Advice: How to support someone dealing with suicidal thoughts

Admin

March 28, 2016

I felt like this was very much needed here. Suicide is a very ignored subject online and I feel that if this information is spread then a few lives may be saved. As someone who has dealt with family members and friends being deathly close to attempts and still have suicidal thoughts to this day, the more people who know about this then the more comfort I can feel knowing that someday someone else can be saved.

There is no one “correct” way to talk to someone struggling with suicidal thoughts. Real caring is what ultimately matters and it can take many forms. But if you’re not sure what to say, these ideas may help.

Avoid advice and solutions

Suicidal people typically don’t feel change is possible. Anything that can be prefaced with “you should” can make them feel even more powerless. They often feel unworthy of help. “Fixing” or “advising” will reinforce that and make things worse.

This gets tricky because suicidal people often don’t see all the options they actually have. It can be of real benefit to point these out, but there is a vital difference between “you should do <action>” and “you could do <action>”. “Have you thought of doing <action>?” or “What do you think about doing <action>?” are other good phrasings. It’s fine to mention something that worked for you, but frame it as an example of something that they may or may not want to try.

If they ask for advice, you could reframe the conversation as working through the “pros” and “cons” of various options together. If you’re worried that someone is at immediate risk, take action yourself, don’t tell them to do it.

Listen, empathize, and don’t judge

If they say harsh things about themselves or others, this can be the truth of their experience even if it doesn’t match objective reality. Consider the emotions embodied by the self-loathing or the tales of woe. You can connect with the person on a feeling level and simply set aside any questions of “fact”. Examples:

If they say: “I’m a useless waste of skin. The world would be a better place without me,” simply disagreeing can make them feel even more “intrinsically wrong”. Instead, you might say “It worries me to think of you feeling so bad about yourself. I wish I could help you feel better.” This respects their emotional experience and shares your sympathy and concern, without getting into whether their self-assessment is accurate or not.
If they say: “Everyone is mean to me”, you could respond with “It must be so hard when every interaction hurts.” This tells them that you hear their pain, but you have not judged (i.e. you have neither supported nor challenged) their assertion about how they’re actually being treated.

Don’t disagree with suicidal people about how bad things are. It’s not about their circumstances; it’s about their suffering, and you can’t measure that from the outside. A message that in any way tries to tell or show the suicidal person that “it’s not so bad” is just another way of saying “I don’t understand what you’re going through.”

Describing suicidal behavior as “selfish” is even worse. The suicidal mindset usually includes a firm conviction that “I can improve the world by taking myself out of it.” Telling them how much their deaths will hurt others reinforces their sense of personal failure.

Never use any kind of “tough love.” If you think they’d be fine if they just stopped feeling sorry for themselves, putting up with abuse, or staying stuck in the past, then you are not the right person to help, even if you’re correct. Chances are they’ve tried to do exactly that, over and over again, and failed. Everything you say to suicidal people needs to be grounded in the belief that they are doing the best they can to help themselves. If you don’t believe that, find them someone else to talk to.

Meet them where they are

The greatest gift you can give a suicidal person is the experience of being truly heard and understood. At most suicide hotlines, rapport-building takes up the bulk of the communications training.

It seems natural to try and pull a suicidal person out of whatever dark place they’re in. That almost always fails. What works, consistently, is simply to join them in the dark place and offer a non-judgmental, supportive presence. This is so simple that it can seem like doing nothing, yet it can also be so difficult that we can’t imagine how we can ever get it right.

Sometimes suicidal people can be reluctant to talk. Say that you just want to understand, and that you won’t try to suggest anything unless and until they are satisfied with your understanding of their experience.

Your questioning style can make a big difference: asking open-ended (“How do you feel?”) versus closed-ended (“Are you sad or mad?”) questions will ensure that they feel able to express whatever need to. If you ask if they’re “sad or mad” and they’re actually something else (anxious, numb, etc.), you may not get the information you need, and they may feel invalidated.

Help them by naming the emotions that you hear in their story, but which they may not be expressing, nor fully aware of.

Active listening, which demonstrates and refines your understanding, is a powerful rapport building technique. People in a suicidal state of mind usually feel profoundly alone. Saying “I understand” without proving it will often reinforce this sense of alienation. Some ways you can “actively listen” effectively are:

Ask lots of open-ended clarification questions. This shows that you care about getting it right.
Summarize, paraphrase and interpret what you’re hearing. This shows what that you’re taking in what they’re saying, and thinking deeply about it. It also offers them the chance to correct anything that you got wrong.
React genuinely and supportively. If you feel a strong empathetic response to what someone is telling you, share it. This shows that what they are going through matters to you, and that they’re getting through to you.
Remember that you’re just building your understanding: suspend your judgment and listen. You may hear some ugly truths, or even ugly untruths. The point is to understand, to go to the dark place with them, and those dark places are often dirty, smelly and full of evil things. Be ready for that.

Sharing your personal experiences can be a great help in building rapport, but it should be done only with the idea of establishing your “street cred” as someone who’s been in a dark place too. The danger is that they can feel like you’re assuming too much, not listening enough, or devaluing their pain.

You may need to ask tough or personal questions. Your goal is to “map” the dark place as well as you can. You can frame sensitive questions with: “Do you mind if I ask you about <subject>?”

If, and only if, they indicate to you that they feel “heard”, you might try some gentle re-framing of their view of the situation. While continuing to stress that you agree with them about how bad it is for them, you can try offering a hopeful perspective, if it’s totally genuine. If they reject it, go back to active listening.

Don’t forget to look after yourself!

Deep rapport with someone who’s suicidal can leave you feeling sad, frustrated, hopeless, or disoriented, even if you’ve really helped. This is why suicide hotline responders are typically required to debrief regularly. Be sure to talk to someone you trust if you find the conversation is weighing on your mind.

Keep your expectations realistic. Even with the best training and resources, sometimes conversations with suicidal people will take a wrong turn. Reaching these people is a tricky business, and not even the experts can get it right every time. Remember too that the immediate response isn’t the outcome. It’s not uncommon for callers to a suicide hotline to tell the responder that they weren’t very helpful, then call back days or months later to say “Thanks, you saved my life”.

What’s the rationale for all this?

It comes out of what has been proven to work at suicide hotlines, and what has been discovered in the latest research into suicide, especially the groundbreaking work by Thomas Joiner’s group at Florida State University. Joiner’s model uses three necessary and sufficient factors for suicide risk, and these can help us identify strategies that will and won’t help:

Desensitization to pain and death. We can’t fix this in the short term; it’s acquired by life experience and extinguishes slowly, if ever.
Perception that one is a burden. We can prevent this from getting worse by avoiding solutions, advice, and judgments. We can sometimes improve it by reflecting back to the person things that we genuinely value or appreciate about them, but it has to be utterly sincere. If you can’t find something specific, positive, and accurate to say, just move on to the next strategy. By building a strong rapport you may discover some genuine positives that you can reflect back to the person.
A deep sense of alienation. We can always do something about this one by making a deep interpersonal connection, and since all three factors are necessary for high risk of suicide, it’s only urgently necessary to fix one. This is why it’s “all about the rapport”!