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Suicide & Suicidal Thinking

Suicide can be a touchy subject. The public is largely unaware that many therapists are afraid (and actually refuse) to treat anyone with active suicidal urges. Instead, the average therapist will send a client to “a higher level of care” (such as a psychiatric hospital or residential facility) rather than take the risk of treating the suicidal person themselves.  Patients may not be able to even hint about suicidal thoughts without concern that they will be hospitalized against their will by a health care provider.

While hospitalization is sometimes the answer, it is rarely a long-term solution. For those who have a history of chronic suicidal thinking and hospitalizations, another weekend in the hospital does little good—and for those with new thoughts about ending their life, the threat of being exposed or hospitalized can prevent a real discussion from ever happening. Therapists need to be able to talk with a patient about their desire to die without immediately calling “the men in the white coats with the butterfly nets,” but that discussion requires learning a set of skills most therapists were not exposed to in school.

Dialectical Behavior Therapy (DBT) was one of the first therapies to treat highly suicidal individuals on an outpatient basis. Because DBT considers suicide as the solution, not the actual problem itself, DBT therapists are focused on identifying the actual problems in order to assist with different, tangible solutions. Not only that, but DBT therapists are able to speak frankly about death instead of tiptoeing around it, treating patients with respect rather than patronizing with whispery tones and “concerned” looks. Within DBT, no person is treated as “fragile” and though the situation may be serious, we don’t take ourselves too seriously.

While it is natural for family and friends to try to step in to “save” a suicidal loved one, that role can get to be sticky business for a person who isn’t trained. DBT recognizes that ultimately, the decision to die by suicide is completely up to each individual. In the end, no matter how much they try, no well-meaning family member, friend, or therapist can control that decision. Our main job in treating a suicidal individual is to help them create a life that is more desirable than their idea of what happens after they kill themselves—a life that is actually worth living.

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