Robin Williams died this week and it reminded me yet again of how easy it is to make a life and death difference in someone’s life and yet how difficult it can be for us to consciously choose to actually do so.
Check out this TedTalk video shared this week by Lauren Ostrowski.
As licensed mental health professionals, we are required to shatter the silence around suicide by starting conversations that matter – not just with our clients but also with our neighbors, our friends, and our family members.
That’s part of the advocacy that we are mandated to engage in.
What I know is that most people who are thinking about suicide never speak to a health care professional . . . not ever . . . even if they already have an ongoing professional relationship with a mental health professional.
Instead, most people thinking about suicide choose to talk to a friend . . . or a family member . . . or even a colleague.
Mental health professionals are not their first choice.
That means that you mother or your child or your partner or your sibling is much more likely to hear someone talking about suicide today than you are in your own office.
As you are thinking about the silence that surrounds suicide today, ask yourself these questions . . . .
- What are you doing to prepare those around you for that conversation?
- When did you last initiate a conversation about suicide with someone outside of your work setting?
- Why is that? (That reason matters.)
- And, what is it you are willing to do today to be better prepared to have another (conversation) that matters?
If the words “Are you thinking about killing yourself?” stick in your throat . . . .
If you’ve never asked someone about suicide . . . .
Please consider getting trained in Applied Suicide Intervention Skills Training through LifeWorks now.
It’s time . . . to shatter the silence.
It’s your job.
I thought this was a very powerful video from a very brave young man. When he spoke about living two different lives, I was reminded of how I will occasionally ask a client if I reacted in a way that was different than they expected (which is usually evident in their facial expressions) and then transition into asking whether they believe there is someone else in their support system who may also react differently than they predict. Also, I find it important to explicitly remind clients that I view them as a whole person rather than a combination of symptoms. Particularly when clients have been in treatment before, I have noticed that some of them truly define themselves as what they consider to be their diagnosis. While I appreciate them sharing that information with me, their treatment for certain emotional changes, for example, is only one part of them. Sometimes a writing exercise asking them who they are can unlock a lot of other thoughts and feelings.
In the video, Kevin says “Real depression is being sad when everything is your life is going right.” This really highlights the idea that sometimes depression (or any other feeling) can be incredibly difficult to explain. One of the parts of my work that I cherish the most is the opportunity to try to view the world through my client’s eyes. Spending time talking about what is “going right” can highlight strengths to help with areas that are not as strong.
It is a privilege to be a member of the counseling profession and to witness moments of insight that can be so profound.
The most “beneficial” outcome I can reframe myself into regarding the lost of Robin Williams is that it wakes people up to the fact that what people are showing you superficially on the outside may have very little to do with their inner experience. As a psychotherapist for 20+ years, I’m very aware of this. I’m also very aware that there are times when someone is determined to end their life, and there is very little you can do to prevent it. Tragic.
It’s true, Mary, that people can show up differently on the inside and outside but I don’t think that the two are unrelated. In fact, I think that they are directly related to one another. It’s just that we aren’t always so good at understanding and recognizing those connections.
I do, however, agree with you that we can only do what we can do and that ultimately the choice to choose life is up to our clients, colleagues, and friends.
I get your point Tamara… I didn’t express myself well enough. What I meant was that outsiders perceptions of someone else can be very superficial and miss entirely the depths/distress within another person because they are mislead by surface presentation / facade presented…..
🙂 Got it, Mary! Ahhh, the risks of communicating solely by text, right? A good reminder for those providing counseling and consulting services via email:)
🙂 there’s probably a blog you could do about that!
Thanks for the suggestion, Mary! I’ll add it to the pile!
Good post! I appreciate the resource you mention at the end and your encouragement to mental health clinicians to reflect on our own behaviors and thoughts regarding suicide prevention with clients and the community at large.
As a millennial who has experienced both depression and anxiety, I can agree with what is mentioned here about mental health professionals NOT being the resource of choice.
