Since it is Suicide Prevention Awareness Month I thought it would be a good time to post some of my thoughts and observations about working with people who experience suicidal ideation. Some of my thoughts and ideas come from personal experience – periods in my own life of feeling varying degrees of suicidal ideation – and from my work as a therapist with clients who have experienced them.
Suicide prevention is a very important mission – according to the CDC, in 2019 45,861 adults died as a result of suicide, and an estimated 381,295 adults visited hospital emergency departments for nonfatal, self-inflicted injuries. Understanding safety planning is one way for therapists to be prepared to help try to bring those numbers done.
At the same time, that CDC reports shows that annually from 2015-2019 about 10.6 million adults reported having suicidal thoughts which means that a significant number of people experience ideation without any attempts. As therapists we also need to be able to work with people to understand where the ideation is coming from and how to try to process it and even resolve it when possible.
It’s my position that when we work primarily from a “prevention” perspective – even before we have any reason to believe that the person is going to make a suicide attempt – we are going to be less effective in trying to actually address the issues underlying the ideation. As a profession I fear that we’ve already leaned so heavily on prevention that we might be deterring people from talking openly about their suicidal ideation, I know I’ve felt that in the past, worried that if I even mention my suicidal thoughts to a therapist they might call 911 and have me hospitalized (and I’ve never made a suicide attempt or seriously planned one).
When I first meet a client, as part of my confidentiality speech, I let them know that I would essentially have to believe that they were going to leave the office and do something to themselves to warrant me calling 911, anything short of that is a conversation (and a conversation that I will have with them anytime they need it). I’ve found that doing this has often lead to clients speaking openly about their suicidal ideation and us being able to explore where it’s coming from (often a sense of powerlessness or helplessness, or from a profound lack of a sense of meaning in their life).
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