TRANSCRIPT
In this video, I would like to talk about my perspective about having been a therapist and how to most effectively work with people who are suicidal. Well, in a way, on the surface, what I mean to say is very, very simple. The main thing that I had to offer people was a relationship, a bond. To offer them caring, to offer them respect, to offer them my ears, real non-judgmental listening, to really take in what they were saying.
The reason the best thing that I had to offer someone who was suicidal was a relationship is what I saw. When people were suicidal, especially when they were really suicidal, they often felt disconnected from the world, even really disconnected from their own selves. Life became meaningless, life became purposeless, life became hopeless. And what I’ve seen is human beings, myself included, are social animals. We are social beings. When we lose the fabric of our social life, when we lose the fabric of our social connections, and most especially when we start losing our connection to ourself on the inside, life can really become purposeless. Life can become meaningless. We can lose our sense of value on the inside, kind of like, what’s the point? Why am I here? I have no reason to be here.
So when someone would come in in that state, an existential crisis kind of to the extreme, sometimes life being meaningless, purposeless, valueless, people feeling like they were unrooted, uprooted, nobody cared about them, they didn’t necessarily care about anyone. I, as a therapist, would try to reconnect them to humanity. And the best way I could do that was using myself as an example of humanity. To be someone who actually gave a [ __ ] about them, caring about someone, having feelings about someone, looking at someone and saying, “Oh my God, this must be a really painful way to live.”
And also remembering times in my own life when it was like, “Ooh, I actually felt little jolts of suicidality myself.” Times of desperation, times of incredible pressure, tons of social isolation, tons of feeling really disconnected, not having friends, not really liking myself, hating myself even. And realizing, “God, when people really liked me, when people cared about me, when I felt a sense of connection, it really helped my sense of meaning and purpose.” And even self-love started to come back.
As a therapist, though, I didn’t find this easy for me. I found that I needed to be willing to tolerate a lot of painful feelings, a lot of stress. And it’s not just the stress that happens in the session, even though it can be incredibly stressful to sit and listen to someone who is going through emotional torment. It’s also stressful, and sometimes more stressful, after the session is done. What if you’re not gonna see this person for three days? What if you’re not going to see this person for a week? You can’t go calling them, “Oh hey, how are you? Oh, are you feeling okay? Are you feeling suicidal?” That is intrusive.
As a therapist, a lot of times you just have to sit back and have faith in them. If they say they’re not gonna kill themself when you talk to them, that sometimes would ask people, “Are you okay until the next session? You’re gonna make it?” Some of it, yes. And I said, “Okay, good, I feel better.” But that doesn’t mean afterward it doesn’t come up for me. It doesn’t mean it doesn’t come up at two o’clock in the morning, “Oh my God.” And sometimes I could have fears or maybe I said the wrong thing. It’s really hard, especially if you’re trying to be authentic and real with someone who is in a suicidal state.
What I found again and again is when people really are on that edge of real existential crisis, the edge of life and death, they are very sensitive to authenticity. So being fake, being back, mmm, being intellectual, being a blank slate, being a mental health professional who is formal and professional, that often does not work at all. Instead, what I thought, if I needed to be real, I needed to be authentic. I had to have my feelings. Sometimes, if it felt appropriate, like it wasn’t gonna harm the client or make them extremely uncomfortable, I might even cry in session with them or tell them, “Oh, that’s horrible.” Really have empathy, sometimes be open and honest about it.
Sometimes, if it might overwhelm them, because sometimes also when people were suicidal, they were very aware that they did not want to overwhelm me. They didn’t want to stress me out. So with those type of people, I might restrain myself more, hmm, be a little bit more tough. Still be authentic emotionally, but authentic to a point where I wasn’t like crying and stuff like that. Maybe I would cry afterwards. Maybe the stories they told about why they were suicidal could make me cry. Often, absolutely horrible stuff.
Another thing I found is when people were suicidal, often there was a damn good reason. Their life had not treated them well. Life had been horrible to them so many times, often lots and lots and lots of childhood trauma, often extreme childhood trauma that they remembered. Another thing was being there to hold the space for them to talk about their history, to talk about why they felt the way that they did. Often I saw when people were suicidal, they were disconnected to parts of their story. Therapy, or whatever relationship they were in, could be a chance for them to begin to piece it together, to understand, “Ah, it makes sense why I’m so miserable.”
