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 see no way out for me suffering "," I would like to disappear "," I can not take it anymore "," It is not worth living like this "," It would be better if I got rid of half"...

These sentences are examples of people who are suffering great suffering and may be contemplating suicide as a way out. 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 will explain some guidelines for psychological intervention in people at risk of suicide that may be useful for those professionals or students of Psychology who may find themselves with similar situations, in which the patient-client manifests in a more or less covert way his desire to finish with everything.

• Related article: "The 9 myths and false topics about suicide"

First step before intervening: detect the risk of suicide

Logically, before intervening we must be able to detect suicide risk and assess it appropriately.

Indicators

Some indicators of suicide risk would be the statements discussed in the previous paragraph, although sudden changes in the patient's life must also be taken into account (p. g., going from a state of nervousness and agitation to one of sudden calm, for no 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 valuables to loved ones ...

Suicidal risk assessment

Suicide therapy should be discussed in a natural and open way, otherwise it may be too late to do so in the next session. There is a misconception that asking a depressed patient about suicide may lead him to think about it in a more positive way and even accept suicidal ideas.

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 subject. What weight would you carry, right? On many occasions, talking about it with a psychologist can be therapeutic in itself.

In cases in which the patient has never raised the subject of suicide and has not verbalized things like "I want to disappear and end it all", it is best to ask in a general. 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

Next 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 her family. In addition, according to the professional's criteria, it will be convenient to extend the frequency of the sessions and provide a 24-hour service number.

1. Empathy and acceptance

One of the fundamental premises for psychological intervention is to try to see things as the patient sees them, and to understand her motivations to commit suicide (p. eg, 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 therapy, and explain what things can continue to be done to help him, in order to establish continuity in it.

• Related article: "Empathy, much more than putting yourself in someone else's shoes"

2. Reflection and analysis exercises

It is interesting to propose to the patient to 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 to commit suicide and to continue living.

This analysis should be performed taking into account various areas of your life (family, work, children, partner, friends ...) so that it does not focus on what causes 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 involves the patient write a list with your reasons for living, and then hang them in a visible place in his house. You are asked to consult this list several times a day, and that 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, no matter how minimal, in order to focus your selective attention on positive events.

• You may be interested: "Suicidal thoughts: causes, symptoms and therapy"

4. Cognitive restructuring of reasons for dying

When the patient identifies the reasons for dying in the previous analysis, in therapy we will see if there are incorrect and exaggerated interpretations (p. eg, everyone would be better off without me because I have made them miserable) as well as dysfunctional beliefs (p. eg, I can't 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 objective is not to trivialize with her situation or paint the situation "rosy", but rather himself saw 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.

In the event that 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 helpful 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 time).