How to Help a Loved One Who is Suicidal

Through dramatic reenactments, experiential exercises and the best of available resources, Dr. Peter brings you critical information to help you better love those near you who are struggling with suicidal thoughts and impulses.  Learn how to be a much better first responder in these situations and to be a bridge to additional resources for your loved ones who are considering suicide.   
Lead-in:  Imagine a young man, a teenager you care about, one you really love, a family member or friend, or the son of a friend, comes to you, in distress, and he shares this with you -- listen closely as he tells you what's on his heart. [insert script].
 So now you have this upset, desperate man in front of you, who wants to be dead.  
What do you do?  How do you handle this situation?  
But before we go there, let's start with you.  We created a scenario to evoke what might come up in real life when your encounter a loved one who is suicidal.  
What do you notice going on inside you right now? 
What is happening in your body?
Emotions?
Assumptions or beliefs about yourself?
Memories, desires, impulses.  
Replay the last clip
What are parts of you saying to you about you right now?
Really pay attention to those messages

I will make a bold claim here -- the number one thing you struggle with in being a first responder to a loved one with suicidal levels distress is [drum roll]  your own internal experience.   

The problem you have is not so much inside the distressed loved one.

 The problem you have is inside of you, deep within you.

 You get wrapped up in our own fear, shame, guilt, anger, or your own sense of inadequacy.

 
Did you feel any of that that in this example, confronted with this teenager in such distress, who feels so strongly the desire to die?
 Did you feel uncomfortable, on edge, uncertain?  Anxious?  Ineffective, inadequate?  Responsible, but not knowing what to do?  Did you experience any self-criticism?  Any of those experiences?

 If so, you’ve come to the right place.  I can help with that.  [Insert Intro]

 

Intro:
 Welcome to the podcast Interior Integration for Catholics, I like being together with you in this whole adventure, as we learn about suicide and what to do about it, all grounded in a Catholic worldview. I am Dr. Peter Malinoski,, passionate Catholic first and clinical psychologist as well, and you are listening to the Interior Integration for Catholics podcast.  Thank you for being here with me.  Interior Integration for Catholics is part of our broader outreach Souls and Hearts bringing the best of psychology grounded in a Catholic worldview to you and the rest of the world through our website soulsandhearts.com

 
This is the fifth in our series on Suicide.
 In episode 76, we got into what the secular experts have to say about suicide.

 In episode 77, we reviewed the suicides in Sacred Scripture, in the Bible.  

In episode 78, we sought to really understand the phenomenological worlds of those who kill themselves -- what happens inside?  How can we understand suicidal behaviors more clearly, dispelling myths and gripping on to the sense of desperation and the need for relief that drives so much suicidal behavior.

 And in the last episode, number 79, we took a deep dive into the devastating impact of suicide on the parents, spouses, children, siblings, and friends who were left behind.

 
Today's episode, number 80 is entitled "How to Help a Loved One Who is Suicidal." 
We are getting into the nitty-gritty of what do you do when someone you are close to is suicidal? 
In short, how do you love someone who is so distressed, so desperate, that they are seriously considering killing themselves?
First a brief caveat -- I can't, in a single podcast episode, train you to be a crisis intervention specialist.  That takes dedicated training.  But you know what?  Most people with these suicidal levels of distress don't seek out crisis intervention specialists or therapists or counselors first.  They go to the people they know.  They go to the people whom they hope and believe will love them.  They go to you.  What you'll learn today is for your own information, to help you understand what's going on and how best to act as a first responder and a bridge to long-lasting help that can heal.  

Love your neighbor as yourself.  Diliges proximum tuum tamquam teipsum. Inflection of dīligō (second-person singular future active indicative)  The second great commandment.  Love your neighbor as yourself. Diliges proximum  tuum.  Love is a verb, an action.  So what if our neighbor is the teenager from our lead in today?  How do we love a suicidal person?  How do we love her?
 Definition of Love -- Charity -- caritas.   
Benevolence -- bonae voluntatis in Latin, good will.  
Capacity
 
Understanding the other
 Operating in the mode of the receiver

 Dependent on us understanding ourselves

 Mistaking what is coming from who

 Unconsciousx

 

Capacity to choose the good -- Freedom.
 
