The 3 Questions That Are Hardest to Ask as a Therapist

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Editor’s note: If you struggle with suicidal thoughts, the following post could be potentially triggering. You can contact the Crisis Text Line by texting “START” to 741-741.

“I just can’t take it anymore. The voices are getting stronger and I find that I can’t pull myself away. It’s getting too hard and I don’t want to live. Please help me.”

Sitting across from me, she speaks those words. Desperation, fear and sadness mix with the tears running down her face. I can’t help but notice her hands; they shake and she tries to control them. It’s the only thing she feels like she can still control.

She settles herself enough to answer a few questions; the questions I hate asking. There are usually three that I start with. Sometimes it’s easier just to go for it; they know what’s coming. 

“Are you thinking about hurting yourself — about killing yourself?”

“Do you have a plan?”

“Do you have means to do it?”

For some reason the last one is the hardest. I have been asking those questions for 15 years, and the answer to the third question feels so final. If they are confident enough in their plan to have a means to carry it out, we are really close to losing them. 

On any given day, this conversation is taking place. It may be happening in a counselor’s office, a classroom, with a therapist, pastor or a friend. We are lucky if it is taking place — that means there is hope. It’s the ones who don’t talk about it that we lose. Those who have meticulously answered all three of those questions on their own. We lost them before they even left us.

According to the Centers for Disease Control and Prevention (CDC), there were 42,773 suicides reported in 2014, making suicide the 10th leading cause of death for Americans. In that year, someone in the U.S. died by suicide every 12.3 minutes on average.

There is a direct correlation between teen depression and suicide. The CDC reports that for youth between the ages of 10 and 24, suicide is the third leading cause of death. It results in approximately 4,600 lives lost each year. The top three methods used in suicides of young people include firearm (45%), suffocation (40%), and poisoning (8%).

Death from suicide is only part of the problem. More young people survive attempts than actually die. A nationwide survey of youth in grades 9 to 12 in public and private schools in the U.S. found that 16% of students reported seriously considering suicide. 13% reported creating a plan, and 8% reported trying to take their own life in the previous year. 

There was one morning in particular that I remember the most. It was winter, so the faint sign of light in my office was coming from a small lamp. I had just arrived at work and saw the shadow of someone sitting in one of my chairs. I wasn’t expecting anyone this early, so I found myself a bit apprehensive about what to expect. 

Sitting in the dark, was the one student I worried about the most. He was the one I thought about when I went home at night; wondering if I would see him the next day. His head was down, and his hands were trembling. Tears escaped his eyes as he looked up at me. His voice was quiet, but serious as he spoke to me. “I almost did it last night.”

I found myself wanting to say something; start asking the questions and going through my list of what to do, but I stopped and just listened. “I was sitting in my room with the gun. It was loaded. I had it in my mouth and my finger on the trigger and then I heard it — my mom. She had just come home and called out my name. I stopped.”

Even writing this now, so many years later, I ache for him. His pain, desperation, isolation, hopelessness and helplessness, was too much; killing himself was the only option he felt he had. I always think about the interruption that night. His mom calling out his name — that defining moment in her life. The moment that saved his life.

Time.

Time is what we talk about with youth. Many of them report an urge to kill themselves that sometimes lasts a short time. If they can get through it, they do not complete suicide. If they do not have access to end their life, they wake up the next day. If someone happens to interrupt them, they can get help before they feel the urge again. If they have a life line — someone to reach out to, we see them at school. 

There is no empty chair in a classroom. 

Trust.

Identifying one person they can go to. One person they can trust to be vulnerable with; to open up and share their thoughts with. This is what we desperately hope for in the fight to save their life. 

Connections.

Human connection is a powerful thing. When it seems there is no one who understands, a hand reaching out is sometimes the one thing that begins the journey towards seeking help. 

I’m not sure if I have the answer for how to end this. I don’t even know if we will ever celebrate a decline in youth suicides. It seems as though the numbers are staggering. Any suicide is one too many. 

