Articles from prior issues of The Advocate

November/December 1998

Working with the Distressed Suicidal Client
Once the person decides to suicide, they feel a weight off their shoulders and seem happier
by Olivia Fralish, Alabama DDS

A SESSION ON WORKING WITH the distressed suicidal client was presented by Robert H. Arnio, Ph.D. Dr. Arnio used information from Edwin Shneidman’s Definition of Suicide. He defined suicide:

Currently in the western world, suicide is a conscious act of self-induced annihilation, best understood as a multidimensional malaise in a needful individual who defined an issue for which the suicide is perceived as the best solution.

He stated that 20-40 percent of people who commit suicide have no premorbid signs of depression. Dr. Arnio used the phrase “D SAD FACESSSS” to define the symptoms of major depression.

Demographics

Sleep changes Appetite changes Dysphoric Mood (or Ups and Downs)

Fatigue (early morning worsening)
Anhedonia (lack of pleasure in everything)
Concentration Encoding (memory)
Social withdrawal
Self Esteem
Sexual Interest problems
Suicidal spectrum (from running away to ending it all)

The common characteristics of suicide and the clinical rules in dealing with suicide are:

1. Stimulus - unendurable psychological pain. Clinical Rule - reduce level of suffering.

2. Stressor - Frustrated psychological needs Clinical rule - Address frustrated needs.

3. Purpose - To seek a solution. Clinical Rule-Help provide possibilities of other solutions to problems.

4. Goal-Cessation of Consciousness. Clinical Rule-Help reduce level of unbearable stress by talking or doing something for person. Indicate alternatives.

5. Emotion-Hopelessness, helplessness. Clinical Rule-Encourage some behavior that has an internal focus of control. Confront “fortune teller” error. Give transfusions of hope.

6. Internal attitude - ambivalence. Clinical note-Recognize the ambivalence as normal and transient. Play for time any way you can!!

7. Cognitive State-Constriction. Clinical Note-Widen the blinders and increase the number of options beyond some magical solution or being dead. Can you wait another day? Can you visit your daughter?

8. Interpersonal Act-Communication of intent. Clinical Rule-Be aware of the communication and discuss it. Involve others to confirm and intervene.

Dr. Arnio stated that once the person decides to suicide, they feel a weight off their shoulders and seem happier.

9. Action-Aggression. Clinical Note-Search for connections worth keeping (pet!) Block the Exit!!

10. Consistency-Life coping patterns. Clinical Note-Emphasize previous successful coping. Look to previous episodes of disturbance, capacity to endure psychological pain and tendency for constriction and dichotomous things with paradigms of aggression. Several therapeutic stratagems were listed by Dr. Arnio to deal with the client. Monitor their activities by having them call daily. Consult with others. Be active and show concern for individual. Involve significant others and make a written contract. The major point to remember in dealing with the suicidal client is to always give the suicidal person a realistic transfusion of hope until the intensity subsides enough to reduce the lethality to a tolerable, life-permitting level.