Helping the Suicidal Person

Tips and Techniques for Professionals

Stacey Freedenthal

• Publisher: Routledge
• Year: 2017
• ISBN:
  9781317353263
• Edition: 1
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Helping the Suicidal Person provides a highly practical toolbox for mental health professionals. The book first covers the need for professionals to examine their own personal experiences and fears around suicide, moves into essential areas of risk assessment, safety planning, and treatment planning, and then provides a rich assortment of tips for reducing the person's suicidal danger and rebuilding the wish to live. The techniques described in the book can be interspersed into any type of therapy, no matter what the professional's theoretical orientation is and no matter whether it's the client's first, tenth, or one-hundredth session. Clinicians don't need to read this book in any particular order, or even read all of it. Open the book to any page, and find a useful tip or technique that can be applied immediately.

one
Understanding Suicide and You

Tip 1: Reflect on Your Biases about Suicide

“Your ethical, moral, and philosophical conceptualization of suicide will have direct and indirect influence on your clinical practice.”

Dana Worchel and Robin Gearing
(2010, p. 4)

Mental health professionals need to have a solid understanding of their attitudes toward suicide and suicidal behavior. Whether they consider suicide to be a sin or a right, their stance can negatively influence assessment and treatment, even outside of their awareness. Professionals who view suicide as unequivocally wrong may have difficulty listening nonjudgmentally as a person describes compelling reasons for wanting to die by suicide. Conversely, people who view suicide as permissible might hesitate to thwart an individual’s suicide, leading to an avoidable tragedy. In many smaller ways, a professional’s stance toward suicide prevention can disrupt treatment.

To examine your attitudes toward suicide prevention, consider the following questions:

• What do you believe about people who attempt or die by suicide?
• Do you believe suicide should always be prevented? Why or why not? And if you do not believe it should always be prevented, under what circumstances should a person be permitted to die by suicide without intervention?
• Do you view suicide as selfish? Why or why not?
• Do you view suicide as cowardly? Why or why not?
• Is suicide a sin? Again, why or why not?
• Under what circumstances would you consider suicide for yourself? (If it seems incomprehensible to want to kill yourself, why?)

The purpose of the questions above is to jump-start your honest examination of your suicide-related beliefs. There are no right or wrong answers. However, myths, biases, and logical inconsistencies shape some people’s answers, and they are considered below.

Should Suicide Always Be Prevented?

This question, like the others, contains no right or wrong answer, but inconsistency can be revealing. Examine whether your response differs based on the person’s age, physical health, mental health, or life circumstances. Also consider how your views on suicide prevention could affect how you respond to a suicidal person, and what safeguards you take (or neglect to take) to ensure that your views do not interfere with providing the most effective and ethical care possible to the suicidal person.

Is Suicide Selfish?

Many people lament that people who die by suicide hurt loved ones and damage the community as a whole (Hecht, 2013). The man whose suicide leaves behind a young widow to raise four children on her own, the teacher whose suicide profoundly scars her students – these kinds of deaths provoke accusations of selfishness. Almost always, however, people who die by suicide do so under the duress of mental illness, hopelessness, trauma, pain, or some other seemingly inexorable problem. It is questionable whether the person is to blame for actions that stem from forces beyond the person’s control.

The psychologist Thomas Joiner (2010) also disputes the notion of selfishness by pointing out that many people who attempt or die by suicide actually want to help the people they love, not hurt them. Falling for the lies of depression, hopelessness, or other mental pain, they often believe, mostly to the astonishment of their family and friends, that their suicide will make life easier for others. However misguided it may be, the wish to spare others is hardly selfish.

Is Suicide Cowardly?

Some people view suicide as “taking the easy way out.” Others note that it requires courage to overcome the survival instinct and actually end one’s life (Joiner, 2010).

Is Suicide a Sin?

This question summons deeply personal beliefs. Whatever your beliefs, it is worth noting that the major world religions once condemned suicide universally but now make allowances for suicide that occurs as a result of mental illness or impairment (Nelson et al., 2012).

In Closing

It is impossible to be neutral about suicide. Bias is inescapable. To not care one way or the other allows for the possibility that suicide should not always be prevented, which in itself is a bias. Uncover your own biases, and make a plan for how to help someone in spite of them.