What I do know is that our kids need us. They need to see hope in our eyes and feel heard and accepted when they come to us. We need to help them understand that they are not alone in a world that feels so lonely. 

We need to tell them to keep holding on.

There is help.

There is hope.

They are not alone.

This is not how their story has to end.

If you or someone you know needs help, see our suicide prevention resources.

If you need support right now, call the Suicide Prevention Lifeline at 1-800-273-8255.

Follow this journey on FitMom.

The Mighty is asking the following: What’s the best thing a medical professional has said to you related to your (or a loved one’s) disability, disease or mental illness?  If you’d like to participate, please send a blog post to [email protected] Please include a photo for the piece, a photo of yourself and 1-2 sentence bio. Check out our Submit a Story page for more about our submission guidelines.

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A Letter to Myself, Almost One Year After My Father's Suicide

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Dear Self,

I know you are hurting. The date on the calendar is looming and soon you will mark the one year anniversary of your father’s suicide. The mere thought of it feels like a ton of bricks have been laid upon your chest. It is hard to breathe, and even harder to fathom that 365 days will have passed since your world was changed forever.

I know you are tired. It’s OK. You have been a full-time student of traumatic grief. You have sat in support groups and therapy, facing the hardships head on. It is called grief work for a reason. The stages of grief have been anything but linear and navigating through them is depleting. Some days all you want to do is lie in bed, and pull the covers over your head. It would be easier to hide from all of the emotions, the firsts, the triggers and the loss. But you don’t.

Every day you get up and out of bed. You put one foot in front of the other and you live your life. You take care of your precious family. You make room for love and laughter. You are present for those you care about. You turn to the things that bring you joy; taking a hike, reading a book, listening to music and the creative joy of cooking. It is time you give yourself credit for all of that.

You have not hidden from the truth of your loss, not once. You told all who would listen that your father died by suicide. You were honest about his struggles with depression and anxiety. Right from the start you were determined not to allow his death to be a source of shame or stigma. And you wrote the story of your grief, sharing it with loved ones and strangers alike. You have turned pain into purpose, even when you have done it through an abundance of tears.

I know one year later you look in the mirror and you feel as if your father’s death has aged you. And I know you are wondering why you are not further along in your healing. Sometimes you allow a perception of weakness to sneak in and take hold. You think to yourself:

If I was stronger, it wouldn’t still hurt this much

If I was stronger, I’d have found a better balance by now.

If I was stronger, my grief would be a thing of the past and I would once again feel whole.

But deep down you know that is not true.

You lost your father in a traumatic way and it has left a painful imprint on your soul. The news of his suicide forever altered you and you were shattered. One year later, I want you to see the strength it has taken to simply gather up the pieces. You are slowly putting them in new places, even if they are held there on little more than spit and a prayer. I want you to honor the emotional healing that you have worked so hard to attain, and that allows you to turn towards life and hope. Anyone can go to therapy, but you do the homework. The session begins and you allow your feelings to come spilling out. I want you to forget about that imaginary finish line on the road of grief and instead look back and see all of the things you could not do or feel in those early days of loss, that now you can. Those are victories and milestones to be savored.

I want you to think about that letter you wrote to the women who cared for you when you got that devastating phone call in Whole Foods that morning; and how it has traveled across social media, around the country and across the ocean. You helped to humanize the face of suicide loss and got people to talk about a subject that most never want to look at, lest it happen to them. Writing is healing for you, but you must see that your writing has helped to bring some healing to others. You have heard from survivors of suicide loss, survivors of suicide attempts and those living with mental illness and something you said allowed them to feel less alone. And in turn their words reminded you of how many accompany you on this journey, strangers in every other way, but connected in this struggle.

You are a survivor of suicide loss. And survival takes strength, tenacity, courage and resilience. To survive is to carry the hardship that life has dealt you and to persevere, to strive to move forward. Survival is the opposite of defeat. So please don’t be defeated. One day, one moment, one breath at a time you are carrying this loss. And you continue to move through the valley of the shadow, striving towards life’s peaks. Some days your stride is certain & quick. Some days your legs feel weak and you inch along ever so slowly. And some days you take ten steps back and surrender to the sadness. But every day you get up and you keep going.

