3 Working with clients who are suicidal is emotionally activating. Becoming comfortable with suicide as an issue in counseling is a developmental process that takes time and practice. One way of looking at the content of this book is as an exposure experience that will improve your ability to self-regulate when facing crisis situations as a counseling professional.
If your goals are to become comfortable, confident, and competent when working with clients who are suicidal—and we hope these are your goals—your best route is to strengthen your professional suicide assessment and treatment competencies. Rigorous and direct exposure to suicide-related material in this book and others, along with workshop training and supervision, will get you on track toward professional competence in suicide assessment and treatment.
In the end, we want you to know—in your head and in your heart—that you have the knowledge and skills to provide effective suicide assessment and treatment. Having confidence in your knowledge and skills will be emotionally stabilizing; it will also help you develop a positive and optimistic attitude toward suicide intervention and prevention that you can then pass on to your clients and students.
Emotional Responses to the Topic of Suicide
We began facilitating workshops, lectures, and trainings on suicide assessment and intervention in the 1990s. One presentation stands out. We asked about 80 school and mental health professionals, “How many of you have worked with clients or students who are suicidal?” Nearly everyone raised their hand. We followed up with, “How many of you have worked with a client who died by suicide?” About 15 hands went up. We asked how many had faced more than one client death by suicide; a few hands hesitantly went up. After thanking the group, we shared our own experiences and then transitioned to talking about coping strategies for professionals when clients complete suicide.
While talking, we noticed activity in the back of the room. Rose, a colleague we knew well, stood up and slipped out. Rose was a licensed mental health professional, an unflappable woman with a reputation for working with the toughest teens in town. We did not make much of her exit, but later Rose contacted us. “Sorry about leaving. You got to me. When you started talking about clients dying, I had to get out. I’ve had too many. Maybe I haven’t dealt with some of my losses.”
Regardless of your experience, suicide is a difficult topic, and emotional reactions run deep. Your own reactions may link to values, religious beliefs, losses, or future fears. Maybe you have had a friend, client, or family member die by suicide. In such situations, waves of painful emotions might come up whenever suicide is mentioned. Or you may struggle with suicidal thoughts yourself. No matter your background, conversations about suicide will activate or trigger your unique emotional response. Gaining experiences can reduce the intensity of your emotional responses to suicide scenarios, but there is also a chance it might magnify them. Either way, recognizing and having a plan for coping with your emotional responses will make you a more competent, ethical professional (Corey et al., 2018).
Professional Self-Care
Rose left the suicide workshop after recognizing that her emotional bucket was full. She stopped listening and removed herself from the room. She realized that she needed to take care of herself. We recommend that as you read this book and work with people who are suicidal, you weave lifestyle strategies for managing the input of stressful information into your life.
Stop Reading
Be sure to follow Rose’s example and stop reading if you need to. During suicide workshops and college classes, we tell people that to avoid being triggered, they can do what our teenage clients do: Just stop listening to us. Suicide information overload happens. One method for dealing with overload is to stop the input, step back, and take time to absorb and regroup.
If you are an avid reader, you can get swept into information about death and suicide and forget to take a break. Planning intermittent breaks from this book and other suicide-related material is wise. You can use the Pomodoro technique: Set a timer for 20 or 30 minutes, and then take a break. Consider inserting a fun, creative, social, or reflective activity into your break time.
You can use a variation on this “stop reading” approach during counseling sessions. For example, if you are feeling overwhelmed in a session, it is perfectly reasonable to take a break from information gathering and instead focus on coping in the moment. You might say something like “When we’re talking about intense topics in counseling, we should also practice positive coping strategies at the same time. So let’s pause, take some breaths, and then talk about how we can weave coping strategies like deep breathing and problem-solving into our session.”
Taking breaks is one coping technique, but not the only one. We recommend having a variety of strategies for self-care. Based on numerous research studies, Norcross and Vandenbos (2018) identified effective strategies that professionals use to manage stress. What follows is our version of Norcross and Vandenbos’s recommendations.
Recognize the Hazards
Facing and talking about death is an emotional undertaking. Do not expect to read this book without experiencing some distress. Humans are not built to continually focus on suicide and death. If you would rather avoid topics of suicide and death, join the club. You are not being weak. Recognizing and accepting that too much focus on suicide and human mortality can be hazardous to well-being is a healthy and reasonable start.
Once you have admitted that this is not easy, then you can take steps to address the dangers and make accommodations for yourself as necessary. The sections below offer suggestions, but you know yourself and what you need, so you may want to make your own list.
Intentionally Focus on Positive and Rewarding Life Experiences
Professionals who cope effectively with powerful life stressors do not wait for positive experiences to come to them—they weave health-enhancing activities into their daily lives. As a counselor, you will hear harrowing client stories and be susceptible to vicarious traumatization (Foreman, 2018; Trippany et al., 2004). To care for yourself and to be a positive role model for clients, it is essential that you integrate healthy habits into your life. To inspire you to embrace positivity, at the end of every chapter in this book we feature one activity from the positive psychology literature that you can use yourself and/or offer your clients. We call these activities Wellness Practices (see Wellness Practice 1.1).
Beyond the Three Good Things activity in Wellness Practice 1.1, you can explore, through journaling, discussion, or counseling, what brings you joy, laughter, and gratification. When your busy life interferes with joyful or positive activities, you may need to post sticky notes or set your personal electronic device to remind yourself to focus on the joyful and positive. As professionals, we can get so caught up in helping others that sometimes we need explicit reminders to use positive interventions with ourselves.
Use a Variety of Self-Care Strategies
A single self-care strategy will not work as the best solution for everyone; we all have our own preferred coping techniques. The best way to cope with stress and stay healthy is to develop a smorgas-bord of stress management and self-care strategies (J. R. Nelson et al., 2018). If you love exercise, that is great, but you cannot exercise incessantly. You need other activities in your stress management toolbox. Try meditation; support groups; recreational pursuits; your own personal counseling; gourmet food; excellent movies or concerts; spiritual, religious, or social justice groups; or whatever