The Judgmental Therapist

A clinical social worker for five years, Ashley held negative judgments about suicide. She believed suicide to be a sin, selfish, and cowardly. As a result, when she asked a client if they were thinking of dying by suicide and the person said no, she invariably responded by exclaiming, “Oh, good!” Sometimes she would elaborate: “People who kill themselves are only thinking of themselves. It devastates those left behind.” Her clients learned quickly that if indeed one day they did consider suicide, Ashley would judge them negatively. When that day came, some chose not to tell her, and others left treatment altogether. For the sake of her clients, when a client reports that they are not considering suicide, a better response would be: “Would you be willing to tell me in the future if that changes for you?”

Works Cited

Hecht, J. M. (2013). Stay: A history of suicide and the philosophies against it. New Haven, CT: Yale University Press.

Joiner, T. (2010). Myths about suicide. Cambridge, MA: Harvard University Press.

Nelson, G., Hanna, R., Houri, A., & Klimes-Dougan, B. (2012). Protective functions of religious traditions for suicide risk. Suicidology Online, 3, 59–71.

Worchel, D., & Gearing, R. E. (2010). Suicide assessment and treatment: Empirical and evidence-based practices. New York, NY: Springer Publishing.

Tip 2: Take Stock of Your Experiences with Suicide (or Lack Thereof)

“Our own histories with suicide, whether that be our own suicidality, the loss of a loved one to suicide, or the death of a former patient to suicide, will greatly impact how we approach and respond to people who actively think about suicide …”

Nadine Kaslow
(in Pope and Vasquez, 2016, p. 324)

Many mental health professionals have personal experience with suicide or suicidality. In one study of psychiatrists, psychiatric nurses, psychologists, and social workers, 43% reported ever having considered suicide, and 5% had made a suicide attempt (Ramberg & Wasserman, 2000). If mental health professionals are representative of the general population, then we can assume that half have known someone personally who has died by suicide, with almost 40% of those people reporting that the person who died was a family member (Cerel et al., 2016). Suicide also touches professionals in their work. Studies indicate that 23% of professional counselors, 30% of psychologists and social workers, and 50% of psychiatrists have had a client die by suicide (McAdams & Foster, 2000; Jacobson et al., 2004; Ruskin et al., 2004).

These experiences with suicide cannot help but influence one’s professional work with suicidal individuals. On the positive side, people with “lived experience” often have keen insight and empathy for others on similar journeys. On the negative side, there is the danger that lived experience with suicidality or suicide loss can give rise to rescue fantasies, overidentification, boundary violations, and even outright impairment. Subtler effects can also occur, such as avoiding asking or talking about suicide.

Professionals who lost someone to suicide or experienced suicidality themselves need to explore how their experiences positively and negatively affect the ways that they talk about suicide with clients and the actions that they take (or do not take) as a result. If your self-examination reveals areas of concern, then awareness is not enough. You also need a strategy to manage your reactions to avoid doing harm. In general, personal psychotherapy, supervision, and consultation can help prevent past troubles from intruding on your present effectiveness.

Can Suicidal Professionals Help Suicidal People?

Many people with suicidal thoughts manage to observe the thoughts dispassionately, easily resist any urges to act on them, and recognize them as a symptom, not a powerful force or fact. This is a goal for our clients and a reality for many mental health professionals afflicted with a chronic mental disorder such as major depression or bipolar disorder. In such cases, when the professional is detached from their suicidal thoughts and lacks any intent to act on them, then it usually is appropriate to continue seeing clients.

If the suicidal thoughts gain strength and become seductive, then the professional must take extra measures to ensure fitness for practice. Therapists caught up in suicidal thinking can do harm to the people they are there to help. For example, a client’s articulation of suicidal thoughts can draw the helping professional into an internal debate about whether to die by suicide, making it impossible for the professional to devote their full attention to the client. The psychiatrist Shawn Shea (2011) recommends that mental health professionals who are experiencing suicidal thoughts receive mental health treatment and, separately, consultation or supervision. The treatment provider and the supervisor or consultant should communicate with each other and work collaboratively with the suicidal professional to assess whether the person can continue seeing clients without doing harm.

Can Professionals Without Lived Experience Help Suicidal People?