April 20, 2016 is coming. You will have endured a whole year of firsts without your father. You have honored his memory. You have learned to honor the grief and the loss. But you must also take the time to honor yourself and all of the growth that you have shown. Honor the brave survivor that you are. Let your scars be a testament to your strength and spirit. And keep on striving towards healing, one baby step at a time. You will get there. Look how far you’ve already come.

Deborah hugging her father
The last dance Deborah shared with her father.

If you or someone you know needs help, see our suicide prevention resources.

If you need support right now, call the Suicide Prevention Lifeline at 1-800-273-8255.

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I Wasn't Able to Prevent My Dad's Suicide

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After losing someone to suicide you can find yourself combing through every moment of the past, questioning whether you missed the signs. Every memory holds new meaning. What if I would have paid more attention that day? What if I would have questioned their thinking or pointed out something that didn’t seem right? Would they still be here today? Questions like this often contribute to the overwhelming presence of guilt we feel in the aftermath of suicide. Problem with this thinking is, it leads to unrealistic expectations of self. We can’t go back. We can’t change the past. So, why do we hold on to these experiences, and why do we struggle to relieve ourselves from the weight of guilt?

I wanted to use this post to talk about my own experience with guilt and how I was able to release the guilt I felt after losing my dad to suicide. It is a part of my story that isn’t always easy to talk about. While it is the part of the story I struggled the most to let go of, it is also the part of my story that brought the most self reflection. When people ask me, “Did you see the signs?” I struggle with my response. Yes, I saw the signs. They were right in front of me, and I wasn’t able to prevent my dad’s suicide.

The night before Thanksgiving 2011, my sister called to tell me she was worried about our dad. “He just seems off, and I am scared he is going to do something to himself.” So, I called him. I remember sitting in the car for over an hour talking to him about how he was feeling. He showed signs then, but I just didn’t think they were severe. I thought they were fleeting thoughts, ones so many people have but don’t act on. Fast forward to Christmas day, the last day I saw my dad, and there you will find every sign you need. He told me he was feeling suicidal. He brought my late grandmother’s large standing jewelry box for my sister and me to go through. He was detached, uninterested in any gift he received. He wasn’t himself. I remember when he left that day, the tears in his eyes as he hugged me tightly and waved good bye until we both could no longer see each other. An act I haven’t done since childhood. I turned to my husband and sister and said, “I don’t think I am going to see him again” and broke down. My sister and I planned an intervention of sorts. We would bring him to my sister’s house, find him a new therapist, get him the help he needed. I would stay in Colorado longer than planned and do what we needed to do for my dad. The following day we talked to my dad. He was back. The lively, happy, fun-loving man was back. He told us he was out shopping and felt “so much better.” The signs disappeared. The next day, I got on a plane back to Chicago. Four hours after getting home I received a call from my hysterical sister telling me my dad took his life. In an instant my whole life changed.

I think we often set unrealistic expectations for ourselves. We forget about one important element within our tragedy: free will. We can’t take away or alter someone else’s free will. I think this is an important reminder as we struggle with guilt after a suicide. I struggled for a long time with this concept. I saw the signs, I could have done something, I could have changed the ending to this story. Those are just a few of the things I told myself after my dad’s death. As I write this post I find myself questioning it all over again. It is hard not to. However, it just isn’t productive. Could have I done more? Maybe. Would it have changed the outcome? Maybe. That’s just it. Maybe. We can’t go back, we can’t change what has already occurred. That is what I had to come to terms with and accept. Not easy, but an essential part of my own journey. I had to make the choice. I can go on living in this world where I hate myself for not doing more. Or, I can accept what is. The reality of the situation is that my dad is gone, and there is nothing I can do to change that. The only thing I can change and have changed is my own way of thinking and my own way of living. I made the choice to forgive myself and decided I would live a life my dad would be proud of. A life that he potentially was never able to have.