And then to start taking steps forward into grieving. Grieving meaning to start to make sense of all this suffering, to make the suffering that they’re going through purposeful, where it feels like it’s actually going in a direction, when it actually is going in a direction. Another thing I saw is when people started grieving in therapy, not just suffering miserably, the suffering where suicidality is an extreme form of it, when people started grieving, often the suicidality went way, way down because they started feeling like there was meaning in their life. They started making sense of all the loss. They started coming back to themselves. Their crying looked different, their faces looked different. I could see it in people.
But I’m thinking another thing that I did, another tool that I used as a therapist, was trying to allow this therapy relationship to blossom as much as possible. And one of the things I did for people that were suicidal is show some human compassion in the therapy relationship in terms of its structure. So, things I might say is, “Let’s lower your fee a little bit and make sure that you can afford to come more.” Probably if you’re really suicidal and you need human connection, and you are getting human connection from this therapy relationship, you find meaning in talking to me once a week, probably isn’t enough. How would you like to come more? How about I cut your therapy fee in half so that for the same price you can come twice a week?
Sometimes just by saying that, a simple thing like that, I saw people just break down and cry. A few times it happened that I saw people every day, five days a week. Sometimes I saw people seven days a week on the weekends. Sometimes I felt like I just, also for myself, I was too anxious to think, “Oh my God, I can’t wait three days before I see this person,” especially if this person says, “I do not want to go to a mental hospital. That is not what I want.” And yet they had nothing else holding them. They’d go home and they’d just sit there and be miserable.
I’d like, “You know, I think I’ll feel better, and maybe you’ll feel better too. Would you like to come every day?” And sometimes people said, “Hmm, yes.” And what I saw sometimes by having that level of continuity, meeting every day, sometimes it didn’t take very long, maybe only one or two weeks of seeing someone a lot, like lots and lots of hours, ten hours a week. Sometimes maybe even, maybe seeing someone for more than 45 minutes, maybe seeing them for an hour, maybe seeing them in the morning and at night, and then seeing them the next morning. Sometimes just that was enough to give someone a real quick jolt of human reconnection. And that was enough to make someone feel like, “Oh my God, it’s like snap them out of that suicidality.” Suicidality being a permanent solution to a temporary problem.
Always our solutions, they’re always, always our solutions. Where you can find ways to make meaning in your life, to reconnect to that feeling of purpose.
So what I think, also, seeing people more, seeing people more for a while, and then also asking them, “Do you like this?” You’re asking for a lot of feedback, letting the person get some control in this relationship. How about I could say this? Well, okay, maybe we’ll meet every day for a while, but when you feel maybe you don’t need it, let me know.
And sometimes the shocking moment would come a week later or two weeks later. It happened to me a couple of times where some of that, you know, I still feel suicidal, but I don’t feel as suicidal as I was before. So I think, I think I’m okay to come every other day. And then they may, a few days after that, might say, “You know, I think I’m doing pretty good now. Yeah, I’m still feeling like I’m kind of suicidal, but now, like I was, maybe I only need to come twice a week.” And then maybe only once a week.
And then I remember people saying, “You know, I’m actually not really feeling suicidal anymore. I feel, in fact, I’m feeling like I don’t need therapy anymore.” And I remember part of me feeling like, “Oh my god, incredible success!” And then another part of me going, “Oh my god, I’ve been so bonded with this person. They’ve actually become a really intense part of my life, and now they’re leaving. Whoo! I’m gonna grieve their loss.”
And people saying, “Well, yeah, I think I can kind of wrap up this therapy, but can’t I come back, like maybe in a month or two, or call if I need something?” And I’d be like, “Yes, of course.” And then hearing people call me back a month later say, “Well, I really don’t need to come back to therapy. However, I just want to let you know that I’m doing okay.” And it’s like incredibly a good feeling.
This is another thing that’s really hard about being a therapist, is wondering whatever did happen to so many of my clients. Many, many, many of my clients I never heard from again after the therapy ended. Or maybe I heard from them once, like two years later. Sometimes, occasionally, I’ll randomly run into a therapy client of mine, a former therapy client of mine, on the subway in New York or walking down the street. It’s actually exciting and amazing.
I’ve had people randomly reach out to me, email me like five years later, “Hi, just a hello to say I’m doing okay.” And it’s like, it’s a great feeling. Or telling me a little thing that happened in their life, new things that happened. Oh, it’s a wonderful thing. But sometimes you don’t get that. Sometimes it’s like just living with that uncomfortable uncertainty of having such a bonded relationship with someone, maybe someone who went through a horrible crisis, and then not knowing.
