The 1977 Denver coroner's report found that 45% of all suicide victims received psychotherapy at some time, and 21% were in treatment at the time of death. The literature on suicide places all responsibility upon the therapist. Four major sources of variance deserving consideration, however, are patient variables, therapist variables, treatment environment, and the wider social milieu. The crisis typically occurs within the first month or even day of treatment and is built around an escape fantasy which affects both the patient and the therapist. For the patient it serves as a suicidal motive, hides the patient's anxiety about terminating therapy, conceals patient's anger at therapist, restores patient's sense of self, and permits patient to construct a better world in fantasy. This fantasy serves the therapist by safely and successfully disposing of the patient, maintaining the therapist's own self-image, screening the shallowness of the patient's involvement in therapy, and denying the absence of a patient and therapist therapeutic alliance. A 10-year study of suicide treatment suggests focusing on the fantasy, continually re-evaluating the patient's death imagery and suicidal thinking, removing lethal means, offering constant mothering whenever the therapist is unavailable, freely offering regressive opportunities, offering particular concern at separation points, and following up serious suicide attempts. (Author/LS)