A good friend always says, “You have a fire of regret and a fire of hope for the future. You choose which one to feed.”

Follow this journey on Our Side of Suicide.

If you or someone you know needs help, see our suicide prevention resources.

If you need support right now, call the Suicide Prevention Lifeline at 1-800-273-8255.

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The Cause of Death Is Never Simply 'Suicide'

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I’ve been on this journey of mental health self-awareness for about 18 months now. In that time, I’ve learned a great deal about myself and the people I’ve chosen to surround myself with. I’ve been a little slow to learn about things like my disease and suicide, however.

Don’t get me wrong, I knew the numbers and statistics. I know where to find the depressing data on youth and veteran suicides.

But my most recent epiphany? Nobody commits suicide. We may die by our own hands, but we do not kill ourselves. Something pushes us to do it. If a cancer patient denies treatment, their cause of death is not listed as self-inflicted. It’s listed as cancer. It is no different with mental illness or bullying.

I have friends who have attempted to end their lives. I stand by the assertion it wasn’t a desire to end life that drove them to it. It was their disease, the voices in their head that pushed them to end their suffering, to see no other way out.

“He committed suicide” creates the false narrative that the victim was actively engaged in the decision. Often, the reality is the complete opposite. We are barely engaged in life, let alone our actions and behaviors. Trapped in the prison of our minds, the disease that locks us away takes over many of our day-to-day operations.

Imagine going through every day expending all of your effort to appear functional and coherent during shallow exercises. Business meetings, water cooler talk with coworkers and customers, grocery shopping and the morning commute are all things we manage in a barely conscious state. We have become actors portraying a life while not actively living it.

None of those scenarios require feelings or true engagement. Fast forward a few hours to family time and we may seem coarse, disengaged, angry or distant. We’ve simply no energy left to maintain a facade that requires us to behave in a deeper and more meaningful way. Breaking out of our minds prison, even for those you love, isn’t an option. The disease does the talking and acting for us.

What about the kids, bullied for weeks, months or years on end? Do we blame them for having a hand in their own deaths? We shouldn’t. The failure wasn’t on them for not being strong enough to stand up against a daily torture.

Sitting here, drinking my tea and watching through the window at the birds coming and going from the new feeder on my deck, I am unable to think of an instance where the blame of suicide should fall to the victim.

No, suicide does not exist in my mind, and I will do my best to end the use of the term and how we use it. In an era when we are working to end victim blaming, it’s time to stop it in these instances as well. We can do better than we have, and I will take a stand, finally, for what I believe.

None of us exist in a bubble that keeps us from interacting with the outside world. Everything we do is the result of an interaction of factors, and assigning a death as simply a “suicide” implies a blame that doesn’t belong. We need to start talking about what really caused the death — it wasn’t me who wanted to pull the trigger that night a few years ago, it was the voice in my head created by my depression.

Until we find a way to reach out to more people and show them that ending one’s own life isn’t the selfish choice of a healthy mind, we’ll never make any headway. We need  a call to action, a group of us to stand up and say, “No more.”

Where does that leave us now? We live in a time unlike any other in history. Technology has us advancing as a species quickly and unpredictably. With that, words become common vernacular quickly while others fade into memory. If a few of us stand up and speak out, we can change the conversation. We can, over time, stop the use of a word that often means the opposite of what it intends, and reframe the conversation so it is clear that those who are victim to mental illness or bullying are not to blame. 

I will fight until the cause of death is never just “suicide,” and we look further.

Follow this journey at Shawn Henfling.

If you or someone you know needs help, see our suicide prevention resources.

If you need support right now, call the Suicide Prevention Lifeline at 1-800-273-8255.

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We Need to Start Talking About Suicide Without Shame

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Editor’s note: If you struggle with suicidal thoughts, the following post could be potentially triggering. You can contact the Crisis Text Line by texting “START” to 741-741.