A person’s lived experience with suicidality need not be harmful, and it can actually be helpful. People who have survived a suicidal crisis may have insights into the experience that others lack. Jack Gorman, a former psychiatrist, writes of the awakening he had when, after decades of treating suicidal patients, he became dangerously suicidal. “I now realize that I never really understood what it means to want to die,” he wrote in 2013. Gorman goes on to state that he had believed that suicidal individuals were frightened and confused by their self-destructive urges. Then he learned firsthand that suicide could seem perfectly rational, ethical, and even necessary to the suicidal person.

A suicidal history is certainly not a requirement for effectively and empathically helping suicidal individuals, just as someone without a history of addiction can be a good addictions counselor. But some people who have never personally experienced suicidal thoughts struggle to understand how someone could want to end their life. If that applies to you, I recommend reading memoirs by people who have survived a suicidal crisis. Here are just a few examples in which the author does a superb job portraying suicidal experiences:

• Cracked, Not Broken: Surviving and Thriving after a Suicide Attempt, by Kevin Hines (Rowman & Littlefield Publishers);
• An Unquiet Mind: A Memoir of Moods and Madness, by Kay Redfield Jamison (Vintage Books);
• This Is How It Feels: A Memoir: Attempting Suicide and Finding Life, by Craig Miller (CreateSpace Independent Publishing);
• Darkness Visible: A Memoir of Madness, by William Styron (Random House);
• Waking Up: Climbing through the Darkness, by Terry L. Wise (Missing Peace, LLC).

“Now I React with Intention and Awareness”

“Mama, where’s Daddy?” Family lore has it that those were the first words Daquan ever spoke, when he was almost two years old, just a few weeks after his father died by suicide. In adolescence, Daquan faced his own suicidal thoughts. He attempted suicide twice, once at the age of 16 and again at 22, before he was diagnosed with bipolar disorder and stabilized with medication. Now 36 and a school psychologist, Daquan works at a high school for at-risk students. Students often disclose to Daquan that they are thinking about suicide or have made an attempt.

At first, when Daquan started working at the school five years earlier, talking with suicidal students triggered painful memories and grief. A few times, he had to lock himself in his office and cry at his desk. Then he found himself avoiding the topic of suicide or changing the subject when students brought it up. Eventually, he resumed therapy and explored the open wounds from his father’s suicide and his own suicide attempts, as well as the gifts of insight and empathy that his experiences provided.

Daquan says the most valuable aspect of therapy was learning to ground himself in the present moment so that he could focus on the needs of the student sitting in front of him, instead of getting lost in his past trauma. “I’m no longer on auto-pilot,” he says. “Now I react with intention and awareness. That wasn’t always the case.”

Works Cited

Cerel, J., Maple, M., De Venne, J. V., Moore, M., Flaherty, C., & Brown, M. (2016). Exposure to suicide in the community: Prevalence and correlates in one U.S. state. Public Health Reports, 131(1), 100–107.

Gorman, J. (2013). I never really understood what it means to want to die. Retrieved 31 January, 2017, from http://attemptsurvivors.com/2013/04/01/i-never-really-understood-what-it-means-to-want-to-die/.

Jacobson, J. M., Ting, L., Sanders, S., & Harrington, D. (2004). Prevalence of and reactions to fatal and nonfatal client suicidal behavior: A national study of mental health social workers. Omega: Journal of Death and Dying, 49(3), 237–248.

McAdams III, C. R., & Foster, V. A. (2000). Client suicide: Its frequency and impact on counselors. Journal of Mental Health Counseling, 22(2), 107–121.

Pope, K. S., & Vasquez, M. J. T. (2016). Responding to suicidal risk. In Ethics in psychotherapy and counseling: A practical guide (6th ed., pp. 314–334). Hoboken, NJ: John Wiley & Sons.

Ramberg, I. L., & Wasserman, D. (2000). Prevalence of reported suicidal behaviour in the general population and mental health-care staff. Psychological Medicine, 30(5), 1189–1196.

Ruskin, R., Sakinofsky, I., Bagby, R. M., Dickens, S., & Sousa, M. G. (2004). Impact of patient suicide on psychiatrists and psychiatric trainees. Academic Psychi...