Author’s Note
• • •
Studies of stress among therapists and counselors show that suicide threats and attempts by those they serve are the two most extreme stresses encountered in professional work. The death of patient by suicide is even more traumatic. Yet, it is impossible to participate in the healing arts and not encounter suicidal clients. They are, literally, everywhere.

This book was written specifically to help mitigate this stress and to create a safer and more comfortable treatment environment for both sufferer and healer. When both parties in the therapeutic relationship are at ease with a subject as difficult, challenging and frightening as suicide, a foundation of hope is laid and a more positive and rewarding outcome becomes possible.
This text was also written especially for the non-expert in suicide prevention. A incomplete list of those who work with suicidal persons includes the crisis volunteer, counselor, pastor, social worker, fire or police chaplain, case manager, youth worker, therapist, physician, nurse, alcohol or drug counselor, and all the other professional or paraprofessional human service workers who try to make a difference in this world. Much of what can be found here is written for those who work with suicidal patients in counseling or therapy.

How to Use This Book
• • •

For ready use, this text is divided into two sections, intervention and treatment.
Intervention and the Suicide Journey
The first section has been laid out along the basic theoretical idea that suicide is a process—not a fixed event. Simply put, what this means is that at the time you first come into contact with someone who is contemplating suicide, you may be meeting that person at either end of what I’ll call the suicide journey.

The suicide journeys begins with the idea that killing oneself will end suffering and solve the problems and pain of living. The journey ends, sometimes, with a completed suicide. This journey can be a short, swift one, but it is more likely a long and labored one. Where you meet someone along this tortured road is all-important.
For example, if you’re the first person to learn about the initial passive suicidal thoughts of a never-before-suicidal young person faced with problems that appear overwhelming, your job shouldn’t be too difficult. However, if you meet an old, white, alcoholic, twice-married, failed accountant under indictment for tax evasion who has a previous suicide attempt history and has just learned his third wife is leaving him next Friday, you may be meeting someone whose journey toward suicide is nearly ended.

How we respond to each of these travelers (and how they respond to our interventions) is critical to helping them survive. The first part of this book, therefore, deals with the various stages of suicidality, its assessment, and the range of possible interventions available to us.

Except for the highly impulsive person (and many suicidal people are impulsive), the majority of suicidal persons I’ve met take roughly the same journey. The back roads, highways, and detours vary, but everyone who kills him- or herself must begin with the notion, move on to active contemplation, and make what they believe will be a fatal plan. Before taking the final action, the suicidal person generally communicates his or her intention to die to others.

This communication will vary from direct to indirect verbal threats, to gestures, to silent behavioral clues, and to non-fatal public attempts. As most people move closer and closer to the end of their journey, they send signals that they are nearing the end. And while there are exceptions to this troubled route and the communication of intent to others as the day of death approaches, most sufferers travel the one I’ve just described.

How to meet these travelers, what questions to ask, and what actions to take to keep them safe is the stuff of the first part of this book. Suggestions here can be adapted to local resources. There are no doubt other ways to do this intervention work, butthese
are the ways that have worked for me.

Treatment and a Therapy of Hope
The second part of the book is for healers … therapists, clergy, counselors, clinicians and others who work with suicidal people. As such, this portion of the book deals with all the many ways we can use ourselves, our training, and our healing relationships to help weary travelers not only pass over a stretch of bad road, but learn to enjoy the journey of life to its natural end. Written in the form of strategies, techniques and interventions, these are tools and considerations from which you may pick and choose in your life-saving work. Last, as there are several problems inherent in ourselves as helpers, our clients and the systems in which we work, I’ve tried to address these as well.

From page 59… regarding therapist’s reactions to suicidal clients….

Strong Feelings
At this point in any difficult suicide risk assessment interview, strong feelings are evident. The suicidal person came in upset and may now be more upset because of being confronted with the inability to manage his or her own life. Autonomy jeopardized, he or she may claim his or her constitutional rights are being infringed and argue that this is still a free country and that you can’t force your will on the person. This can be very genuine hostility, and unless you are from some other solar system, you too will be feeling some strong emotions.

The good feelings of empathy and understanding you felt toward the suicidal person only moments before may be replaced with boredom, anger (fear), or frustration. Such negative reactions to a suicidal person often mean – at least in my experience – that the suicidal person is attempting to drive away or alienate the very people who could help them. It is as they are saying, “Get away from me! Can’t you see I’m already dead!”

Therefore, it is a good idea to check your emotional reactions to suicidal people as you assess and work with them.

Boredom. Feeling suddenly bored with a suicidal person’s problems may signal that you are, emotionally, withdrawing from the relationship at a high rate of speed. After all the time you’ve just spent together, now the person doesn’t want to play ball. You’re tired, it’s late and, after all, there are better things to do than to keep spinning your wheels with someone who can’t seem to make a decision.

Anger. As fear is usually behind anger’s face, expect at least the possibility that you will begin to feel a bit of anger. In this case (where you’re trying to save a life), the fear comes from the feeling that you’re failing. Here you’ve been trying to save this person’s life and, after giving it your best effort, you’re now being told to get lost. Becoming angry is an extremely common emotional reaction to someone that has placed his or her life in your hands and now wants to tie those hands behind your back.

Frustration. Unless you do suicide assessments for a living, expect to feel at least frustrated. A lot is at stake. The person is now less than cooperative and testing all your skills. Without necessarily meaning to, the person may try you and push you to the limits of your kindness. This is okay. Consider that a lot of people may have let this person down lately. You just happen to be the last one in line.

Handling Your Emotions
Feeling boredom, anger (fear), and frustration—and knowing these are normal and on schedule—may help you identify them as they occur. Owning such emotions is good, not bad. It means you’re on target and know what’s going on inside you. Depending on circumstances, it may be quite appropriate to say to the suicidal person,

“You know, I’m getting a little scared here. Despite our having talked together and having gotten started on understanding some of your problems, you’re acting like you don’t want me to help you any more. Have you had this experience with others?”

You may get a helpful answer here and one that can put the relationship right again. Very often the suicidal person will come in with a history of similar unhelpful conversations. Your question may cut right to the heart of the matter by acknowledging everyone’s sense of impotence and helplessness. Another congruent statement to make is,

“I realize you may not be able to make a commitment to safety and treatment right now. That may be okay for you, but it isn’t okay for me. I’m here to do the best job I can to keep you alive and I intend to do it.”

By showing the suicidal person you’re willing to make a stand, he or she will generally calm down and go along with the program. Based on your objectivity and good judgment, you’ve decided to pry the person’s fingers from the wheel and take over the driving. As the designated driver (the clear thinking and sober one), you did the right thing. Later, and this proves true more often than not, the suicidal person will return and thank you for having the courage to act in his or her best interest.

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