SUICIDE PERI-VENTION* Using Contextual-Conceptual Therapy

One-Day CCT Training


(What 16,000 Suicidal Patients Have Taught Us) 
A one-of-a-kind workshop to present a cutting edge approach to suicidality. This 1-day experiential/didactic workshop
for professionals teaches you how to: 

  • Explain suicide as a context-bound problem
  • Conceptualize the paradoxical context of the suicidal person
  • Understand how suicide is the symptom and not the problem
  • Define the theory of the bifurcated self and its implications for therapy with suicidal persons
  • Understand the metaphoric "language" of suicide 

CCT (Contextual- Conceptual Therapy) is a unique educational approach to suicide prevention. Fredric Matteson developed CCT
through his 25-year experience with over 16,000 suicidal patients at St. Francis Hospital in Seattle, Washington. Matteson's holistic
approach combines expressive arts techniques, education, and therapy. CCT can be used in conjunction with traditional methods
like Cognitive Behavioral Therapy. This training satisfies the requirements on suicide training in the State of WA.
As seen online in the New York Times: "After seeing so many thousands of suicidal persons, I discovered a ubiquitous ‘through-line’ or underlying common pattern running through all of those thousands of cases: the suicidal person is struggling in a "bifurcated state." -Fredric Matteson

CCT Scotland Associate Carolyn Wood's account of her experience with CCT Training:

Carolyn Wood - CCT Scotland

Carolyn Wood - CCT Scotland

The thrust of the CCT Level One Training workshop was that suicide is not something we need to medicalize and try ‘to get rid of’.  Instead we need to go where the person is—where they are trapped.  The client themselves directs us there, through their metaphoric language—their words/pictures/signals, and we, the therapist, need to hear, see and follow these, rather than ignore or treat them (the signals) as ‘madness’.

In CCT, suicide is seen as an identity crisis. The person is struggling between their two ‘selves’—who they are trying not to be (who think they are, as in the ‘bad’ person) and who they are trying to be (the ‘perfect’ or ‘good’ person).  But the reality is that neither is the TRUTH—they are based on intrapersonal views of what they believe to be their self.  (Read the full article here.)

Professional Testimonials

 “The CCT group is on the cutting edge of suicide work. Mental health professionals and many others will certainly benefit from their education. Their work needs to be widely disseminated as soon as possible.

"Fredric Matteson's approach to the Suicide field is powerful. He helps clients become conscious of material that they are missing in their liminal processes. Mr. Matteson is masterly in this helping approach."

Brian C. Riedesel, Ph.D., B.C.E.T.S.
Licensed Psychologist
Board Certified Expert in Traumatic Stress (1999-2016)
Staff Psychologist, University of Washington Counseling Center.
Lead Psychologist, Stillbear Consulting
Seattle, Washington


Tom Rusk

Tom Rusk

“I have been involved in learning, practicing and teaching psychotherapy for forty-five years. In that time I have been fortunate to have observed many masters of the craft in action, including Carl Rogers, Michael Balint, Carl Whitaker, Fritz Perls, Victor Frankl, and Albert Ellis. However, Fredric Matteson is unique in his background and approach. He neither belongs nor owes allegiance to any established school of therapy. An established poet, he mines his genius for metaphor and finds a way to apply himself to reach to the very core of those in extremis — those hospitalized because of severe suicidal impulses, plans and who frequently have made actual attempts. Aided by his gifts, including an intensity of spirit that resonates with those who are desperate, he finds ways to convert the instability of crisis into a loving, healing process. It’s wonderful to see that his creativity, talents, compassion, and vast experience have begun to be recognized internationally."

Tom Rusk, MD,
Senior Psychiatrist Penobscot Community Health Care
Diplomate of the American Board of Psychiatry and Neurology, Distinguished Life Fellow, American Psychiatric Association
Author of the Bestselling Books: "The Power of Ethical Persuasion"; "Get Out Of Your Own Way"; "I Want To Change But I Don't Know How"

Read more professional testimonials here.

Two-Day Introductory CCT Training Overview

Traditional medical/psychiatric models approach the problem of suicidality from a variety of theoretical perspectives: biological, cognitive, psychodynamic, etc. However, practical interventions based on these theories often fail. Many suicidal persons often admit to years of counseling, hospitalizations, and medication. They say they will feel better for awhile but then feel twice as suicidal the next time they are in crisis. What this indicates is that an underlying problem keeps changing form, but never changes. 

Fredric Matteson, creator and founder of the Contextual-Conceptual Therapy (CCT) model, a new cutting edge approach to suicidality, has sought to understand the core experience of being suicidal by exploring the language of suicidal persons in the midst of suicidal crises. In this highly original, one-of-a-kind workshop, suicidologist Matteson, and his CCT team, will explore that language and what being in dialogue with 16,000 suicidal inpatients in individual and group therapy has taught Matteson over 25 years of hospital clinical experience. By the end of the two days, you will be introduced to the unique context and metaphoric language of the suicidal person. You will leave knowing a new way to conceptualize the phenomenology of the suicidal state. You will learn a counterintuitive way to be able to communicate with the suicidal person, to be able to “reach” them from inside of their own experience with the life-saving information they so desperately need. You will learn the 7 Stages of the Causal Chain of Suicide that can then serve as the basis for effective treatment strategies and interventions with your suicidal clients founded upon a new conceptualization of suicide.

