This is what psychological intervention looks like for patients at risk of suicide.

These are the strategies therapists follow when treating people who are thinking of killing themselves.

"I wish it were all over", "I am a burden to everyone", "life has no incentive for me", "I see no way out of my suffering", "I would like to disappear", "I can't take it anymore", "it is not worth living like this", "I would be better off if I got out of the way"....

These phrases are examples of people who are undergoing great suffering and who may be contemplating suicide as a way out. as a way out. Hearing these kinds of statements should trigger 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 can be useful for those professionals or students of Psychology that can be found with similar situations, in which the patient-client manifests in a more or less covert way his desires to finish with everything.

First step before intervening: detecting the risk of suicide.

Logically, before intervening we must be able to to detect the risk of suicide and to evaluate it adequately..

Indicators

Some indicators of suicide risk would be the statements discussed in the previous paragraph, although sudden changes in the patient's life (e.g., going from a state of nervousness and agitation to one of sudden calm, for no apparent reason) should also be taken into account, as they may indicate that the patient has made the decision to commit suicide.

Other more visible indicators would be preparations that are the prelude to deathGiving money, making a will, giving valuables to loved ones...

Suicide risk assessment

Suicide should be discussed naturally and openly in therapy, 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 or her to think about it in a more positive way and even accept suicidal ideation.

However, asking the patient directly makes the patient feel relieved, understood and supported.understood and supported. Imagine that you have been thinking about suicide for a long time and you cannot talk about it with anyone because it is considered a taboo and uncomfortable subject. What a burden you would be carrying, right? In many cases, talking about it with a psychologist can be therapeutic in itself.

In cases where the patient has never raised the issue of suicide and has not verbalized things like "I want to disappear and end it all", it is best to ask in a general way. For example: sometimes, when people go through bad times they think it would be best to end their life, is this your case?

If the risk is very high, we should proceed to take measures beyond psychological intervention in our practice..

Principles of psychological intervention in patients at risk of suicide

Below is 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 co-therapist support (to mobilize the patient) and/or family. In addition, at the discretion of the professional, it will be convenient to extend the frequency of the sessions and provide a 24-hour service.

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 his or her motivations for committing suicide (e.g., dire economic situation, very negative emotional state that the patient sees as never-ending, divorce, etc.). Psychologists must make a profound exercise of empathy, without judging the person we meet.without judging the person in front of us. We must try to involve the patient in the therapy, and explain to him/her what things can be done to help him/her, in order to establish a continuity in the therapy.

2. Exercises of reflection and analysis

It is interesting to propose to the patient to write down and analyze in a reflective and detailed way the pros and cons, both in the short and long term, for him/herself and for others, the options of committing suicide and continuing to live.

This analysis should be done taking into account various areas of his/her life (family, work, children, partner, friends...) so that he/she does not focus on what causes him/her the most suffering. We must convey to him/her that we are trying to help him/her make a reasoned decision based on a deep analysis.

3. List of reasons for living

This exercise consists of the patient to write a list of their reasons for livingand then hang them up in a visible place at home. The patient is asked to consult this list several times a day, and can expand it as many times as he/she wants.

In addition, he can be asked to focus on the positive things that happen in his daily life, no matter how small, in order to focus his selective attention on positive events.

4. Cognitive restructuring of the reasons for death

When the patient identifies in the previous analysis the reasons for dying, in therapy we will see if there are incorrect and exaggerated interpretations (e.g., everyone would be better off without me because I have made them unhappy) as well as dysfunctional beliefs (e.g., I cannot live without a partner).

The goal of cognitive restructuring is for the patient to understand and see that there are alternative see that there are alternative and less negative ways of looking at things. (the objective is not to trivialize his situation or to paint the situation "rosy", but to make him see 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/she has overcome in life and how he/she solved them.

In case there are unresolved problems that lead him 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 useful to teach the patient skills and strategies to regulate very strong emotions. skills and strategies to regulate very intense emotions, as well as to use the technique of temporal projection.as well as to use the technique of temporal projection (to imagine how things would be in a certain time).