Robert A. Neimeyer & Angela M. Pfeiffer
1. Superficial reassurance.
Example: “You are so young and have so much to live for, how can you be thinking of killing yourself?” or “Come on, things can’t be that bad.” This kind of response may cause suicidal persons to feel even more isolated and misunderstood. Make certain that your responses don’t come across as trivial or superficial.
2. Avoidance of strong feelings.
When faced with intense depression, grief, or fear, don’t retreat into professionalism, advice giving or passivity. Do not move into an analytical discussion of why they feel as they do. Do communicate empathy by putting expressed feelings into words: “With all the hurt you’ve been experiencing, it must be impossible to hold back all those tears.”
A statement like, “You can tell me; I’ve been trained to be objective,” may be intended to put a person at ease, but can come across as disinterest or hierarchical. Be empathetic.
4. Inadequate assessment of suicidal intent.
Example: “You say you are suicidal, but what’s really bothering you?” This response was most common among physicians and master level counselors, perhaps arising out of time pressures, personal theories, or discomfort with intense feelings. Find out what they’ve been thinking, for how long, specific plans, and previous attempts.
5. Failure to identify the precipitating event.
Ask about any recent key incidents or events: “It sounds like everything collapsed when your brother died three years ago, but what has happened recently to make you feel even worse? That dying is the only way out?”
In one study of counselor interaction with suicidal persons, 25% of the counselors took a passive stance: “Go on, I’m here to listen” or “Call me back some other time when you can talk more easily.” Early stages of suicide intervention need to be active, engaging, and empathetic, with the helper structuring the interaction.
7. Insufficient directness.
Example: “If you keep feeling suicidal, you can call me back.” At a minimum, a verbal “no suicide” contract should be obtained. Action must be direct:“Ok, we have an appointment set up for you, you have my phone number for tonight, and I will come by to see you tomorrow.”
8. Advice giving.
Examples: “Just ignore the person who’s bothering you” or “Try not to worry about it.” or “Remember, focus on the positive.” Establishing a personal connection is more important than giving advice. Concrete action steps are important, but after trust has been established.
9. Stereotypic responses.
During a crisis, attempts to use shortcuts can result in stereotypic assumptions. Example: “She’s a borderline, attention getting female.” Focus on the individuality of each person.
Anger and rejection is common during intense crisis. In the heat of the moment and the hurt of their circumstances, suicidal persons may lash out against the person trying to help them: “How can you ever help me? Have you ever tried to kill yourself before?” Don’t engage in power plays, quick witted sarcasms, or put downs. Do not become defensive and respond negatively to insults. Maintain a caring posture.