Well-governed self
 Regulated

 Organized

 Calm. Compassionate

 Good human formation

 

Possessing virtues

 Possessing the knowledge and expertise in a situation.  

Constancy.  
Need peace and interior integration'
Being vs. doing.

CCC 1829 The fruits of charity are joy, peace, and mercy.  

Loving all their parts
 
Definition of parts
 Suicidal distress makes so much more sense if we understand each person not as a uniform, monolithic, homogenous, single personality, but rather as a dynamic system including a core self and parts.  That helps to explain so much, including shifts over time.  

Definition of Parts:  Separate, independently operating personalities within us, each with own unique prominent needs, roles in our lives, emotions, body sensations, guiding beliefs and assumptions, typical thoughts, intentions, desires, attitudes, impulses, interpersonal style, and world view.  Each part also has an image of God and also its own approach to sexuality.  Robert Falconer calls them insiders.  You can also think of them as separate modes of operating if that is helpful.  Not just transient mood states, but whole constellations of all these aspects.

Unintegrated parts are not focused on loving others
Unintegrated parts can be exiled
Parts often have very different attitudes toward suicide.  

Blending
 What is the key word here?  Blending.  

Definition of a Blend:  
Richard Schwartz and Martha Sweezy Internal Family Systems Therapy, 2nd Ed. --   The act in which a part takes over a person’s seat of consciousness, or self.  
"Blending in IFS" March 7, 2010 Blog post:  Modes of Blending in IFS In IFS a part is “blended” with someone when they ARE the part as opposed to being in Self. This could mean that they feel the part’s emotions, they hold its beliefs, or their behavior in the world comes from this part.
Jay Earley October 17, 2018 Blog post:  A part is blended with you and has taken over your seat of consciousness when any of the following is true:
 Flooded with the parts emotions

 Caught up in the beliefs of the part

 Dominated by the perspective and worldview of the part. 

Blended part is now driving the bus with the self and all the other parts aboard
 Part that takes over your internal raft

 Example of Pixar moving "Inside Out" when Anger takes over the control panel

 Taken over by the passions -- e.g. irascible passions, such as fear or anger.

everything seen through the very limited perspective of the blended part. 

 

Starting with what to notice.  Excellent sources
 Columbia University Departs of Psychiatry 

American Foundation for Suicide Prevention (afsp.org)

 National Institute of Mental Health nimh.nih.gov

 Suicide Prevention Resource Center sprc.org

 Suicide Prevention Lifeline suicidepreventionlifeline.org

 Helpguide at helpguide.org

 
Risk Factors, Signs:  The behaviors listed below may be signs that someone is thinking about suicide (NIMH):
 
Talking about wanting to die or wanting to kill themselves
 “I wish I hadn’t been born,”

 “If I see you again…”

 “I’d be better off dead.”

 

Preoccupation with death -- focus on death, dying, violence.

 
Talking about feeling empty, hopeless, or having no reason to live
 Depression

 Helplessness

 

 Making a plan or looking for a way to kill themselves, such as searching for lethal methods online, stockpiling pills, or buying a gun
 Researching ways to kill oneself on the Internet

 

Talking about great guilt or shame

 Rejecting compliments

 
Talking about feeling trapped or feeling that there are no solutions
 Nothing is ever going to get better.  

Feeling unbearable pain (emotional pain or physical pain)

 Loss of a sense of purpose or meaning in life

 Talking about being a burden to others

 Apathy -- not caring about things he used to be passionate about.  Feeling numb, detached

Not caring about the future

 Self-neglect -- lack of self-care -- neglect of personal appearance, hygiene

 Using alcohol or drugs more often

 Acting anxious or agitated -- panicky

 Withdrawing from family and friends

 Changing eating and/or sleeping habits 

Showing rage, lots of anger, irritability, feeling upset more than usual -- or talking about seeking revenge

 Taking great risks that could lead to death, such as driving extremely fast -- impulsive or reckless behavior

 Talking or thinking about death often

 Displaying extreme mood swings, suddenly changing from very sad to very calm or happy

 Previous suicide attempts

 Giving away important possessions

 Saying goodbye to friends and family

 Being exposed to others who have taken their own lives, family, friends, acquaintances.  

