Depression and Suicide
People with suicidal thoughts might feel like they are not allowed to talk about them. They may be afraid their therapist will have them involuntarily committed. There are very specific rules about why or how someone can be admitted against their own will. The person must have the thought, a plan of how they will do it, an intention to do it and a time line of when they plan to do it. Even if a therapist thinks a client should be committed, the magistrate has to sign off on it and then the doctor at the hospital has to agree that an IVC is warranted.
Confidentiality
In my professional disclosure statement I have the following statement; “Our discussions and even the fact that you are in counseling with me are confidential. In psychotherapy, very personal and intimate details of your life may be revealed to me. I regard you and your situation with great respect. Confidentiality and trust are required in your therapeutic experience and outcome. There are exceptions to confidentiality and they include but are not limited to the following situations:
If I determine that you may cause danger to yourself or others.
If you provide information that leads me to believe that a child under the age of 18, an elderly person, or a disable adult is being abused or neglected.
A court order has been issued to release information about you and your clinical record.
You request in writing that I may release information about you.
It is required by law that I follow these guidelines for reporting.”
Talking about Suicidal Thoughts
However it is not required by law that we don’t talk about your suicidal thoughts. If someone has a suicidal part, it wants to protect the person from unbearable suffering and overwhelm. Just because it [the suicidal part] has good intentions, doesn’t mean the method is very effective. But not talking about the feelings might not help either.
I like to allow a client to be able to help understand more about these suicidal thoughts and one way to do that is to give the part a voice. The suffering a person is experiencing when having suicidal thoughts is significant and a counselor might be the only one a client feels safe to talk to about these feelings. With Internal Family Systems, IFS, we can give the suicidal part a chance to express how much they hurt, why they hurt and what other things the part might want the client to know.
Sometimes a person’s suicidal thoughts may stem from a past trauma. In IFS we can, “witness” the event(s) and validate the feelings experienced at the time of the trauma. If you have experienced a trauma, you might think, I know what happened, I don’t necessarily have to relive it. But, in witnessing, we are not just reviewing the trauma, we are fully validating the feelings that occurred and maybe this is for the first time.
Several Reasons to Feel Suicidal
Some people have suicidal thoughts every day but never intend to act on those thoughts. In therapy, we can learn what lies under the thoughts. There could be different reasons for the thoughts. Sometimes it could stem from loneliness, other times from commitment overwhelm. A person can begin to discern what needs are not being met and look for solutions other than suicide. Overwhelming loneliness begins to illicit new thought for figuring out how to make a friend or two, or simply reach out to a friend to meet for coffee or a walk. Likewise, stress from overwork begins to signal a person to find ways to get more rest at night, increase relaxing activities in the evenings or weekend, or ask co-workers for some help.
PTSD and Suicidal Thoughts
PTSD can linger for years and the effects may lead to depression. A person might think, “I’ve dealt with this trauma,” but still have the lingering effects. It is not always easy being human and it is possible to keep improving and experience more joy. The DSM describes trauma in a very specific way, “actual or threatened death, serious injury, or sexual violence,” and in the counseling community, we talk about big T traumas and little t traumas. A person might think, well I had an usual childhood, but I would not consider it traumatic. And yet, the events that occurred may be affecting your reaction to the world. Someone may have flashes of violent events, such as crashing a car into a tree or off a bridge, with no intention what so ever to actually do such a thing. Never the less, the images flash. If a client describes such momentary thoughts, in my opinion, they may not be suicidal because they have no intention of acting on them.
Asking better questions
I believe our brains are like computers. When we ask a question, in our mind, the brain goes whirring in the background searching for the answer. Sometimes we have dreams that bring the answer, sometimes we have a flash of an insight, and often we are just more open to suggestions. For example, if we ask, “why do I always ruin everything?” Our brain goes around trying to prove again and again that we actually do ruin “everything.” However, if we ask, “How can I think of this differently?” Our brain looks for new ways to look at something. A great exercise is to write out your negative thought and then write out 5 ways to reframe the thought. Now the thought of, “Why do I just sit in bed all day when I should be out and doing things,” can turn into;
Would it be possible for me to just move from the bed to the couch?
What if I had my coffee on the porch instead of the bed
I wonder if when I got out of bed, I made it, then I would not be so likely to get back into it
How can I motivate myself to move more?
I wonder what would happen if I chose something different.
Just sitting in bed and journaling about how to get out of the bed could be the start of a whole new routine. A wise man once told me that often when someone thinks suicide is the answer, they stop looking for other solutions. Asking your brain, what are some ways I can begin to enjoy life, could just be the thing that turns your day, your week, your whole life around.
If you know someone who might be contemplating suicide, give them the suicide hotline phone number 800-273-8255 and let them know there are other solutions.