To some degree, this is because we think that, if we go to one, that makes us “crazy.” To some degree, this is because we don’t want to admit to ourselves that something is wrong. To some degree, at least in my case, it was because I saw calling myself ‘depressed’ as a cop-out, an attempt to place the responsibility for solving my problems on someone or something other than myself. And to some degree, it was because the boomer generation in particular, to which many therapists belong, has a tendency to view my generation as “lost” and “distracted” and “misguided” and “disconnected”—all of which, in my mind, are untrue and insulting and good reasons not to place full stock in the things that they say about out mental states. But the truth is that we are extremely open with our friends and our peers. On more than one occasion, when college classmates of mine committed suicide, peers mentioned that they had some inkling that it might happen, but felt unsure of what to do. Any effort to make the average person more capable of acting in this situation is well worth the effort. Then again, efforts by mental health professionals to NOT be the judgmental, behind-the-times people we view them to be would also be helpful in the long term.
Hi, Chelsea! Thanks so much for dropping in today to talk about this from the other side of the aisle with your lived experience! I love your frankness and willingness to educate mental health professionals about the hurdles that we must overcome in order to be more useful to the public, in general, and to Millennials, in particular.
Psychotherapists that are new to private practice often wonder why they can’t get those clients in the door and you have just spelled it out. Those myths about our profession – that seeking professional help makes you “crazy” or . . . that there has to be something really “wrong” before you make that call or . . . a diagnosis is a “cop out” or . . . that working with a therapist is a failure some sort . . . . If mental health professionals just prance into private practice without figuring out what they myths are and how they are going to address them, then clients like you will never make those first appointments to learn otherwise and get the help they are seeking.
I also appreciate you talking about the perceptions you believe that mental health professionals share about your generation – “lost,” “distracted,” “misguided,” and “disconnected.” WOW! I don’t blame you for being a tad reluctant to show up in our offices if you really believe that. I’m sure, of course, that there are some that do. However, I can also say that I’ve never had a client that I thought of as “crazy” or “lost” or any of those other things. I’ve had clients that felt trapped and couldn’t figure out how to get out of certain situations; and, I’ve had other clients who were panicking about some of the situations they were in. And, sometimes, they couldn’t see all of the options that I could see (and vice versa); but, they HAVE always shown amazing strengths and wisdom and they’ve always done the best they could do given the circumstances they were presented.
I would urge you to please not stereotype my generation (Yes, I’m a Boomer) or those in my profession just as I would urge others to not stereotype Millennials. We all look a little bit different, bring different gifts, have different strengths. Lumping all of us into one big pot isn’t accurate and, as you pointed out, is really quite judgmental.
Please let your peers know that after 30 years in mental health, the BEST training I’ve ever attended for suicide intervention is ASIST by LifeWorks. It’s an acronm that stands for Applied Suicide Intervention Skills and Training. Anyone over 16 years of age can attend – It’s perfectly appropriate (and really designed for) the general public rather than shrinks. It’s interesting, practical skills that can serve you and your friends for the rest of your life – and likely save a few lives in the process.
Lots of people say that they would like to “feel more prepared” when their friend or coworker starts thinking about suicide. I’m not really sure that’s true because if you really wanted to know what to say and what to do, you would sign up for a class or go talk to someone who already knew what to do, wouldn’t you? It’s fine and good to say “This bothers me” or “I’m concerned . . . .” But if something bothers me enough . . . if I’m concerned enough . . . I do something different.
Chelsea, I’m not singling you out or accusing you of anything other than taking the time today to clue us here at Private Practice from the Inside Out in. I’m just saying . . . we all say we are concerned . . . about the safety of children and abused animals and homeless people and children dying in Africa . . . and suicide . . . . But, how many of us really make the time and take the steps to change our little corner of the world?
Thanks for not mincing words and for opening our eyes. If clients / potential clients never tell us what we’re missing or getting wrong, nothing changes. Today, Chelsea, you helped change a little corner of our world. I hope you’ll drop in again to chat!