Suicide. A single word, which invokes fear, shame, misunderstanding, anger, confusion and a stigma equaling the weight of the Titanic. It will make those you think are your closest allies go running so fast, it’s as if they are being chased by the burning flames of a rapidly spreading bush fire. The word is associated with selfishness, with weakness and with a lack of willpower. The reactions to the word run the gamut from “that’s ridiculous, who thinks about that” and “what is so wrong in your life,” to “how self-centered you are” and finally “I can’t deal with this.”

Suicide. The action generates feelings of grief, terror and trauma. It carries the misconception of irrationality, instability and egocentrism. It will cause your relations to judge you, hate you, love you and mourn you. It will leave them with questions that will remain unanswered for perpetuity, for the only true motivation for your action perished when your life flame extinguished.

What makes this word materialize from an assemblage of letters, to a culmination of ideations, to an objective, to a precise action of irreversible finality? Stigma. The topic of suicide is still taboo, disapproved and in some places, forbidden. One may be strong enough to disclose their diagnosed mental illnesses — borderline personality disorder, depression, anxiety, bipolar, just to name a few — however, when one reaches the absolute darkness of self-extermination, it is as if their tongues have been cut out, eliminating the capacity to  even verbalize the word. The fear in sharing the darkness of the ideas and emotions that run through the self-destructive mind is so immeasurable, that letting go of the rope that has kept you from falling seems effortless. The angst of judgment, the trepidation of rejection and the fear of hospitalization often making the ability to ask for help an insurmountable chore.

The stigmatization of the word itself has to end, in order to see any reduction in the number of actual actions. Very few wake up one morning and spontaneously choose to end their lives. Suicide is the complete and utter loss of hope, strength and desire to exist. The survivors you leave behind questioning why you left them, why you did not reach out for help or speak the words “I’m feeling suicidal,” yet the answers, for you, come as easily as flicking on a light switch. Fear and stigma. No one climbs a ladder from the first step to the top without the rungs in between. The same could be said for suicide. It starts at the bottom and slowly creeps up until it not only reaches the top; it jumps off and drags you with it.

What if the thoughts of suicide could be as openly discussed and accepted as the myriad of mental illnesses? What if someone could safely and honestly express those ideas and emotions with no fear of condemnation or repercussions, while still on the ladder’s lower rungs? Would it help decline the speed of the ascent or perhaps eliminate the need to reach the peril that lies atop at all. Could becoming educated, understanding and less judgmental of one single word effectively make a difference in a single life, or even in societal views? Is it possibly as straightforward and uncomplicated as that?

As a suicide survivor, I will answer the above questions from my perspective. Yes, it can be as simple as that. In some instances, the people on the top rung will jump off before you even notice they started to climb. Their ascent so rapid it leaves not even an indication of a footprint. They are silent, focused and prepared, their actions usually a success. The others climb at a slower pace, leaving behind traces of their emotions and intentions while screaming ever so quietly for help. They wish for someone to hear them and provide a sanctuary for that one deadly word. These are the people that could be helped if we reduced the outside noise in our lives and took a moment to focus on the silence. Listen carefully. Pay close attention as the cries for help are there, and truly hearing and finding them could not only be a preventative measure but actually save a life.

So if you are at the top and at risk of immediate of danger, hospitalization or intervention is a must. If you are at the bottom and feel yourself gradually and uncontrollably making that ascent, stop. Reach out. Scream it, shout it and write it. Express it without shame or fear of repercussions from the ignorant. Know that someone, somewhere is not only listening, but hears you. Know that as much as you feel it, you are never alone. Know that by reaching out, your voice can start a momentum so powerful it instills the same fearlessness in the masses.

Destigmatizing begins with you, right here, right now. After all, it is only a word.

If you or someone you know needs help, see our suicide prevention resources.

If you need support right now, call the Suicide Prevention Lifeline at 1-800-273-8255.

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Facebook Creates New Support Tool to Help People Who Are Suicidal

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Update Jun. 14: According to the New York Times, on Tuesday Facebook officially announced it introduced new suicide prevention tools that are now available globally. Facebook also said posts flagged as potential self-harm or suicide notes will be expedited and reviewed more quickly by community operations team members who are given special training.

