Suicidality is a complex symptom with many possible causes, often arising from conflicting inner experiences and trauma. Building on Sigmund Freud, who introduced a key distinction between external triggers and unconscious conflict themes, subsequent psychodynamic explanatory models have also focused on the fate lines of intrapsychic object relations and their reenactment in therapy. Contemporary psychoanalysis thus possesses differentiated explanatory models and clinically profound treatment techniques. Fundamental to the psychotherapeutic treatment of suicidal patients is the concept of transference and countertransference. Its refined repertoire of interpretation and treatment allows for deciphering the extent of destructiveness within the patient-therapist relationship.