“I wish it was all over”, “I am a burden on everyone”, “Life has no motivation for me”, “I see no way out of my suffering”, “I would like to disappear ”,“ No I can hold out longer ”,“ it’s not worth continuing to live like this ”,“ it would be better if I stepped aside ”…
These sentences are examples of people who are in great pain and may be considering suicide as a way out. When we hear these kinds of statements, a “wake-up call” must be activated within us. As psychologists, what should we do in such complex situations?
In this article we will explain some guidelines for psychological intervention in people at risk of suicide which can be useful for professionals or students of psychology who may encounter similar situations, in which the patient-client more or less secretly expresses his desire to end everything.
First step before intervening: detecting the risk of suicide
Logically, before intervening, it is necessary to be able to detect the risk of suicide and assess it appropriately.
Some suicide risk indicators would be the statements discussed in the previous paragraph, although sudden changes in the patient’s life should also be taken into account (for example, changing from a state of nervousness and agitation to sudden calm. , for no apparent reason), as they may indicate that the patient has made the decision to commit suicide.
Other more visible indicators would be the preparations which are the antechamber of death: Give money, make a will, give valuables to loved ones …
Suicide risk assessment
Suicide needs to be brought up naturally and openly in suicide therapy, otherwise it might be too late to do so in the next session. There is a misconception that asking a depressed patient about suicide can cause them to think more positively and even accept thoughts of suicide.
however, ask the patient directly for relief, Understood and supported. Imagine that you have been thinking about suicide for a long time and cannot tell anyone about it because it is considered taboo and uncomfortable. How much weight would you carry, right? In many cases, talking to a psychologist can be therapeutic in itself.
In cases where the patient has never raised the issue of suicide and has not verbalized things like “I want to go away and end it all,” it is best to ask in a general way. For example: sometimes when people are going through difficult times they think it would be better to end their life, is that your case ?.
If the risk is very high, we will take action beyond psychological intervention during our consultation.
Principles of psychological intervention in patients at risk of suicide
Below is a list of exercises and principles from the cognitive-behavioral model for intervening with patients at risk of suicide. In some cases, it will be necessary to have a supportive co-therapist (To mobilize the patient) and / or with the family. In addition, depending on the professional’s criteria, the frequency of sessions should be extended and a 24-hour service number provided.
1. Empathy and acceptance
One of the basic premises of a psychological intervention is to try to see things as the patient sees them and to understand their motivations for suicide (for example, bad economic situation, very negative emotional state which the patient considers interminable. , divorce …). Psychologists must do a deep exercise in empathy, Without judging the person in front of us. We must try to involve the patient in the therapy, and explain to him what we can continue to do to help him, in order to establish continuity.
2. Reflection and analysis exercises
It is interesting to offer the patient to write and analyze in a thoughtful and detailed way the advantages and disadvantages, both short and long term, for him / her and for others, the options for committing suicide and continue to live.
This analysis must be carried out considering various areas of his life (Family, work, children, partner, friends …) so that he does not focus on what makes him suffer the most. We need to make you understand that we are trying to help you make a reasoned decision based on careful analysis.
3. List of reasons for living
This exercise consists of the patient write a list of your reasons for living, Then hang them in a visible place in your house. You are asked to view this list several times a day, and you can expand it as many times as you want.
Additionally, you may be asked to look at the positive things that happen in your day-to-day life, no matter how small, in order to focus your selective attention on the positive events.
4. Cognitive restructuring of the reasons for dying
When the patient identifies in the previous analysis the reasons for his death, in therapy we will see if there are any incorrect and exaggerated interpretations (for example, everyone would be better off without me because I made them miserable) as well as dysfunctional beliefs (eg I can’t live without a partner).
The goal of cognitive restructuring is for the patient to understand and see that there are other alternative and less negative interpretations of seeing things (The goal is not to trivialize with his situation or to paint the situation in “pink”, but for him to see that there are other interpretations halfway between the most positive and the most negative). The patient may also be prompted to reflect on past difficult situations that they have overcome in life and how they have resolved them.
In the event that there are unresolved problems that lead him to consider suicide as a valid means (relationship problems, unemployment …), it is useful to use the problem-solving technique.
5. Emotional management and time projection
For example, with borderline personality disorder, it may be helpful to teach the patient skills and strategies to regulate very intense emotions, In addition to using the technique of temporal projection (to imagine how things would be in a moment).