People across the world can now flag a message as one that could raise concern about suicide or self-harm; those posts will then come to the attention of Facebook’s global community operations team, a group of hundreds of people around the world who monitor flagged posts 24 hours a day, seven days a week.

Posts flagged as potential self-harm notes are to be expedited and reviewed more quickly by the team members, who also examine posts that Facebook users have reported as objectionable. Community operations team members who evaluate potentially suicidal content are given special training, Facebook said.

start with a drop-down menu that lets people report posts, a feature that was previously available only to some English-speaking users.

Seeing a friend post a cry for help on Facebook can be scary — especially if you’re unsure of what to do. But now, instead of just reporting the post to Facebook and hoping for the best, Facebook has created a new suicide prevention support tool to help those who may be feeling suicidal.

The new tool aims to give friends and family more resources when they think a loved one needs help. Facebook partnered with the National Suicide Prevention Lifeline, Suicide Awareness Voices of Education and Forefront to develop the initiative.

“One of the best ways to prevent suicides is to promote caring connections between people,” John Draper, executive director of the National Suicide Prevention Lifeline, says in a video explaining the new tool. “With its newest initiative, we can leverage the Facebook community’s biggest asset to preventing suicide — and that is each other, and the support we can all provide to our friends in crisis.”

Here’s how it works:

When you see a friend’s post that seems concerning, you can click on the “click down” arrow, like you’re reporting any other content:

A Facebook post that reads: I can't do this anymore. Death is the only way to end the suffering. I love you all! The "click down" arrow is circled.

Then, select “report post.”

A Facebook post that reads: I can't do this anymore. Death is the only way to end the suffering. I love you all! Reporting options are visible.

When prompted to choose a reason for reporting, select, “I think it shouldn’t be on Facebook.”

Text box that reads Help Us Understand What's Happening. The options are It's annoying or not interesting, I think it shouldn't be on Facebook, and It's Spam. "I think it shouldn't be on Facebook" is selected.

Next, choose “It’s threatening, violent or suicidal.”

Text box with the options, It's rude, vulgar or uses bad language, It's sexually explicit, It's harassment or hate speech, It's threatening, violent or suicidal, something else. The option, it's threatening, violent or suicidal is selected.

Then, choose “suicidal content.”

Text box reads Choose a type. Options are Credible threat of violence, self-harm, suicidal content, graphic violence, theft or vandalism, drug use. Suicidal content is selected.

Now, a menu of support options will appear on your screen:

Text box reads, What can you do? Options are Offer help or support, Reach out to a friend, Chat with a trained helper, Call lifeline, and ask us to look at the post.

If your friend is in immediate danger, they suggest you call emergency services right away. If it’s not an emergency, your options are:

Offer help and support: This option lets you message the person directly, with suggested text in case you’re unsure of what to say. But, you can also write your own message.

Message that reads, "Hey Todd - your post really concerned me, and I'd like to help and support you if you'd be open to it."

Reach out to a friend: This option prompts you to message a mutual friend or a friend who lives in your loved one’s area.

Chat with a trained helper or Call lifeline: Both these options will bring you directly to the National Suicide Prevention Lifeline’s services, where you can either chat or talk to someone on the phone about how to best support your friend.

Ask us to look at the post: Facebook will look at the post and offer resources to the person in need. Facebook will not reveal who reported the post.

Once you’ve reported a post, the friend you’re concerned about will automatically receive a pop-up message with support options:

Text box with the options: Todd, can we support you? Talk with someone. Contact a support service. Get tips and support. Skip this.

“In the past, our focus has been on helping Facebook members report friends… so Facebook could get their friends the help they need,” said Draper. “This new approach is not just about reporting friends in a suicidal crisis, it’s about supporting them.”

Watch the full video explanation below: 

If you or someone you know needs help, see our suicide prevention resources.

If you need support right now, call the Suicide Prevention Lifeline at 1-800-273-8255.

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