In this blog, UKCP psychotherapist Lorraine Davis discusses the therapeutic process when working with someone experiencing suicidal ideation.
Misconceptions and reactions to suicide
The experience of suicide and suicidal thoughts results in different reactions, for instance, fear, anger, sadness, numbness and dissociation. Our reactions can offer insight into how misconceptions have emerged. For example, ‘people who take their lives are selfish’ or ‘they took the easy way out’. Yet individuals who suffer, do so in silence feeling helpless and hopeless, and all they want is an escape from the overwhelming emotional pain.
Another misconception is that only those with mental health issues are suicidal. Stressful, or life-changing events can trigger suicidal thoughts and attempts, with no prior mental health problems. Examples include a relationship breakdown; the death of a loved one; sexual abuse/assault; a life-changing illness or accident; redundancy or loss of employment. Some assume that those who experience suicidal thoughts are more likely to take their own lives, or think that talking about suicide may encourage active suicide attempts. These fears only incite more fear, disconnection and withdrawal, from those suffering from suicidal ideation. Individuals then become more afraid to open up, and yet talking about suicidal thoughts, plans and actions help to validate and neutralize feelings of despair, distress and isolation.
Working therapeutically with suicidal ideation
Suicidal thoughts and attempts provide useful insight into levels of desperation and suffering. A person’s emotions and body are in an intense, extreme state of pain. Often it is about killing off the pain or a part of self, rather than death itself. People who are suicidal don’t see the point in life, they have no sense of purpose. They want to protect others from their feelings of being toxic, and a burden to others.
In my experience of working therapeutically with individuals who are suicidal, it is useful to be aware of our reactions. For example, dissociation, numbing, withdrawing through fear, and threat. Freezing and escaping are normal healthy responses when we are exposed to threat and violence. Working with suicidal clients is frightening, scary, and yet hugely rewarding. As therapists working with suicidal clients we also need to address our own isolation, and capabilities, and so need to be engaged with risk assessment, responsibility, supervision and ensuring that other healthcare professionals (e.g. GP and mental health teams) are involved.
Pacing the therapeutic process
When working with suicidal individuals, it is useful to slow everything down, encourage and focus on embodied states, and what sensations and feelings want to say, to provide a voice for these experiences. Validate the person’s experience with empathy rather than recoiling with fear, disconnecting, or avoiding. Reflect on what you are being pulled into, as a client’s helplessness, and hopelessness is anaesthetizing and numbing. When clients are helpless, we too feel stuck, frozen and overwhelmed.
Suicidal individuals want to go into hiding; therefore, it is imperative to encourage expression. When we go into hiding, we are looking to be found. Not being found or noticed creates emptiness, isolation, alienation and shame. The antidote to this is compassion, connection, curiosity, and empathy.
For help with suicidal thoughts:
In an emergency, call: 999
NHS (England), call: 111
NHS Direct (Wales), call: 0845 46 47
The Samaritans 24 hour helpline, call: 116 123
Lorraine Davis is a UKCP Psychotherapist and works with clients on a wide range of issues.