tight ropes and safety nets

Transcription

1 tight ropes and safety nets counselling suicidal clients Most people who commit suicide talk about it; most people who talk about suicide do not commit it. Which to believe? Schneidman, 1996 Dr Andrew Reeves 5th Annual Counselling Conference, Keele University - 27 March 2011 Prediction-Prevention Culture in Working with Suicidal Clients Rights vs Risks

2 Rights Area of Good Practise Litigation Zone Litigation Zone Risks Social policy tries to objectify human experience through the process of risk assessment

3 Over reliance on tick-box forms Plethora of risk assessment tools Mistaken view they are a panacea Can help contextualise, but are no replacement for dialogue windows of opportunity difficult to spot fleeting rare not available to all, often not to families

4 the challenge for therapists People are often reluctant to talk about suicidal feelings Distress can present in many different ways Asking about suicide can feel clumsy, insensitive and inappropriate Frightened about what they should do, or getting it wrong Must be aware of, and engage with, windows of opportunities the challenge for therapists We can all become immobilised by our own terror We are very good at projecting our own discomfort onto our clients, making it their problem We are also very good at acting out our own perspectives in sessions Our tasks is to face, head on, the shame and stigma of suicide

5 the discourse of suicide Discursive Object = Suicide Stopping it Too tired There s nothing keeping me here What s the point? Black/blackness Too heavy to manage Do myself in Just too much Carrying on Feel really alone in it Way out Going somewhere else Continuing with it Don t exist Feel empty and dead inside Don t belong in the life I live in Can t move forward really stuck counsellor responses Can you say (tell me) a bit more about that (could you tell me a little bit more ) Wonder how you re feeling about that (I wonder if ) (I m [just] wondering ) I m getting the impression I guess that this is (I guess there s ) (I guess you re ) So almost as if Am I right in thinking It sounds like (So it s sounding like ) (It sounds as though ) (You sound a bit ) It feels as though (You re feeling that ) Can you help me understand I can t help noticing How about you tell me It seems to me (You seem to be ) So I think I m hearing (What I m hearing is that ) This is the sense that (I am sensing that ) (I m [almost] getting a sense that ) (I get a real sense that ) (I really get a sense that ) It s almost like It seems like Somehow though it seems (So it seems that you re saying) You re saying that Let me just get this right Is that something you could tell [share with] me So tell me It seems almost as though you are saying I could be wrong here but I m aware that

6 an example from the discourse Cl. Comes and goes yeah, when it gets bad I want to get out of the way. Th. I m sorry, I don t know what you mean? Cl. Get out of the way get out of everyone s way.. it s not. Th. You feel like it would be a way to Cl. Yeah everybody would be better off. Th. It really sounds as if this business that you feel like you get in everyone s way is important for you? Cl. That s what s happening, isn t it. Respect and tune in to emotional language

7 Never minimise talk of suicide, always take it seriously Don t be lulled into a false sense of security

8 Impulsivity: the highest suicide risk for young people Always be prepared to ask the suicide question

9 Always be prepared to ask the suicide question I wonder how bad this gets for you? Are there times when you hurt yourself to cope with your feelings, or think about killing yourself? Use risk factors to inform, but not to silence

10 Understanding suicide potential comes from within a relationship Be aware of professional arrogance... listen to what families and others have to say

11 understand our anxieties and terror be prepared to ask about suicide don t act out our own beliefs ensure suicide exploration is embedded within diaglogue take suicide-talk seriously engage with strengths help to create crisis plans know the research involve others, when needed thank you If you would like to download this presentation, go to the above website and select DOWNLOADS and click on the link for this conference A.Reeves@liverpool.ac.uk