In my many years of teaching and training clinicians to work effectively with suicidal patients, a common question I have been asked is, “What if they say they have nothing to live for, how can I work with that?”
It is a great question, and one many mental health professionals struggle to answer. In my clinical practice, I have encountered many suicidal patients who say they have had no reasons for living. In response, I generally ask, gently and with great respect, “Why are you still alive? And why are you talking to me?”
Out of context, I understand that this may sound glib and provocative. But if done with genuine warmth and concern, invariably there are some things that keep them going because they are in fact still alive and talking to a mental health professional. In this line of discussion it is my intention to make them curious about this notion, with no judgement or coercion.
Again, this is not to be said lightly or with any hint of sarcasm; rather it is an honest and direct query that usually opens the door to my saying something like: “You may not know why you are still alive with nothing to live for, but you are, in fact, still alive. Something brought you here to see me…perhaps we should honor that part of you, to see if there is a way to somehow make your life livable. You have the rest of eternity to be dead; perhaps we should make a run at trying to see if we can save your life. What do you think?”
In my experience, this has been a pretty irresistible “pitch” to the suicidal people I have worked with over the years. It puts me in the position to propose 6-8 sessions of CAMS suicide-focused treatment. I invariably ask: “What do you have to lose? In my view, you have everything to gain and really nothing to lose; you will get to be dead one day, guaranteed.”
Through multiple randomized controlled clinical trials, CAMS has shown, for most suicidal people, there is a rapid reduction of suicidal ideation, along with decreases overall symptom distress, depression, and hopelessness in as few as 6-8 sessions. Additionally, this treatment has been shown to increase hope and improves clinical retention to care
The CAMS intervention is guided by four “pillars” which are very relevant to this line of discussion:
- empathy of the suicidal state,
- collaborating to see if there is way to save the life by targeting and treating the “drivers” that the patient says makes them suicidal,
- honesty and transparency at all times, and
- being focused on suicide as the singular emphasis of this treatment ultimately with the goal of pursuing a life worth living with purpose and meaning.
Beyond my own approach, I believe that all the evidence-based suicide-focused treatments supported by randomized controlled trials do essentially the same thing:
- They create a way of empathically connecting with the patient and their suicidal struggle with no blame, shame, or coercion.
- They teach the suicidal person to recognize when, how, and why they are getting into suicidal trouble (in effect becoming their own suicidologist).
- They then teach the patient what to do when they are getting into trouble (e.g., various coping skills such as re-regulating their emotions).
- They invariably instill hope and by the nature of the empathic clinical engagement and experience, there is a shared effort to create reasons for living and the pursuit of a life with purpose and meaning (i.e., reasons for living).
While working with suicidal patients who believe they have no reason to live is extremely challenging, relying on CAMS philosophy and the guidance of the framework is a proven way to effectively tackle this and other challenges, and better enables us to clinically help save lives.