How To Deal With A Suicide Crisis. Case Description

2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43

Below I bring to your attention a brief illustration of therapeutic work based on the proposed model of psychological assistance. In it, you can find the sequence of a therapeutic process that unfolds in a phenomenological field, determined by acute suicidal tendencies that unfolded against the background of an acute traumatic event experienced by the client

Schematically, this sequence can be represented by the following chain: acceptance of the uniqueness of the phenomenological picture of what is happenin

- restoration of sensitivity to mental pain

- support of the process of experiencing all phenomena that arise in the field (without the elective involvement of the facilitator, and with an emphasis on the natural therapeutic dynamics of the field)

- restoration of the ability to creative adaptation.

R., a 24-year-old girl, asked for help in an acute suicidal crisis. A few months ago, she was faced with an extraordinary event in her life - her boyfriend, whom she was going to marry, tragically died in a car accident. R. lost all taste for life, felt devastated and had been depressed for a long time.

LAny attempts to experience what had happened were beyond her reach. With bitterness and pain in her voice, she told me that no one understood her and could not support her. Girlfriends tried to divert her attention from the event to other affairs and activities.

The parents said something like: “Don't be upset, daughter. You will find yourself an even better guy than the old one. Apparently, both friends and parents were proceeding from the best intentions, but for the obvious reasons mentioned above, they could not be present in R.'s life, since they proceeded from an excellent phenomenological situation. For R., what happened in her life turned out to be not just a tragic event, but completely unique (which, it seems, her relatives did not understand or were afraid to understand).

The inability to accept the situation, in turn, blocked the process of experiencing it. My primary therapeutic task at this stage was to immediately accept the uniqueness of the situation in which R.

I told her that the loss she had suffered was irrevocable and that I noticed that it was impossible for R. to compensate for it in any way at the moment. After that, R. for the first time looked me straight in the eyes and burst into tears, the process of experiencing could now be restored.

R. talked about the pain that does not leave her for a minute. Until now, she had to "be alone with unbearable pain." Now the pain could be placed in a relationship with another person, and, therefore, be experienced and relieved.

After some time (about 2 months of therapy had passed), the dull undifferentiated pain that R. experienced in our contact gradually began to transform into more differentiated experiences. R. suddenly realized a strong feeling of rage towards the deceased, which greatly surprised and embarrassed her. However, after my comment on the attitude to this feeling as a natural, R. was able to express and experience it as well.

Soon the rage was replaced by anger, the main motive of which was R.'s idea that the deceased young man left her alone in a world where she does not find any meaning for life. Initially existing in connection with this in the background shame and the image of oneself as “evil, cruel and insensitive” were transformed into the image of “abandoned, vulnerable and sensitive” and assimilated into self.

R.'s social activity began to gradually recover, albeit with some difficulties, since it was "difficult and almost unbearable for her to be in the company of people who can enjoy life." Relief came when R.in communication with other people, she stopped pretending to and try to live an artificial life in order to adapt to the environment at any cost, and began to experience her own life, no matter how difficult it was at this stage. At this stage of therapy (about six months from the beginning), suicidal tendencies ceased to be as acute and constant as it was at the beginning.

Further, in the process of the experience supported by us in therapy, sadness appeared related to the loss of a loved one, and gratitude for the fact that he was in R.'s life. During this period of therapy, the pain experienced by R. ceased to be perceived by her as unbearable; there are also phenomena of experience that are not associated with the tragic event that has occurred, but are related to the actual period of R. Suicidal thoughts no longer bothered R., although she still looked a little confused, fragile and vulnerable. A year after the tragedy, the nagging pain still, of course, lived in R.'s wounded heart. However, the despair that formed the "pitch hell of existence" disappeared and no longer reminded of itself.

For the first time since the loss of a loved one, joy and pleasure gradually began to return to R.'s life. R.'s life, which had been blocked for a long time, also returned to her ideas about her feminine attractiveness, and she developed sympathy for some of the men around her.

This was a significant progress in R.'s therapy, since up to this point any sexual images and fantasies caused her disgust and almost a phobia. At this stage of therapy (about 1, 5 years from the moment of its beginning), the sexual arousal that appeared at the first moment was also accompanied by a certain pronounced mixture of fear and shame, since she interpreted it as a betrayal of the previous, still most valuable relationship in her life. The vital struggle of fear and shame, on the one hand, and pleasure and arousal, on the other, continued for some time. We were in no hurry to resolve this conflict by facilitating any one "truth".

The premature resolution of the conflict before the formation of a dead end, in my opinion, would turn out to be another narcissistic (in the sense of betraying the natural process of experiencing) the project of the traumatized person, which would inevitably entail a “traumatic rollback” in the form of the impossibility of assimilation of the experience formed in the course of therapy and the chronicity of the “defeated self-tendencies (be it pleasure, or, on the contrary, shame) in an unconscious mental opposition.

However, soon in the process of therapy, it became possible for R. to survive the agonizing state of impasse relevant to this choice, and to integrate the image of herself as a "devoted and loving woman" and the sexual experiences that arose in her. From the "ashes of the burning pain of tragedy" a woman "entitled to love" was born. Currently, R. is dating a young man she likes, and they are going to get married. It took us about 2 years to go through this difficult path from the "fascination" with the breath of death of an almost obsessive nature to the restoration of the vitality of life.

The presented therapeutic vignette illustrates the process of treating a client with acute and significantly expressed dangerous suicidal tendencies, the inner content of which was the process of acute grief blocked in its course.

Nevertheless, the model of psychological assistance to people in a suicidal crisis, proposed in the article, turns out to be effective also in other cases with a different phenomenological picture.