This Is Psychological Intervention In Patients At Risk Of Suicide
“I wish it would all end”, “I am a burden to everyone”, “life has no incentive for me”, “I see no way out of my suffering”, “I would like to disappear”, “I can’t take it anymore”, “it’s not worth it to continue living like this”, “it would be better if I got out of the way”…
These phrases are examples of people who are experiencing great suffering and who may contemplate suicide as an exit route. Hearing these types of statements should activate an “alarm” signal in us. As psychologists, what should we do in these complex situations?
In this article we are going to explain some psychological intervention guidelines for people at risk of suicide that may be useful for those professionals or students of Psychology who may encounter similar situations, in which the patient-client expresses in a more or less covert way his desire to end everything.
First step before intervening: detect the risk of suicide
Logically, before intervening we must be able to detect the risk of suicide and evaluate it appropriately
Indicators
Some suicide risk indicators would be the statements discussed in the previous paragraph, although sudden changes in the patient’s life must also be taken into account (e.g., going from a state of nervousness and agitation to one of sudden calm, without apparent reason), since they may indicate that the patient has made the decision to commit suicide.
Other more visible indicators would be the preparations that are the prelude to death: give money, make a will, give valuable items to loved ones…
Suicide risk assessment
Suicide should be talked about naturally and openly in therapy, otherwise it may be too late to do so in the next session. There is a misconception that asking a depressed patient about suicide can lead them to think about it in a more positive way and even accept suicidal ideation.
However, Asking the patient directly makes them feel relieved, understood and supported. Imagine that you have been thinking about committing suicide for a long time and that you cannot talk about it with anyone because it is considered a taboo and uncomfortable topic. How much weight would you be carrying, right? In many cases, talking about it with a psychologist can be therapeutic in itself.
In cases where the patient has never raised the topic of suicide or verbalized things like “I want to disappear and end everything,” it is best to ask in a general way. For example: sometimes, when people go through bad times they think that the best thing would be to end their life, is this your case?
If the risk is very high, we must proceed to take measures beyond psychological intervention in our consultation
Principles of psychological intervention in patients at risk of suicide
Below we will see a list of exercises and principles from the cognitive-behavioral model to intervene 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 his family. Furthermore, according to the professional’s criteria, it will be advisable to extend the frequency of the sessions and provide a 24-hour service number.
One of the fundamental premises for psychological intervention is to try to see things as the patient sees them, and understand their motivations for committing suicide (e.g., dire economic situation, very negative emotional state that the patient sees as endless, divorce …). Psychologists must do a deep exercise in empathy, without judging the person in front of us. We must try to get the patient involved in the therapy, and explain to him what things can continue to be done to help him, in order to establish continuity in it.
2. Reflection and analysis exercises
It is interesting to suggest that the patient write and analyze in a reflective and detailed way the pros and cons, both in the short and long term, for him/her and for others, the options of committing suicide and continuing to live.
This analysis must be carried out taking into account various areas of your life (family, work, children, partner, friends…) so that you do not focus on what causes you the most suffering. We must convey to you that we are trying to help you make a reasoned decision based on in-depth analysis.
3. List of reasons to live
This exercise consists of the patient write a list of your reasons for living, and then hang them somewhere visible in your home. You are asked to consult this list several times a day, and you can expand it as many times as you want.
Additionally, you may be asked to notice the positive things that happen in your daily life, no matter how minor, in order to focus your selective attention on positive events.
4. Cognitive restructuring of the reasons for dying
When the patient identifies in the previous analysis the reasons for dying, in therapy we will see if there are incorrect and exaggerated interpretations (e.g., everyone would be better off without me because I have made them miserable) as well as dysfunctional beliefs (e.g., no I can live without a partner).
The objective of cognitive restructuring is for the patient to understand and see that there are other alternative and less negative interpretations of seeing things (The objective is not to trivialize his situation or paint the situation “rosy”, but rather for him to see that there are other interpretations halfway between the most positive and the most negative). The patient can also be made to reflect on past difficult situations that he has overcome in life and how he resolved them.
If there are unresolved problems that lead you to consider suicide as a valid option (relational problems, unemployment…), it is useful to use the problem-solving technique.
5. Emotional management and temporal projection
In cases of Borderline Personality Disorder, for example, it may be useful to teach the patient skills and strategies to regulate very intense emotions as well as using the temporal projection technique (to imagine how things would be in a time).
