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’s a great question, and one that many mental health professionals struggle to answer. And while it can feel daunting to talk with your patients about something as big as their reasons for living, there are a few simple ways you can have more productive conversations with suicidal patients when they ask you something as blunt as, “What’s the point in living?”
You just need the tools and techniques to effectively engage in this fundamental conversation. Because once you address your core suicidal drivers — like hopelessness — you can pave the way for meaningful engagement from patients with the next stages of their suicide treatment and ongoing preventative care.
Here’s how to respond when your patients say they have no reasons for living, as well as a few simple, yet effective ways you can prepare yourself for more meaningful conversations with suicidal patients.
Reasons for Living: You are Still Here
In my clinical practice, I’ve 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 you ask these questions with genuine warmth and concern, invariably you will encourage your patients to engage with some of the things that have kept them going to get them here to this moment. You can do this.
Because the simple truth is that right now, at this moment, they are, in fact, still alive. And something is responsible for that. By definition, a suicidal patient in treatment is someone who wants to live. They are seeking help just by talking to a mental health professional; even if it’s about how hopeless things are. And that fact lets you ask direct questions like, “Why do you think you’re still alive?”
Again, none of these questions or responses are said lightly or with any hint of sarcasm; rather they’re an honest and direct question that usually opens the door to a meaningful conversation. I often follow up with something like this:
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?
Other examples of similar responses to “I have nothing to live for” include:
“It’s hard to see solutions when we are in distress.”
It’s important to acknowledge that stress, depression, and exhaustion can make anyone feel overwhelmed. It’s almost impossible to “find answers” to complex problems when things are in turmoil.
As Holocaust survivor Vitor Frankl wrote: “An abnormal reaction to an abnormal situation is normal behavior.”
“Something brought you here to see me…perhaps we should honor that part of you.”
Just being in the room, and being willing to talk, is incredible progress. That’s not a small thing. Acknowledge the courage implied by this seemingly simple act with your patients.
Life can always change. In fact, change is really the only thing you can count on. And that includes you. You deserve time for another chance. Time to change. As long as you’re here, there’s still hope to change and make things better. So, stay here. Nothing is decided yet.
How to Respond When Someone Says They Have No Reasons for Living
The point with these frank discussions isn’t to answer any of these questions directly, at least not immediately. My intention is to make patients curious about why they think they’re still here and talking with me, without any judgment or coercion.
In my experience, just having an honest conversation — even if it’s about hopelessness (often a major suicidal driver) — can be the perfect opening to “pitch” to the suicidal people I’ve worked with over the years.
During our discussions, 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.” It puts me in the position to propose 6 to 8 sessions of CAMS suicide-focused treatment.
And that’s when things start to improve.
Empathy & CAMS Interventions
CAMS is an evidence-based suicide treatment framework, that’s been shown through multiple randomized controlled clinical trials, to rapidly reduce suicidal ideation, along with decreases in overall symptom distress, depression, and hopelessness in as few as 6 to 8 sessions, for most people.
Additionally, this treatment has been shown to increase hope and improve clinical retention to care. With CAMS, suicidal patients stay in treatment longer, reduce more of the “drivers” that lead to suicidal thoughts, and report feeling more “hopeful.”
In essence, CAMS helps more people find more reasons to live, and it does so through intervention guided by four “pillars” which are very relevant to this line of discussion:
- Empathy. Treatment always begins from a place of empathy for people in a suicidal state.
- Collaboration. Always show that you’re there to work together to find a way to save someone’s life by targeting and treating the “drivers” that the patient says makes them suicidal.
- Honesty. No treatment works without honest and transparent communication at all times.
- Purposeful. The ultimate goal of suicide treatment is to pursue a life worth living with purpose and meaning.
Giving Patients the Tools They Need to Find Their Own Reasons for Living
Beyond my own approach to this essential conversation with patients, I believe that all successful evidence-based suicide-focused treatments supported by randomized controlled trials do essentially the same thing:
- Empathize. Create a way of connecting with the patient and their suicidal struggle with no blame, shame, or coercion.
- Awareness. Teach the suicidal person to recognize when, how, and why they are getting into suicidal trouble (in effect becoming their own suicidologist).
- Educate. Provide patients with the resources and techniques they need when they get into trouble (e.g., various coping skills such as re-regulating their emotions).
- Empower. Instill hope through the nature of empathic clinical engagement and experience in a shared effort to create reasons for living and the pursuit of a life with purpose and meaning (i.e., reasons for living).
Working with suicidal patients who believe they have no reason to live can be extremely challenging. But relying on CAMS philosophy and the guidance of the evidence-based treatment framework is a proven way to effectively tackle this and other challenges, and better enables us to clinically help save lives.
Learn more about how you can become CAMS Trained and Certified to provide the best evidence-based suicide treatement so you can have better conversation with your patients and ultimately facilitate better outcomes for everyone.