Putting affairs in order, making a will

 
Signs I will add
 Changes in attitudes toward God

 Changes in religious practices, e.g. no longer praying, no longer going to Mass

 

What to do when someone is at risk of suicide  from these six sources
 Take time.  Calm down. 
Prayer
Monitor how you are doing.  

Assume you are the only one he has told

 
Have an honest conversation
 Talk to them in private

 Be yourself.

 Understand that the person may be dominated by one or more parts right now, and those parts may seem like they are telling the whole story, but there are often other parts with different beliefs and desires about living and dying.    

Be with them.  Finding the right words is not as important as your presence, your "being with."  

Avoid judgment.

 Take a breath if they are really agitated, like the teenager in the introduction.  

Tell them you care about them
 “I have been feeling concerned about you lately.”

 “Recently, I’ve noticed some differences in you and wondered how you are doing.”

 “I wanted to check in with you because you haven’t seemed yourself lately.”

 
You can use parts language
 Maybe a part of you is really desperate right now.  

Listen to their story, take their concerns seriously -- talking about suicide reduces the likelihood of enacting it.
 When did you begin feeling like this?”

 “Did something happen to make you start feeling this way?”

 “How can I best support you right now?”

 “Have you thought about getting help?”

 
Let them know they have been heard.  Mirror back to them what you are hearing, invite them to help you understand more deeply.  
Ask directly if they are considering suicide:  "Are you thinking about killing yourself?"
 Does not increase the risk 2012 Study by Charles Mathias and colleagues in Suicide and Life Threatening Behaviors  Change in suicidal ideation was tested using several analytic techniques, each of which pointed to a significant decline in suicidal ideation in the context of repeated assessment. 

Helpful things to say
 You are not alone in this. I’m here for you.”

 “You may not believe it now, but the way you’re feeling will change.”

 “I may not be able to understand exactly how you feel, but I care about you and want to help.”

 “When you want to give up, tell yourself you will hold off for just one more day, hour, minute—whatever you can manage.”

 
Encourage them to seek treatment or contact their doctor or therapist
Work with the person to keep him away from lethal means as the situation permits.  
Firearms 
Drugs
Stay with the person.  This can be hard.  Parts that want to get away.  

Suffering is temporary
Call the hotlines 24/7
 
National Suicide Prevention Lifeline at 1-800-273-8255  (TALK)
 First, you’ll hear a message telling you that you’ve reached the National Suicide Prevention Lifeline.

 We’ll play you a little hold music while we connect you.

 A skilled, trained crisis worker who works at the Lifeline network crisis center closest to you will answer the phone.

 This person will listen to you, understand how your problem is affecting you, provide support, and share any resources that may be helpful.

 Remember, your call is confidential and free.

 
Should I Call The Lifeline?
 No matter what problems you’re dealing with, whether or not you’re thinking about suicide, if you need someone to lean on for emotional support, call the Lifeline.

 People call to talk about lots of things: substance abuse, economic worries, relationships, sexual identity, getting over abuse, depression, mental and physical illness, and loneliness, to name a few.

 

Texting option:  Text HELLO to 741741  

Escort him to mental health services or an ER
Stay connected

Avoid:
 Argue with the person 

Discuss how suicide is wrong

 Debate the value of his or her life

 Act shocked

 Minimize their problems

 Give advice or offer ways to fix the problems.  

Promise confidentiality or be sworn to secrecy.  You may need help

 

Assessing the immediacy or the urgency
 Do you have a plan? (PLAN)

 Do you have what you need to me carry out the plan (firearms, pills, etc.) (MEANS)

 Do you know when you would do it (TIME SET)

 Do you intend to take your own life (INTENT)

 
Levels of risk
 Low – Some suicidal thoughts. No suicide plan. The person says they won’t attempt suicide.

 Moderate – Suicidal thoughts. Vague plan that isn’t very lethal. Says they won’t attempt suicide.

 High – Suicidal thoughts. Specific plan that is highly lethal. Says they won’t attempt suicide.

 Severe – Suicidal thoughts. Specific plan that is highly lethal. The person says they will attempt suicide.

