Suicidal Clients: An Attachment-Based Approach
How can we apply an understanding of attachment styles to working with suicidal ideation? Gülcan Sutton Purser, an attachment-based relational psychotherapist and trauma specialist, sets out the characteristics of disorganised and anxious attachments, explains the link between suicidal ideation and loss, and illuminates the internal world of clients for whom death has become the apparent ‘secure base’.
Suicide leaves a mess behind for others to bear. It’s a destructive way of expressing rage, which has turned to self, and also an expression of the deep yearning for comfort in the arms of death. The feelings are overpowering and overwhelming, difficult to manage and regulate for the sufferer.
Suicide beckons when a client feels all attachments have failed. It appears to turn feelings of helplessness and being out of control into action, providing a kind of mastery, both horrific and compelling.
Suicidal ideation and disorganised attachment
Trauma causes disorganised attachment. In disorganised attachment, there is distress with no solution. It isn’t safe to be connected, yet the yearning of other for comfort is so strong. There is fear and anger of the other, too. The caregiver may be frightening or frightened. The forever dilemma of ‘is it safe to be close or is it safe to be by myself?’ is constantly at play.
The typical characteristics are:
- Attachment relations are enmeshed
- … confusing
- … full of denial and of unexpressed feelings
- There is role reversal between child and parent
- There is a strong sense of shame
- … of badness
- … and of being a burden on others
Suicidal ideation and anxious attachment
As in disorganised attachment, we can see hostility and over involvement in anxious attachment. The characteristics are:
- High levels of hostility
- High levels of emotions and over involvement in relationships
- A primary caregiver with an avoidant attachment style, causing rigid boundaries, which can lead to hostility
- Or a primary caregiver with an ambivalent attachment style, making it difficult to separate themselves from their children and draw clear boundaries, as they can be overwhelmed with worry and guilt
In the early stages of infancy, father’s job is to protect the mother-child dyad, to allow the attachment to develop, and maternal preoccupation to happen. Later he needs to intrude on the intimacy of the mother-child dyad, partly to build a relationship with the child himself, and partly to encourage the healthy separation from the mother. Without this oedipal paternal function, the mother may actively reject the child and/or enmesh with the child.
Suicidal ideation and loss
There is strong evidence of a relationship between experiences of loss and vulnerability to suicide and suicide attempts, as the loss has become so unbearable and remained un-mourned.
In the absence of a functioning caregiver, suicide will appear to offer safety and relaxation. When the decision is made, it brings a sense of calmness. Now, the prospect of oblivion has become a source of comfort, and a soothing other. In this delusional state, death becomes the secure base where pain and suffering are finally assuaged.
We can help suicidal clients by…
- Allowing conversation around suicidal wishes
- Helping the client to understand their different parts – understanding that the part who wants to die will kill everyone, whether they want to die or not, is crucial in the therapeutic work
- Helping the client to acknowledge and understand the rage, which is caused by trauma, and an absent caregiver
- Validating and helping the client to regulate the painful and overwhelming feelings are vital parts of this delicate work