Responding to a Suicidal Client: The Experience
Having a plan of what to do when you are working with a suicidal client is really useful (Responding to a Suicidal Client: The Practicalities), but it is worth thinking about the emotional reality of having to break confidentiality.
The following fictional piece is based on a variety of scenarios that I have encountered, to try to give a sense of how it feels and what can happen when you make that decision.
It’s nearly time for the last client of the day. The daylight is fading so I turn on the lamps to add some light, but it still feels gloomy. It often does with him; he seems to suck the light out of the room. I feel my chest tighten, in anticipation of another difficult session.
He has been battling with dark suicidal thoughts since our first session, and each time we meet I am poised to act, nervous about making that judgement call while protecting his autonomy, his right to feel this way, to explore those darkest thoughts and hold him in that space while checking that he will keep himself safe. It is a balancing act, and each time he comes I mentally prepare for the fact that I may have to act. It is exhausting.
He arrives. As I welcome him and lead him to the therapy room, straight away I can feel the weight he is carrying. It is palpable. He sits heavily in the chair, not looking over at me, and he is silent. I wait for him to speak, noticing his shallow breathing, his shoulders sagging as though every muscle hurts.
Eventually I speak, keeping my tone soft so as not to fracture his fragile state further.
“It feels really difficult today…?”
He can’t speak, but nods, slowly. Eventually words come, but quietly, almost from far away.
“I don’t want to be here anymore.”
What does this mean? Does he mean here with me in this room, or does he mean he wants to be dead? Gently I ask him, I need to be clear. Again, he nods, and I think I hear him say he wants to die but the words are so faint I can barely catch them.
“That sounds so hard for you… are you safe? Can you keep yourself safe?”
He shakes his head.
“I nearly walked in front of a bus on my way here… I don’t know how I’m going to stop myself…” The words almost choke in his throat.
I believe him. He has reached the point of no return. This is it – I need to act now.
“Do you remember, we’ve spoken before, about our contract, that if I’m concerned that you can’t stay safe, I’ll need to speak to someone…” Again, I keep my tone as gentle as possible.
He nods again.
“I think we are at that point now, what do you think?”
He nods again.
“So, I’m going to call your GP, that’s what we talked about, is that ok?”
He nods again.
I am anxious as I gather the information I need about the client and make the call. The rings seem to go on forever. Eventually someone answers. I explain who I am, that I am with the client, and why I am calling. There’s no one available to speak to me. The receptionist is harassed and curt. If he can’t keep himself safe, tell him to go to A&E, that’s what we advise, I am told. I insist they make a note of the call and my client’s details. I’m disappointed and worried for this young man in front of me who has lost all hope.
“Will you go to A&E?” I ask him. “They will talk to you, help you. Can you promise me that you will do that?”
He slowly nods his agreement. We plan what he is to say when he gets there. I write him a note to take. I walk him to the door and gently touch his shoulder: “Message me how it goes?”
And now, anxiously, I wait for news.
