Working with severe suicidal clients

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velveteenrabbit

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For those working in the field long-term (especially inpatient clinicians), what has your personal journey been like working with severe/suicidal patients? Especially the long-term clients who relapse, are re-hospitalized?

What's the stress been like? How has this carried over/ affected your personal life? What're some thoughts/ things you know now that you wish you had known starting off in this career path?

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I'm not a long-term clinician or anything, just a grad student. Anyway, one student in our practicum class a while ago presented on an article (Responding to Clinicians After Loss of a Patient to Suicide -- Eric M. Plakun, MD, and Jane G. Tillman, PhD, 2005) regarding impacts of suicide on mental health providers as well as some personal accounts of clinicians' experiences and coping after having a client who committed suicide. Doesn't really answer any of your questions, but could serve as some interesting reading.
 
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I would very much be interested in hearing everyone's responses on this topic.
 
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I'm a student but recently came across this Linehan quote that stirred me up a little bit

"When I teach my graduate students - who work with complex, difficult-to-treat individuals at high risk for suicide - I always remind them they can choose whether to look out for themselves or to look out for their clients, but they cannot always do both. If they want to look out for themselves at a possible cost to their clients, I remind them that they are in the wrong profession."

This is kind of the mindset in our training clinic too for those who work with high risk clients. Which I guess just reinforces that is not the field for me, because I am willing to make compromises for my clients, but I'm not willing to be on call 24/7 on my cell phone, or put myself in such a stressful position that it is interfering with my life. I feel like it is extremely difficult to balance being available but not overly involved with clients, and not stressing yourself out too much/making yourself responsible for their life with keeping them "safe." I'm sure this is something that you need a lot of experience to even come close to mastering. I would be interested in hearing others' thoughts as well!
 
I have been dealing with suicidal patients since my first practicum. It can be very stressful and I have had a patient who completed suucide while in my care. They had just been discharged from a hospital and referred to me for outpatient follow up. He had about ten of the biggest risk factors. I have had many more patients who were suicidal that credit me with helping save their lives. The reality is that we are often dealing with life or death issues and solid training and supervision gives us the tools to help. The one positive about suicidality is that everyone thinks they can do our job much of the time, but when it gets to this point they turn to us and recognize that psychologists tend to have the best skill set for helping with this. Also, when it comes to suicide we have to work at overcoming our own natural anxieties about it and train ourselves to go into the fire when everyone else is going the other way.
 
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The reality is that we are often dealing with life or death issues and solid training and supervision gives us the tools to help. The one positive about suicidality is that everyone thinks they can do our job much of the time, but when it gets to this point they turn to us and recognize that psychologists tend to have the best skill set for helping with this. Also, when it comes to suicide we have to work at overcoming our own natural anxieties about it and train ourselves to go into the fire when everyone else is going the other way.
Doing acute care work can be stressful and also very gratifying. The key is to never do it alone: work with a team. Linehan's model is an excellent framework and a core element is that you are always supported by a consulting team. And you also need to be someone who can accept loss and that fact that we are not in control. Some clients will successfully suicide--on purpose or accidentally, so you need to be able to live with some grief and compassion for their right to choose. But helping clients through a long dark passage and to keep going can be very rewarding. It is also not for everyone and okay to say you can't.
 
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Doing acute care work can be stressful and also very gratifying. The key is to never do it alone: work with a team. Linehan's model is an excellent framework and a core element is that you are always supported by a consulting team. And you also need to be someone who can accept loss and that fact that we are not in control. Some clients will successfully suicide--on purpose or accidentally, so you need to be able to live with some grief and compassion for their right to choose. But helping clients through a long dark passage and to keep going can be very rewarding. It is also not for everyone and okay to say you can't.

I'm a student, but:

Yes, I think it's helpful to remember that, in the end, it's the client's behavior and you can't 100% prevent it. Additionally, I've also found that it's really important to be able to tolerate your own feelings of distress as a therapist without necessarily acting on those feelings if the action isn't therapeutically indicated.
 
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I'm a student, but:

Yes, I think it's helpful to remember that, in the end, it's the client's behavior and you can't 100% prevent it. Additionally, I've also found that it's really important to be able to tolerate your own feelings of distress as a therapist without necessarily acting on those feelings if the action isn't therapeutically indicated.
Yup. Distress tolerance is a good skill for us to have as well and all we can do is take reasonable steps to help. We have to be cautious about taking too much responsibility for our patients safety as that can just replicate other dynamics or maladaptive patterns from either our own family or the patient's family. That is why both treatments that I utilize for treating chronic suicidality recommend maintaining an overt and consistent therapeutic frame so that you are able to recognize and address the "pulls" to deviate from that.
 
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