This is the psychological intervention in patients at risk of suicide
"I wish everything was over", "I am a burden for everyone", "life has no incentive for me", "I do not see an exit to my suffering", "I would like to disappear", "I can not 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 suffering great suffering and who may be contemplating suicide as a way out. When listening to this type of affirmations we must 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 Patterns of psychological intervention in people with suicide risk which can 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 disguised way their desire to end everything.
- Related article: "The 9 myths and false topics about suicide"
First step before intervening: detect the risk of suicide
Logically, before intervening we should be able to detect the risk of suicide and evaluate it adequately .
Indicators
Some indicators of suicide risk would be the statements discussed in the previous paragraph, although sudden changes in the patient's life should also be taken into account (eg, moving 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 away valuables to loved ones ...
Suicide risk assessment
You should speak in therapy naturally and openly of suicide, otherwise it may be too late to do so in the next session. There is a misconception that if a depressed patient is asked about suicide this can lead them to think about it in a more positive way and even accept suicidal ideas.
But nevertheless, asking the patient directly makes him feel relieved , understood and supported. Imagine that for some time you have thought about suicide and that you can not talk about it with anyone because it is considered a taboo and uncomfortable subject. What weight would you carry, right? On many occasions, talking about it with 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 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 lives, is this your case?
If the risk is very high, we will have to proceed to take measures beyond psychological intervention in our practice .
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. In addition, according to the professional's criteria, it will be convenient to extend the frequency of sessions and provide a 24-hour service number.
1. Empathy and acceptance
One of the fundamental premises in the face of psychological intervention is to try to see things as the patient sees them, and understand their motivation to commit suicide (eg, dire economic situation, very negative emotional state that the patient sees as endless, divorce ...) Psychologists must do a deep exercise of empathy , without judging the person in front of us. We must try to get the patient involved in the therapy, and explain what things can be done to help him, in order to establish continuity in it.
- Related article: "Empathy, much more than putting oneself in the place of the other"
2. Reflection and analysis exercises
It is interesting to propose that the patient write and analyze in a thoughtful 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 of continuing to live.
This analysis should be done taking into account several areas of your life (family, work, children, partners, friends ...) so that you do not focus on what causes you the most suffering. We must convey to you that we try 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 with your reasons to live , and then hang them in some visible place in your house. You are asked to check this list several times a day, and you can expand it as many times as you want.
In addition, you may be asked to look at the positive things that happen in your day to day, however minimal, in order to focus your selective attention on positive events.
- Maybe you're interested: "Suicidal thoughts: causes, symptoms and therapy"
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 (eg, they would all be better without me because I have made them miserable) as well as dysfunctional beliefs (eg, no I can 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 paint the situation "pink", but he himself sees 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 or she has overcome in life and how he or she resolved them.
In case there are unresolved problems that lead you to consider suicide as a valid way (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 technique of temporary projection (to imagine what things would be like in a while).
