What would you say to a person on the roof? That is, if you were called out to a crisis scene, where a young woman sat on the roof of a tall building weeping and shouting that she would jump at any moment, what would you say to her?
This provocative question – What would you say to a person on the roof? – was the title of an article that appeared in the academic journal, Suicide and Life-Threatening Behavior. The authors presented what they called a suicide prevention text. The 36-paragraph text provides a script with statements intended to convey empathy and understanding of the suicidal person’s unbearable pain, while also challenging the person to consider other options.
As you read the following statements in the script, keep in mind that the helper is presumed to never have talked (or listened) to the person before:
First of all, let me say that I understand that you are now at the very limit of the human capacity for endurance…In your mind, the present suffering may be just the first step on the way to far greater suffering.
What I am trying to tell you is that I understand something about your despair. You didn’t get there out of laziness or neglect of possible solutions. I am sure that if you could only see any other way out, a glimmer of a solution, you would not want to die.
The experience you are going through shakes you to your very foundations. For many people, this was the turning-point in their lives. After such experience, most troubles may seem small in comparison. I am not saying that you will feel like this immediately. These things take time. However, I think that the worst is already behind you.
How Would You Listen?
Shortly after this article, along came another, titled, “How Would You Listen to a Person on the Roof?” by the late suicidologist Israel Orbach. This title captures beautifully the essence of helping suicidal people – listening, really listening.
Active listening involves:
Not trying to talk the person out of their thoughts or feelings.
Not professing to understand a story that is not yet known.
Not offering superficial reassurance.
Not giving advice.
The author Orbach argued that having a preconceived agenda, relying on presumptions of how the suicidal person feels, can exacerbate an already dangerous situation. The suicidal person may feel further alienated and misunderstood.
Years ago, when I first started working in the field of suicide intervention, I had to observe calls at a suicide hotline before I could work the phones myself. I listened as a man called and told the counselor that he wanted to die because he was worthless, a bad person.
Having talked with the man for fewer than five minutes, the counselor said, “No you’re not, you’re a good person.”
Certainly she had good intentions, but such a statement does not usually bring about a good result. It is likely that the caller felt misunderstood, unseen, lonely – shut down, even. The counselor’s lack of connection with the caller could have reinforced the caller’s conviction that he was alone in the world, that nobody cared to understand him, and that he should die.
Orbach recommends asking the person questions that invite him or her to discuss her unique pain – poignant, yet pithy, questions such as:
How did things get so hopeless?
What pain are you feeling from now?
What is your unbearable pain?
It makes sense, and it sounds deceptively simple: Listen. Ask questions that invite the person to say more. Hear the person’s story. Listen so well that when you repeat back to the person your understanding of why they want to die, they say something along the lines of, “Yes, yes, that’s it.”
If, even after the person has shared their story, you cannot say to yourself, “I can really understand why you want to die, even if I don’t agree or approve,” then you need to listen more.
Of course, listening alone is not enough. There is also the need to assess the person’s level of risk for suicide along the way. And, after you have truly heard and joined with the person, then comes the need to explore their ambivalence, to examine their reasons for living and dying, to tap into their hope, to challenge distorted thoughts, to engage in problem solving, to develop a safety plan, and to provide other aspects of psychotherapy. Those are topics for other posts, some not yet written.
© Copyright 2013 Stacey Freedenthal, PhD, LCSW, All rights Reserved. Written For: Speaking of Suicide
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