Working with Suicidal Clients
What happens if a client says they have been having suicidal thoughts? What actions do EFT therapists need to take? The following article discusses the steps you need to take as a therapist if confronted with this situation.
To become a professional EFT therapist, just attending an EFT training course is not enough. You need to have a support network and access to advice post-training. Mentoring provides the essential support behind an EFT Practice.
I run group mentoring days, which means people get the opportunity to connect with their peers, which can be invaluable. I can also set my students up with one on one mentoring if required. We discuss a range of topics during mentoring. An issue that has come up multiple times; however is suicide and suicidal clients.
I think this is an important topic to cover as therapists need to be prepared for this eventually with a clear protocol for how they should act. When a client opens up and mentions the word suicide therapists have the potential to make a substantial positive difference in that person’s life.
Suicide Statistics
In 2017 there were 5821 known suicides in the UK (1). In young people between the age of 20 – 34 it is the leading cause of death (2). In 2017, America, it was the 10th leading cause of death (3). More people die as a consequence of suicide than due to war and murders combined (4).
Suicidal tendencies are very treatable. The act of suicide is a strategy to alleviate the pain a person is experiencing. The urge to act can be transient, given the right support and treatment people can fully recover. Of the 26 jumpers who survived their suicide attempt leaping off the San Francisco Bridge; all said that after jumping, they had instantly felt regret and wanted to live (3). In most if not all cases part of the person wishes to live.
Warning Signs of Suicide
Suicides can be planned or sometimes impulsive. People who commit suicide often talk about it at some point before acting on the thoughts. Any talk of suicide should be taken seriously and explored. It can be reaching out and at some level asking for help.
Signs of potential suicide can be excessive moodiness or sadness. A sense of hopelessness that nothing will change. Suddenly feeling calm after having symptoms such as depression etc. This can be a danger sign as it can indicate that they have made a decision and are at peace with it. Withdrawing from friends and family can also be a warning sign. Feeling isolated can be a significant part of this problem. Changes in personality or behaviour can also be warning signs. Other potential warning signs include recent traumas or crises such as the death of a loved one or relationship breakdown.
It is estimated that 50 – 75% of those who do go on to complete a suicide attempt will warn someone of their intention. Generally, people who complete suicide develop a plan making preparations, such as visiting friends, putting everything in order, making a will, giving their possessions away, etc. before suicide (2). People who have previously attempted suicide and failed in their attempt are at higher risk, especially if their circumstances have not changed.
EFT Suicide Intervention Strategy
What should an EFT therapist do when a client mentions the word suicide? Clients in my practice often say the word suicide. The moment they mention that word, I switch to assessing the potential threat. A lot of people have an occasional suicidal thought; however, many are not that close to taking action on it. But you still need to make sure? Firstly normalise the situation to make it easy to talk frankly about it. This can in and of itself help the person experiencing or having experienced suicidal thoughts.
Many people in society are uncomfortable talking about the subject, as a consequence it leads to it being hidden and suppressed. Bringing it up into the cold light of day, by talking about it, can begin to lessen the intensity of the emotions. “It is a common problem, lots of people have those thoughts” or words similar should help them feel that they are not the only with this problem. I think it is essential the therapist reacts to this statement calmly.
When the therapist is calm about it, it sends a very subtle message, “I am OK and comfortable working with this.” This can begin to give the client the confidence to open up and speak about what they are experiencing.
Questions such as, “Are you thinking of doing it?” “When did you have the thoughts?” “Are they still happening now?” Suicidal thoughts that occurred a long time ago and no longer happening generally indicates little to no current threat. An occasional thought in the present time period increases the threat level.
Their answer to “Are you thinking of doing it?” Is important, if they say “No,” Ask, “What stops you?” I have heard answers such as, “I couldn’t do that to my family.” I acknowledge their point, and we sometimes discuss the negative impact it would have on the people they love. Knowing what stops a person from completing a suicide attempt is critical. Leave those emotions there, that is not where you would make a therapeutic intervention.
When you do a safety assessment, you are checking whether there is an imminent threat to life. For people who have booked an appointment to see me in my clinic, it is evident that a part of them does not want to complete a suicide, there is still some hope or wish to recover. For those sent by family, it might be a very different situation.