This innovative workshop will explore the importance of conceptually understanding the bifurcation of the suicidal context, the “false dilemma” of the suicidal double bind, and the necessary destabilization of the suicidal person. You will learn how the suicidal crisis is, at its core level, a crisis of identity and how it can be turned into a liminal opportunity for transformation towards authentic selfhood. You will learn the indirect and paradoxical method of communication needed to bypass the resistance of the suicidal person’s fierce intelligence and specious logic which sustains the psychological and emotional “trap” that binds them. Throughout the workshop, you will be introduced to some of the counter-intuitive CCT methodology for orienting and guiding suicidal persons.. During the two days you will also be introduced to some of the key maps and visual metaphors that have been used effectively over the past two decades on the hospital mental health unit in one-to-one and group sessions, and now in private practice. You will also have the opportunity to learn about a sampling of the 32 complementary CCT "assignments" that are available to tailor to the specific needs of each suicidal person to begin the process of introducing them to a new pathway out of suicide. 


  1. Explain suicide as a context-bound” problem; Conceptualize the context of the suicidal person.
  2. Define the theory of the bifurcated self and its implications for therapy with suicidal persons.
  3. Explain the importance of spatial understanding to “communicate” with suicidal persons via the use of maps, models, and other visuals.
  4. Understand the use of metaphors, paradox, and other forms of “indirect” communication, to bypass the suicidal person’s lethal logic.
  5. Realize, counter-intuitively, why suicidal persons need to be destabilized.
  6. Understand the “danger” in comforting the suicidal person.
  7. Conceptualize the CCT questionnaires as based on the suicidal patients’ own algorithmic information.
  8. Understand how suicide is a symptom and not “the” problem; see suicide as a crisis of identity.
  9. Explain the difference between divergent and convergent thinking with the suicidal person and the importance of looking for questions and not “answers.”
  10. List the 7 Steps in the Causal Chain of Suicide (“The Suicidal Algorithm”).


DAY ONE:   C O N T E X T U A L (The Way In)    


  • Conceptualizing the core problem: A Bifurcated Context
    • Understand the contextual problem represented by the suicidal state  
    • Explain the concept of "bifurcation”, its origin, and its dynamics
    • Examine the 10 stages of “The Context Map”; understand “you” and YOU discrepancies
    • Understand the “false dilemma” of the suicidal person
    • Conceptualize suicide as a context-bound problem: a “Crisis of Identity”                     
  • Establishing the suicidal context through spatial understanding: maps, models, & metaphors
    • Identify the Key Principles for communicating with the suicidal person – including the “danger” in comforting them, the need for destabilization, and the use of  indirect communication
    • Define maps & metaphors: how they address the contextual problem of the suicidal person
    • Review step-by-step the 10 stages of “The Hope Bridge” map to “orient” the suicidal person    


  • Theoretical overview of Contextual-Conceptual Therapy (CCT)
    • Understand a concise description of Contextual-Conceptual Therapy: the CCT “Abstract” 
    • Learn the 10 “Findings” from discourse with 16,000 suicidal inpatients
    • Understand the 10 CCT Treatment Principles
    • Explain the difference between divergent and convergent thinking with the suicidal person and the importance of questions and not “answers.”
    • Leading them to their own answers
  • Practical applications of CCT: the mental health unit, hospital ER, private practice
    • Leading the CCT Group with 10 suicidal clients: a “spherical” versus “linear” process
    • Conducting the one-to-one CCT session with the suicidal person: “locating” them first
    • Applying CCT in the Emergency Room: a new way to “triage”; a proposed “map” room
    • Using CCT methodology in private practice: the use of “mapping” and spatial understanding
    • Explore the “Bi-lateral Risk Management” map and the need for a “Play Field


DAY TWO:   C O N C E P T U A L (The Way Out) 


  • The 7 Steps in the Causal Chain of Suicide
    • A panel-by-panel review (in reverse order) of the 7 Steps in the Causal Chain of Suicide
    • Implications of the Causal Chain “map”: A context of “Inverse Wellness” not illness
    • Suicide is not the problem but a symptom of the problem: the bifurcation
    • “I want to die is a metaphor for I want to live”: a normalized survival mode
    • The False Dilemma: “Life” = pain; “death” = no pain
  • Introduction to the CCT assignments & ways to use them to effect change
    • Practice the NSO/ CSO Traits Worksheet: the importance of the NSO/CSO “traits”
    • Understand the questionnaires as based on the suicidal patients’ algorithmic information
    • Explore some the CCT assignments and exercises: using ALL the information circled or not
    • The “problems” aren’t problems but definitions; the “goals” aren’t goals but wishful fantasies
    • Explore the idea of “tricking” the suicidal person into giving their own “answer”


  • CCT handouts and exploration of some key CCT “tools”
    • Contrasting the differences between “you” / YOU definitions
    • The Compassionate Self-Observer Card and its use
    • Imagine what your own CSO card would look like
    • Examples of the CCT “Flashcards”: metaphoric images demonstrating CCT concepts
    • Create your own personalized map of “The Hope Bridge”
  • Questions and Answers about the CCT Model of therapy
    • Explore questions in CCT application
    • Describe differences in your current approach to working with suicidal person and CCT
    • Explore implications of implementing and utilizing CCT in your present setting
    • Conceptualize CCT as Suicide PERI-vention (an “upstream” approach to complement Suicide PRE-vention)             
    • Identify future in-depth CCT trainings potential & CCT program implementation



* "Perivention": It is what we need to know BEFORE we can address suicide and despair.