How Do You Use SFBT With Clients Struggling With Suicidal Thoughts?

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Today I’m going to answer a question that came in from someone named Kristin and Kristin wants to know how do you use Solution Focused Brief Therapy with clients who are struggling with suicidal thoughts and suicidality.

And I think this is a really important question. So I wanted to take some time to really go into it and address this point that Kristin is asking about. And I’m going to go back to the beginning of my career. When I first started applying Solution Focused Brief Therapy in my work, I was working at a community mental health agency in Fort worth, Texas. And I got really excited about doing Solution Focused work. And this was a psychiatric agency that was dedicated to working with children and families. And we had really intense problems come through there.

And we had people that were struggling with really serious issues, drug addiction, suicidality, axis ll diagnosis, like real serious things were happening there. And I can remember when I first started doing Solution Focused work, the clinical team, which was made up of about 12 different professionals, they thought I was being neglectful doing Solution Focused Brief Therapy. It seemed counter-intuitive to them.

How could you work with this population if you’re not focused on the problem? And at the time I was working at this agency, they were trying to shift to what they called doing all evidence-based work. This was in 2006, 2007, something like that. And evidence-based, the term evidence-based was kind of new at the time. And they were trying to move everything to doing evidence-based work.

And they took the entire clinical team and got us trained in something called trauma focused CBT. Now I’m not here to bash any type of therapy and all therapy is good. And all therapy must be applied and you have to learn how to do it. I get all of that. But trauma focused CBT made me really concerned because when I went through the training they talked about how we have to force the client to talk about their trauma experience.

Now being someone who’s had some trauma in my history, being someone who’s had some trauma in my past, I was really nervous about this. If you forced me to tell you about the traumatic things that I experienced, if you forced me to tell you about the traumatic things that I went through, it would not do good things for me. And right after we got that training within the next month, this agency had a crisis hotline, a suicide hotline, actually. And three times in the first month after we got that training, people called the suicide hotline from the parking lot of the agency after immediately experiencing a counseling session where they were forced to talk about their trauma.

But when I was doing Solution Focused Brief Therapy, I realized something really important. People come to therapy when they’re struggling with suicidal thoughts, because they’re like losing hope and in Solution Focused Brief Therapy we’re doing two really important things when we’re working with our clients.

Number one, we’re talking to them about their future wherein their desired outcome has become possible. And number two, we’re talking about important people in their lives that they would be experiencing that desired outcome with. You know, I’ve worked with clients for a really long time who had made attempts on their life. We’re thinking about making an attempt on their life. And I remember working with this one woman and she had made an attempt on her life and she was sent to a psychiatric hospital.

When she got out of the hospital, her husband asked her to see a therapist and she came to see me and I asked her what are your best hope from our talking. And she said, I just don’t have any hope. I’m really struggling. And I don’t trust myself anymore. I don’t know that I want to live. And I asked her, what problem was she hoping to solve?

And she told me about the pain and suffering and struggle that she lived with. And I said, suppose you up tomorrow and you found a way to solve that problem without the permanence of death. And she looked at me and she said, well, I guess I would wake up and just find a way to keep going. What would you notice as you kept going?

And she said, I would, I would have to learn to love life again. And suppose you started living life again. What would you notice? And that became the basis of the work. I saw that woman probably about six times over the course of a couple of months. And her turnaround was drastic. She contacted me several times over the years to let me know that life has been good.

And she thanked me for being able to ask her about how could you go about solving your pain and your struggling and your suffering without the permanence of death. So how do you work with clients who are struggling with suicidality? You have to be able to understand that Solution Focused Brief Therapy is an approach that brings hope language into each session and hope language helps clients when they’re struggling with hopelessness much more than talking to people about their pain and struggle.

If you would ask me to tell you about my trauma experience, it would cause me harm. But if you would ask the young Elliott Connie when I was really struggling in those ways, what do you hope to achieve? My ability to tell you what I wanted to be in my future would have helped me.

I know that because I had conversations with people at a really crucial, important time in my life, and they weren’t trained Solution Focused Brief Therapy, but there were people who loved me. And as a consequence of loving me, they asked me about the future that I wanted to create. And here I am living in that future far beyond what I thought I could achieve way back then.

And you have to believe in your client’s ability to hold a future. That will guide how you talk to them. I think very often we’re afraid that if we don’t focus on the problem, we’re neglecting the clients. But I actually think if you don’t focus on hope, you’re neglecting the clients. And I think that’s what Solution Focused Brief Therapy does best.

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