) investigate if specific early interpersonal hostility from caregivers, learned and copied, and measurable using the SASB model, are better predictors of adult suicidality, relative to broadly framed ACEs, and (2) to understand, in depth, these associations using descriptive clinical narratives that characterize the experiences of suicidal individuals in a psychiatric sample (N = 103). An additional methodological goal included applying ACE ratings to individuals based on clinical interviews and reports, and to test the reliability of this application. Statistical analyses included exploratory principal components analysis, correlations and multiple linear regression. Content analysis was used to analyze qualitative data. This study demonstrated that an individual’s ACE score can be reliably measured through interviews or case reports that provide descriptions of an individual’s childhood history. Quantitative and qualitative findings support the hypothesis that interpersonal specificity of learned patterns of relating between an individual and their caregiver, as articulated by copy process theory, is significant to their vulnerability to suicide (Critchfield and Benjamin, 2008). Findings have clinical implications for clinicians working with suicidal individuals. This study bridges the ACEs literature and the clinical literature around IRT case formulation and SASB. Limitations and future directions are discussed.



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