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Suicide is preventable: The inadvertent implications of what we say.

Updated: Jan 2, 2023

Sometimes hurting people have a shame filter.

I saw my first big example of this about a year ago. Back then I used to end my first session saying, “Typically clients have some sort of improvement in about five-ish sessions. After that some clients continue meeting with me once a week, other clients decide they’ve had enough, and some clients decide to continue therapy every other week.”

I told clients this because I wanted them to know what to expect.

One very brave client, months into our therapy, told me that my opening line almost caused him to drop out, and by implication, was probably scaring off many other clients.

Improve after five sessions? He thought at the time, What if I don’t improve in five sessions? I’m not sure this can be fixed by then? What does it say about me if I’m not done in five sessions?

He spiraled under the pressure.

I told my wife this story and she said “Of course. I can totally see that [1].”

“But that’s not what I meant,” I said.

“No, but it’s what my brain does. As soon as you say five sessions the pressure is on.”

Once you see it you can’t unsee it.

Have you ever noticed how suicide prevention campaigns will say things like, “Suicide is preventable!” On the surface it sounds great. It’s meant to be empowering after all. “You don’t have to feel powerless. Something can be done. Suicide is preventable!”

But imagine my client. How would he take this?

He’d likely think well if someone dies on my watch it’s because I didn’t do enough. Suicide is preventable after all.

The pressure is on.

Seeing this can be a bit handicapping. Imagine having a shame lens and reading this post! Oh my gawd, I’ve got to watch everything I say! I don’t want to inadvertently shame clients!

I don’t have a magic answer. I can only tell you what I do. I label this dynamic, validate this dynamic, and state my intent.

An example of this might be, “So, you asked about how long this would take. Well, I’ll tell you, but I also realize this might put pressure on you (Labeling the dynamic). And if it does, that would make sense. I’m kinda giving you a way to compare yourself to others. That comparison might make you feel pressured (Validating the dynamic). My intent though is to just be transparent (State my intent).” This usually works to defuse the situation. I actually think it works too well. Since I’ve started using this skill clients say some version of, “man, why are you using kids gloves? Just say it.”

Which is actually what I want. After all, I'd rather them say that than hear what I say through a shame filter.


[1] No client information was revealed in this conversation with my wife. I merely stated the fact that my statement had nearly caused a client to consider terminating therapy.


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