If you identify an imminent threat to life, you can take action. You can inform the client that you think that they need immediate help and that you intend to call 999. Ideally, get their agreement to take this action. You should request that they stay with you while you wait for them to arrive. Or you can arrange to go with them to the emergency room. Rapport skills come in very useful at this point.
If you think there is a threat but it is not imminent, check out their support network. “What support do they have?” Have they informed their support network of what they are experiencing? Are they getting the required help?
Once you have done the threat assessment, if it is appropriate that you continue with the therapy session, the next step is to deepen your connection with the client. People who consider suicide often feel isolated and alone. They can feel isolated and alone in a room full of people.
Connecting at a deep level can be an essential step toward their recovery. Although I put this as step 2, you would already have been doing this while conducting the Safety Assessment. In my view, the therapist needs to stay in a state of heart coherence. Heart coherence is a powerful state, one in which we can, and do subtly influence those around us without the need to utter a word. It is an energy we transmit.
The therapist needs to be in a state of positive emotions, such as love and acceptance (this does not mean they gush with loving words!) It is about holding a state within, one which is non-judgemental and empathic. This is another reason why it is crucial that the therapist is not fearful of the situation. Research has shown that when we are in a state of heart coherence, we act as a tuning fork and begin to entrain the things around us. This can be subtle, but it is important to start to connect with a person who is suicidal.
Connection with another human being is about active listening, being present with the client. It is about accepting their world view, including their beliefs, even if you don’t agree with them. It is how they feel, what they believe at this point in their life. Accepting that and acknowledging it, can help them feel listened to and understood.
During this phase of the therapy, you can if you think it is appropriate, ask permission to tap on the client’s hand points. If they don’t give permission for you to touch their hand and tap (EFT therapy) you can ask that they tap on their own hand points. As they tap, you should tap on your hand points, as well, guiding them visually. This is conversational tapping. While doing this form of tapping, I find it best to get a pillow beneath their arm to support it, avoiding any strain on the muscles.
I generally tap at about waist height if you are both sitting down. Their hand resting on a pillow if I have one available. I intently listen while tapping through the points. I do not need to look at the hands as I can easily move through the finger points by touch alone. I also include the wrist point. The effect of this is that you begin to work through the layers of the problem gently. This can be a powerful intervention that works on so many levels.
Social interaction is one of the ways we can begin to recover from trauma. The work by Stephen Porges on Polyvagal Theory explains this in detail. Tapping on another person’s hand points can be very nurturing. The goal at this point is to give the client the space to open up and feel listened to and accepted while they do so. Let them express what is going on for them and listen and accept this is their current experience, and tap. I also suggest you make sure that they have future sessions booked as they will need on-going support.
Key Emotions Linked to Suicidal Inclinations
The key emotions linked to suicides are, feeling hopelessness, helplessness, trapped, and isolated. The key to successfully working with this is to clear these emotions. During the clearing, you may need to come up with action steps to stop the problem reoccurring. At the beginning of therapy, the client might not be able or motivated enough to help themselves. Only when their emotional state reaches a certain point can they become proactive in their recovery.
The first goal of working emotionally with this problem is to bring hope back. I have often found that when people take action on their issue, and this can be as simple as making an appointment to see me (the therapist), they begin to feel less helpless. Of course, if they have seen endless therapists and experienced little to no improvement in their problem, this may not happen as they have little to no expectation of the therapy helping. They may just be attending because they don’t have any other options. It is an act of desperation.
Tip to Prevention
At a recent EFT Mentoring day, some of the therapists shared their ways of working with suicidal clients, which included:
- "When do the suicidal thoughts occur?" Identify the pattern of behaviour; it could be that the suicidal thoughts only occur in the evening, before going to bed. In this case, you can develop a pattern break that is easy for them to do. "What could you do that would stop you doing this?" (David Kinvig)
- Practical steps can be removing all items that could be used in a suicide attempt from the home.
- Create a card or handout with emergency support numbers for your clients. Keep it in your office or therapy room so that it is available if needed.
Questions and Answers
References
Please note although I have added the references below due to the statistics they provide and in some cases, the practical tips in no way am I advocating the treatment methods described.
Resources
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