How to Respond to
a Suicidal Chatter
New Hope Case Discussion
Dr. Bill Gaultiere
Here's a chat room
conversation with a suicidal man that didn't go well. This interaction
is a helpful reminder for all of us on the importance of the
two most important New Hope Counseling skills, especially for
crisis calls: triage (focusing on the most urgent concern) and
active listening. In the discussion that follows names are omitted.
The caller's comments are in bold.
Welcome to New
Hope Online. How can I help you?
I feel hopeless...no
use to continue on. I've been through a divorce, lost career,
lost my children. You name it!!!!!!!!!!!
You sound as though
you have been through quite a meat grinder.
For the last
1 year and 13 days now.
Comments: The counselor connects
with the caller's pain and the conversation gets off to a good
start.
Wow, I wish I had an easy fix,
but I don't. How many children do you have? Do you ever see
them?
I have 3.........I have just got to see my 3 yr old, very
little in the last year.
Comments: The easy fix comment is not helpful. The counselor
needs to continue to respond to the caller's pain. The caller
opened by saying that he feels hopeless and that it's no use
for him to continue on. He may be suicidal and so the counselor
needs to assess this directly.
Alternative response: "I
hear that you've been in so much pain for so long that it's
hard for you to go on. Are you having thoughts of killing yourself?"
(If the answer is yes, then assess the risk carefully with additional
questions, as suggested in the "Summary" section below.)
Do you live near your children?
About 50 miles or so away.
That's not real close, but not really so distant these days.
Do you still have a car available, even if it's not yours? Does
your ex cooperate in helping the kids have access to their Dad?
No - none at all.
That's a shame. Parents who bad mouth or try to keep the kids
away from the other parent will often have bitter, angry children
later who are angry with the parent who kept them away.
Comments: The inquiry into this
man's relationship with his children is a good idea as a means
to look for some positive motivation for him to live or perhaps
to connect with his sadness over not seeing his children. It
doesn't work though, partially because the counselor changes
the focus to the ex-wife and makes some negative assumptions
about her. Unfortunately, this brings up more problems for the
caller to be depressed about and he wants to end the conversation
prematurely. Instead the counselor needs to reflect feelings
to connect and comfort.
Alternative response: "I
hear that your children are very important to you and you really
miss them."
I have to go... I've hurt long
enough!!! Sorry for taking up your time.
I have to go....
You are not taking up my time. Although it doesn't seem like
it now, the situation is bad. I won't say it isn't. I've been
through similar times twice in my life. There is a brighter
day ahead.
Twice ???
Comments: The counselor makes a helpful clarification for the
caller who apparently feels guilty by saying "You are not
taking up my time." Then he/she tries to give this man
some hope by reassuring him. He does need hope, but this approach
doesn't work, partially because the two haven't established
a good connection. She/he tries to connect with the caller here
using his/her own story, but he's too depressed about his own
problems to think about anyone else's. Instead, he/she should
keep the focus on the caller and demonstrate concern for his
feelings.
Alternative response: "It
seems that you feel bad for using my time. Please don't. I want
to talk to you. I'm concerned for you. You're really hurting
and I want to do what I can to help you."
God loves you and so do we. Please
come back soon.
I won't be here to come back.
Yes, twice. Turn the numbers around in your age and that's how
old I am.
I feel 136.
All I can say is don't do anything foolish and final. You will
have a good life later. I don't know how long, but things do
change and a better day comes.
Yes, l can understand how you fell so old and despairing. Like
I said, I have lost a mate, children, my career and my health
twice in my life. It is a terrible time.
Comments: (Some of the replies
seem out of sequence because of the time delay of the comments
appearing in the chat room.) The counselor's comment, "Please
come back soon," expresses his/her concern for the caller.
The man's reply of an implied suicide threat, "I won't
be here to come back," is very disturbing. It takes us
back to the point of despair he started at and leaves us very
concerned for his well-being. He doesn't like the counselor
talking about his/her age and so he "one ups" him/her
to get the focus back on himself. He/she makes an important
last plea for him "not to do anything foolish or final."
Then the caller abruptly ends the call.
Alternative Response: "It
scares me to think that you might kill yourself! Please don't
leave! Let's talk some more. I'm very concerned for you and
for your children too. They need you alive."
Summary: There's two things we
need to learn from this conversation.
- Attempting to prevent suicides
is our most important service. We need to take it seriously
whenever a caller is depressed, despairing, or not wanting
to live and assess whether or not there is an immediate risk
and then respond. Ask if the caller is suicidal. Ask if the
person has a plan and how and when he or she'd do it. Ask
if anyone knows and what it would take for him or not to attempt.
If the suicide is in progress or might be imminent then we
trace the call on the phones and send out the police to take
the person to the hospital. In the chat room, use the location
information from the user profile and if you don't have it
then ask for it. If you can't get it then you have to do the
best you can to talk the person through the suicidal feelings
by demonstrating care, finding a reason to live, and setting
a contract for the suicidal person to call New Hope back or
talk to another caring, responsible person soon.
- Using active listening skills
to connect with the caller's feelings and needs in the moment
is the heart of New Hope Counseling. We can't help people
if we don't do that. Don't digress into secondary factual
information. Don't change the focus to talk about your own
problems. Instead, use open-ended questions to invite further
and deeper self-disclosure, offer summaries of what you're
understanding so far to clarify and validate, and reflect
feelings to connect emotionally. Active listening skills like
these are essential and should be used in every New Hope Conversation.
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