 
Practice sessions -- two more voice actors -- we had a voice actor at the lead-in -- she was imitating a highly distressed teenager.  Now we have two teenage voice actors playing out a scenario.  
Upper Room Crisis Hotline is a faith-based hotline in the Catholic Tradition. We are a non-judgmental listening and referral hotline to clergy, religious and laity in spiritual need 24/7.  We bring comfort to those facing spiritual need.
 Discovered it while researching this series on Suicide.

 I called them up -- wanted to find out more

 Spoke with Dr. Terry Smith Executive Directory and Sr. Mary Frances Seely. Who has more than 50 years of experience in creating, maintaining and growing crisis hotlines, and she is now writing the definitive history of crisis hotlines in the United States.  

Started 2004 priests, brothers, deacons -- dealing with the difficulties of the sex abuse crisis -- grew and grew
 500 calls per month

 Cals from 32 different countries

 Not only Catholics, but also Protestants, Jews, Muslims, Agnostics, and Atheists, too.  

Major operation 45-50 phone counselors --
 Trained by addiction specialists, psychologists, social workers, mental health. 
Eight week training session, four hours per week.  Substantial.  
Next training runs from September 2 to October 21, 2021, on Tuesdays and Thursdays from 11 AM to 1:00 PM Eastern Time -- all Zoom meetings -- Contact Dr. Terry Smith at [email protected]

Often are retired mental health professionals

 Staffed by volunteers

 Funded by donations -- worth cause, I will be donating to this group

 Brings in the Catholic spirituality -- really important for someone of faith.    

I asked Dr. Smith hard questions -- how equipped are your volunteers to handle imminent suicide crisis -- gun-to-the-head type scenarios
 Confident in his team -- trained in imminent situations

 

I asked if there was an imminent situation would a person be better served calling the National Suicide Lifeline or the Upper Room Crisis hotline
 Element of Faith -- we have the virtue of hope and can address that specific aspect, which is so important.

 

I was impressed with the answers and feel very comfortable passing on their contact information as Catholic resources.  Had considered setting up a crisis hotline within Souls and Hearts, but now I don't have to -- I don't have to reinvent the wheel.  

Contact information
 1-888-808-8724

 Catholichotline.org

 

Takeaways
 Caritas or Agape or Charity -- love consists of Benevolence, Capacity, and Constancy

 
Our struggles to love others have more to do with our internal worlds than with the other person
 Monitor yourself and care for yourself while working with another person

 

Suicidal loved ones are often dominated by a suicidal part that blends with their core self and takes over, driving the bus

 You can be a first responder and a bridge to other resources.  

If you are having suicidal thoughts or know of someone who is, contact 
the Upper Room Crisis Hotline at 1-888-808-8724 
National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance 
 If you or a loved one are in immediate danger, call 911. 

Action Items
 I want to hear from you Conversation hours T, R 4:30 PM to 5:30 PM  317.567.9594   

Pray for me and for the other listeners

 
Catholic Mental Health professionals -- Many of the Interior Integration for Catholics podcast listeners are Catholic clinicians -- so  all you counselors and therapists, social workers, psychologists, psychiatrists, marriage and family therapists -- and also, all you graduate students in mental health fields, stay tune in after the invocation -- special invitation for you, special opportunity for you to work with me 
 ITC discussion
 
Are you seeking:
 Greater insight into yourself as a clinician and better self-care? 

Better human formation on the natural level as both a person and a therapist?

 Deep, personal connections with a small group of other Catholic therapists who understand the unique demands of our lives?

 New therapeutic skills to help your clients help themselves, especially those with complex trauma?

 Do you want this all in a Catholic community of therapists committed to grounding Internal Family System-informed therapy in a Catholic worldview?

 And would you like to work with me, your dear Dr. Peter, as your consultant and guide?

 

Here is an answer for you.  The Interior Therapist Community within Souls and Hearts.  In September, psychologist Peter Martin and I are opening up four new IFS-informed Foundations Experiential Groups for Catholic therapists and graduate students in mental health fields.  No previous IFS training is necessary to participate.  

Go to soulsandhearts.com/itc and check out our landing page.  Soulsandhearts.com/itc. There's a registration link there with lots more information.  I will also be hosting an Informational Zoom meeting on Friday, August 13 at 7:00 PM Eastern time -- register for that and have your questions answered. You're also welcome to get in touch with me at [email protected] or on my cell at 317.567.9594 to find out how we can work together!