Suicidality in Therapy: Why Those Most in Need Often Get the Least Support

Suicide is a loaded issue, even within the therapy community. Sulome Anderson's article in The Atlantic, "How Patient Suicide Affects Psychiatrists" addresses numerous issues therapists struggle with. Anderson invokes this issue of the undesirable therapy patient in a very personal way. The author’s friend, Margaret, had numerous suicide attempts, self-harming behaviors, and was constantly in and out of psychiatric hospitals. Because of her great needs and the fact that she is so high-risk, her therapist said she could no longer work with her and she is struggling to find a new one.

This is a precarious situation in more ways than one. On the one hand, many therapists are reluctant to take on someone like Margaret because of the risk. Margaret is in a place where she is full of hopelessness and pain and sees death as the only potential relief. Many therapists find the time and energy needed to help Margaret overcome these feelings very daunting. There is also a lot of pressure when someone is so severely depressed and suicidal to get them out of that place and quick so they can be safe. Additionally, there is liability risk and a fear of lawsuit if something were to happen to her. Anderson does a thoughtfully highlights past trauma as another piece of the reluctance-- some therapists have lost a patient to suicide and that has been traumatic and taken a toll on them.

Yet this leaves therapy patients like Margaret who are most in need with very few options. Furthermore, it continually sends a message that they are difficult, that their problems are overwhelming to others, and that they are broken. The impact of this message is immeasurable and surely has an impact on that person's self worth and their ability to get better. There is no clear or easy solution but there are resources that would be a better fit and help to minimize future interruptions in treatment.

For one, folks who are so actively suicidal may need a great deal of intensive treatment that takes them away from their regular day to day life for some time.  That could look like attending a Partial Hospitalization Program, an intensive mental health, outpatient version of rehab.  Or it could look like individual and group therapy on a frequent basis.  Any therapist should be located in a hospital with easy access to psychiatrist and an ER.  Having a therapist connected to these services can help to minimize the trauma if and when inpatient hospitalization seems needed. When someone is in this much pain, it takes a network of support and the right type of services to facilitate healing. To build up someone's support system and feeling of meaning in the world, therapy should focus on creating connections and a network well beyond the therapy room.