However, I want to say one thing also. I want to talk about this aspect of money, people paying money to therapists. Because I can think of, well, I can think of people who actually did pay me good money when they were suicidal, and especially people who came a lot. And they paid me, I mean, I still charged a lot than other therapists I knew, but still for me it was really good money. And people did put a lot of money into it, especially if they were coming more than once or twice a week.
And what I think is, how much money do they pay me versus how much money would they have paid if they had just gone into the conventional mental health system? If they had gone to a psychiatric hospital? And I think, let’s say someone paid me $75 a session for psychotherapy in New York City, much less than $200 a session that a lot of people charge, but still a lot of money. Well, let’s say they came four times a week when they were really suicidal. That is $300 a week that they are paying me to help them become less suicidal. $300 a week is a lot of money.
But then I think, what if it cost to go to a psychiatric hospital? And I think that can often be, especially in New York, a thousand or more dollars a night, in addition to having to pay a psychiatrist to come and see you, maybe for 10 minutes, and to put you through some different suicidal assessments, to just, you know, taking these different tests to determine how suicidal they are. You are only then to put you on a medication, which can also cost a lot of money.
Another thing I’ve seen, and unfortunately I’ve seen it not infrequently, is that the medications people take sometimes make them suicidal from the very beginning. Or the medications they’re forced to take can make them more suicidal, which seems kind of strange. Someone is depressed, they take something called an antidepressant, and this antidepressant makes them more suicidal. Well, the strange thing is that’s even known. Look at some of the black box labels on some of these drugs, especially the SSRI antidepressants. It even says directly, “This can increase suicidality, especially in younger people.”
And then also what I heard a lot of times in the psych hospital is people got little or no therapy at all. And then it’s like no wonder people often didn’t feel less suicidal as a result of being in a hospital. It’s like they had more of their autonomy stripped away from them. They became more hopeless as the result of being in the mental. And also I think what the conventional mental health system so often does when people are suicidal and puts them on medication is it just actually pushes them away from their feelings, more to sort of numb themselves out as a goal.
And for me, it’s like I think the real cure for suicidality is not to go numb. It’s actually the opposite. It’s really to reconnect with the feelings, to reconnect with the buried feelings that are on the inside. All those post-traumatic feelings of rage and pain and sadness and fury and anger. I’ve heard depression as being called anger turned inward a lot of times. I think that can be true. When people really are super depressed to the point of being suicidal, they can be incredibly furious about life, how life is treating them, how life has treated them. But a lot of times they’re not in touch with those feelings. Those feelings are buried down in the unconscious, below that layer of dissociation that is the result of trauma.
And part of being in therapy or being in a connection with other people sometimes is just to have those feelings come out in a safe way, to learn how to process them, to learn how to take them and realize where do they come from, why am I feeling them? To use anger to rebuild boundaries, to have healthier relationships in the future as people go forward, so they don’t end up having bad relationships, so they don’t get traumatized again, so they can become stronger in their lives, to be able to weather the storms that life throws their way.
Because that’s what I’ve also seen. Life doesn’t suddenly get easy if you come out of suicidality. Life isn’t easy for me. I don’t know anyone that has life that really deep on an emotional level is easy, unless you’re, of course, you’re completely numbed out. And then maybe, yes, life might be easier. But also then what’s the point? If you’re numb, if you don’t have your feelings, in a way it’s kind of like almost not being human. It’s kind of like being a robot.
So for me, the goal of working with someone who is suicidal, the goal of anybody who is feeling that, is to learn how to reintegrate our feelings, to bring all those feelings up, to bring up the trauma slowly in a safe way, in a self-loving way, in relationship to others. Or maybe if there is no other, to learn how to do that for ourselves, to make sense of our history, to make sense of our narrative, and to learn how to love ourselves again, to love people again, to rebuild those bridges of connection with humanity. But to do it by starting to build that bridge within ourselves to our own real self on the inside, to learn to love ourselves, to learn to care for ourselves, to have respect for ourselves, to have boundaries in our own life, to have meaning, to have purpose, to have something that we do in.
The world that we find value in, and yet as a therapist, I think we can model all these things for someone by really caring for them, by being respectful to them, and also really ultimately to be loving to a human being who is in terrible pain.