HI Tamara and Chelsea:
Tamara – thanks so much for another essential post. I was just thinking about this topic this week.
And Chelsea, –
I just wanted to say how much I appreciated your insights about how folks of your generation may be viewing therapists of mine (Gen X.) I had no idea. I too would feel really insulted and marginalized if I felt judged this way, and also wouldn’t seek help with those people. I am a therapist who specializes in working with girls and women – 13 – 45 mostly – so I see LOTS of folks in their late teens and early twenties. I certainly notice some of the differences in the styles of communication with their friends and loved ones because of text, Instagram, etc. etc. But beyond that, perhaps I am missing something, but I just don’t see a big difference from my generation to yours.
What I see with the women in my office are amazing young women who are struggling with something. They are incredibly motivated to change – they may just not have ever been offered the tools or perspectives before. Once we team up and figure out what they need and how to help them meet their goals, they work incredibly hard and meet them. It’s a huge honor for me to get to be a part of that.
I am not a therapist who thinks that therapy is for everyone, so please don’t hear me trying to “sell” you on it. There are people who benefit from the therapy of hiking the Appalachian trail, there are people who do best with meds only, there are people who benefit from a relationship with a clergy, or from baking their way through something. I just wanted to share from my heart, how much I enjoy working with teens and young women TODAY – the strong, amazing young women of your generation. I do this because I really wanted you to know that despite what you have encountered with other mental health professionals, not everyone feels that way.
I really appreciate your comments.
All the Best,
Amy
Hi Tamara. What a great subject. I inherited a legacy of suicide. Just in my lifetime, my mother’s brother, two uncles, and sadly, my own brother and father all committed suicide. At the time of their deaths I was under the care of a therapist (a psychiatrist when my brother died and a supervised masters level student when my father died. I was suicidal myself.
I actually did go to friends and family with my thoughts. They made me feel ashamed for not caring about who I would leave behind. My therapists pushed me deeper into my anxiety and depression by digging into my past and trauma history over and over again. At that time, CBT wasn’t practiced like it is today (this was the 1970’s).
With that history, I wondered if I would be able to deal with clients who have suicidal ideation or behaviors. I felt as healed as possible from it, but at first I noticed I could be triggered. I exposed myself to the stories and became desensitized so that I do not think of my own family when I am talking to a client who is telling me they are struggling (physician, heal thyself). And I always validate their pain when they try to tell me that they feel stupid because others have it so much worse than they do.
I must say that having been through serious suicidal ideation helps in this work. When Robin Williams or anyone else famous commits suicide and I hear all the comments about how selfish it was or any other disparaging remark, I know inside that when a person commits suicide it’s more like a person on fire escaping the flames. It gives me a sense of compassion without judgment.
I have several clients who experience suicidal ideation, both because of ongoing environmental factors and because of biologically-based chronic mood disorders. I am relentless about asking where they are each week and they have permission to call me any time (I’m a DBT therapist…we offer phone coaching). There are a couple of clients of mine that keep me on my toes. I wonder if I will lose them or if someone in the future will lose them. I pray not. Literally.
Hi, Linda. Welcome back to Private Practice from the Inside Out and thank you for sharing a bit of your own struggle with suicide. When I was in graduate school there was never one professor who spoke openly about his / her own struggles with mental health. No one said “I’m an alcoholic” or “I’ve struggled with OCD my entire life.” No one said “My sister was schizophrenic” or “The last time I tried to commit suicide I was 36 years old.” In other words, we were trained by omission that these things are simply shameful little secrets.
After I got out of graduate school, I went to work for a local community agency. One of the counselors there didn’t show up for work for several days and he didn’t call in to give any explanation. When he was picked up by the police in the midst of a psychotic break, word spread through the agency like wildfire. He had been diagnosed apparently long ago with Bipolar Disorder.
