A current article in the Psychotherapy Networker has several interesting and unique case examples, as well as some good discussion of general practice. The case dealing with suicide, below, is one of my favorites, because it is based on an attitude toward suicide that is very different — and much more effective — than the typical mainstream attitude.
If you only have time for the other case examples, start reading on p. 5 and continue through p. 8.
-Steve Andreas
What’s the Rush?*
I (Jay) was asked by a hospital to see a young man on an emergency basis. Joseph was contemplating suicide and, until that point, had been in treatment with one of their staff psychiatrists. Unfortunately, when Joseph arrived for his appointment, he was told that his therapist was “unavailable.” But he soon discovered the truth — that the very person who’d been trying to convince him that life was worth living had just made her own suicide attempt and was now in a coma.
When Joseph came to see me, he took the position that if his therapist was trying to end it all, why shouldn’t he do the same? I replied that as far as I was concerned, he had every right to do so. In fact, every one of us does, including his therapist. After all, if we don’t have that right, what rights do we really have? Aren’t we allowed to smoke — which some consider just a slow way of killing oneself? What about overeating, bungee jumping, or jaywalking?
I pointed out that if Joseph thought I was there to talk him out of killing himself, he had another think coming. Perhaps his regular therapist had that goal, but I was operating from a different philosophical position. As we talked about this, I asked him if he’d ever been to Brazil. “No,” he said, looking at me as if I was mildly deranged. I explained that if I was going to kill myself there are things I might want to do first. For example, I might want to try parachute jumping or hang gliding. I might want to travel to South America to see some of the sights. After all, what was the rush? Was there a Tuesday special on suicide that I hadn’t heard about? Was this Tuesday better than the following Thursday? I also cautioned that if he were going to do himself in, he should make sure it’s what he really wants, because do-overs are unlikely.
Of course, because of his history at the psychiatric clinic, I knew that he preferred to discuss suicide rather than do it. It was the topic that had preoccupied him and his therapist for many sessions. However, in my view, their discussion wasn’t going anywhere because he and his therapist were both card-carrying members of the same “You’re not allowed to kill yourself” club. My approach disregarded those club rules entirely, enabling the conversation to move into new territory. Another one of the few fundamental principles worth retaining as a therapist is the notion that if the current strategy isn’t working, it’s necessary to do something different.
So Joseph and I discussed the fact that although he knew how Act One had turned out, he had little information about how Act Two might unfold. Sure, it might end up being just as dismal as Act One. On the other hand, it might turn out differently, especially if he could harness some of the life lessons he’d learned in Act One. I indicated that if he was willing to stick around for a few months, I’d be happy to chat about possible Act Two “scripts.” He agreed, and in our work over those next several months, he never again brought up the subject of suicide or showed any interest in discussing the topic.
*From “Spitting in the Client’s Soup: Don’t Overthink Your Interventions” by Jay Efran and Rob Fauber. Psychotherapy Networker, March/April, 2015, p. 47