If the secrecy and stigma weren’t so tragic, it would be laughable that mental health professionals are unable – even in universities – to acknowledge the prevalence and cost of mental illness in our own lives. It’s also interesting to note how some diagnoses seems to come with bragging rights while others find less support in our communities. In any case, thank you for having the courage to own your own history and to see how it does and does not impact your daily work with clients.
I’m betting, Linda, that you may already know about this but for others that do not . . . . The American Association of Suicidology has a special interest in supporting clinician survivors i.e those clinicians who “remain alive following the suicide death of someone with whom they had a significant relationship or emotional bond.” You can find lots of great information on suicide there and they have a very active email discussion list for clinician survivors. I would encourage anyone who is a mental health clinician survivor to take the time to check out AAS email list.
Hi Tamara,
I did not know about that site but now I do! Thank you so, so much. There are so many of us who are wounded healers. I think it’s important to come out of the closet when it does not impact our clients in a negative way. I have found my clients are relieved when they know I know what they are dealing with…I’m on the other side. There is so much hope. It also gives me hope for them as I remember being in that spot so long ago. Thanks again Tamara!
🙂 You’re so welcome, Linda! You’re right, of course. That “wounded healer” role can be a curse and a blessing! And, I completely get how knowing your therapist has “been there” can be such a comfort – like a beacon of hope.
Linda,
How courageous you are to share your story. What strength and resilience you have to be able to work with clients who have a great likelihood of bring up things that connect to your own past.
It is amazing how our past experiences certainly color some of our counseling experiences. My experience is nothing like yours and I’m not making a comparison by any means. I do think that my own college experiences have certainly changed my reactions in crisis situations. What I was a college student, most of the mental health crises were something that I dealt with (because there was no one available who was more qualified and because I didn’t want to see something happen to someone if I could possibly do something to help. I wasn’t nearly as savvy about crisis hotlines as I am now.)
The reason I mention this now is because several colleagues have told me that I’m much more likely to ask about suicidal ideation (not using the term) than they are. If I hear anything that is even remotely on that spectrum, I’ll always ask about it.. Even people who are talking about “just wanting to go to sleep” can be sending signals. I’ll usually ask them to clarify whether they are just talking about sleeping better at night or wanting to get a good nights sleep or being asleep forever. I find that people are very comfortable with this because if it doesn’t apply, they just say “no, I was talking about sleeping better,” and we go on from there. I’ve had clients bring up some very back door ways of expressing suicidal ideation and I think it’s because they know that I’ll eventually ask about it.
Thanks for being such a wonderful and unconditional therapist for your clients. You are giving them a gift each and every time they interact with you.
On another note, what special self-care strategies do you use if you are on call 24/7?
Hi Lauren,
Thank you for your comments! It made my day. I also hear all the little subtle ways people will let me know they are thinking about suicide without coming right out and saying it. They seem very relieved when I just “go for it” and talk about it in a very frank way. It seems to give them permission and I validate their feelings rather than criticize them for having the thoughts. It helps! This is based on years of research by Marsha Linehan (DBT).
My 24/7 phone coaching is very structured. I hardly ever get a call. My clients know it is not for therapy purposes. They are to call me if they are thinking about self-harm, suicide, or any other “bad” idea. I ask them what skills (DBT) they have tried so far. I coach them through some ones they haven’t tried, ask them to try this for a period of time and then to call me back. If they end up cutting or in the ER, they cannot contact me for 24 hours. This is a very structured phone coaching that DBT therapists must be willing to offer their clients. I think I am lucky that I hardly ever get one of these calls in the middle of the night. :o)
Linda, You are certainly right that clients seem relieved when I bring it up. I, too, have seen the research on this, but experiencing the moments of clarity is much different than reading about the idea that talking about suicidal ideation can be a welcome conversation for most people who are considering suicide. They also seem to be relieved by the idea that just because we have a discussion about thoughts that they are having, that doesn’t always mean that they are going to end up in the hospital.
I like the sounds of the way your coaching works. With that structure, it seems like the 24/7 availability is not overused because they are aware of what it’s really for.