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‘The new age of what therapy should be about’


Before regular contributor GC takes over today’s post, here’s an important development for anyone who’s had thoughts or actions of suicide.

The American Association of Suicidology, which launched this blog, has been around for decades and has divisions for research, clinicians, prevention, crisis centers and the bereaved. People with lived experience have had to slot themselves into one of these groups or float freely.

But last month at its national conference, the association agreed to create a special interest group for attempt survivors _ essentially giving us an organized voice there for the first time.

This means we continue our “coming out” from a long history of silence. It also means we have a stronger way to make change, both inside a national association that often sets the standard for similar groups around the world and on the public stage.

If you’re interested in being involved, or if you have ideas for projects this new group should consider, let us know. And now, here’s GC:

I was at Starbucks the other day, taking notes on a book called “Building a Therapeutic Alliance with Suicidal Patients.” This book is so powerful that you really need time and energy to digest it. The book describes how to go about being a better therapist to handle a suicidal person.

The most that suicidal patients want is to be heard, to have a voice. Konrad Michel, co-editor of the book, writes, “We could only have talked to a person who we knew would not be afraid of listening without judging. In a suicidal crisis we could never have trusted a person who would want to talk us out of it.”

There lies the problem. Many suicidal people feel too hopeless to think that talking with someone will help them, but if you are one of these people, I know that in reading this you are trying to find the answers you need to not commit suicide.

When you are contemplating suicide, there is not a whole lot out there to help you help yourself. But I’ve found a few useful approaches and want to share them here.

The Aeschi model (pronounced “eshi”) is a patient-oriented model, meaning that the patient has a say over treatment more than the clinician does. It takes away the clinician-as-expert model. What has been found is that the clinician-as-expert model doesn’t work, as patients can get frustrated over the “provider knows best” thinking. The patient feels he or she is not being heard and so retreats from treatment.

The Aeschi approach has the patient and provider working together to finding out what is at the heart of suicidality of the patient. The idea is to have the suicidal person in charge of treatment and have a voice _ a novel thing when so many clinicians think they know it all better than the patient.

I know that if my therapist had been in this know-it-all category, I probably would not be here, or I would be seeing another therapist. I believe that if there is a collaborative effort between the therapist and patient, there will be a higher success rate.

Another nice thing about the Aeschi model is that it can work for social workers, psychologists, psychiatrists, mental health workers, etc. It just takes a little courage to step out of the normal boundaries and put the patient first. To let the patient tell their story without being judgmental or critical. As Dr. David Jobes says, “This is unabashedly a suicide prevention approach and would never be endorsed as a viable or desirable treatment option.” But the goal is to work with the client to try and avoid a hospital stay and keep the outpatient treatment going.

They can try and prevent suicide by putting me in the hospital, but that is no guarantee that when I get out, I won’t kill myself. Even the hospital knows this. It’s like they are saying, “Well, we stopped the immediate threat of you killing yourself, but we hope that by keeping you here, we took that away. No, you are still suicidal? Well you can go home now”. I have had this happen to me time and time again. Maybe they just didn’t believe that suicidality can lasts more than three to 14 days.

After the patient tells their story following the Aeschi model, there is an openness that can be trusted. Once the clinician has a sympathetic ear that is open to whatever the patient is saying, the real journey begins. This is the new age of what therapy should be about.

I once had a therapist who was trying to cram dialectical behavioral therapy down my throat, saying it was the answer to my problem. I didn’t believe it for one second. One of the exercises had you write down all your negative thoughts for one day. At the end of the day, I had over 100 thoughts of wanting to hurt myself or kill myself. I felt like an asshole. How was this treatment supposed to help me feel better when I felt worse? I know of some success stories with this treatment, but it just isn’t for me. I’d rather tell my story to my therapist and see what we can make out of it to help me.

Through my research about psychological pain, I found that Edwin Schneidman, Ronald Holden and David Jobes helped me find the answers I was looking for and augment the bond with my therapist. In Jobes’ CAMS, or Collaborative Assessment and Managing Suicidality, and in the Aeschi model, I knew that I was onto something right.

I really believe that if more clinicians used Jobes’ assessment tool, the Suicide Status Form, there might be fewer suicides. Because initial intakes sometimes get lost in the health care system, Jobes wanted a way to track the outcome of suicidal cases. By developing the CAMS method, he has done just that. People who are suicidal don’t get lost in this system of treatment. There are many reasons why people leave treatment, but not “getting” that someone was suicidal was a big one.

What makes CAMS attractive to me is that it is a collaborative effort between patient and therapist. This is the basis of all therapies, but not every person in therapy will have it. When a patient is more involved in treatment, they better adhere to the plan.

I now have a therapist I am trying to teach suicidology to. She has learned the terminology fairly well. When I am in suicidal crisis, she runs down what are known as the press, perturbation and psychache. These three things are what Schneidman calls the suicidal model. If these three things reach a 5-5-5 on a scale of 1-5, suicide is imminent.

Unbearable pain cannot last more than a few days at a time before being acted upon. Bringing down the press _ the pressure of built-up emotions _ can lower suicide risk, as well as lowering the perturbation, or the feeling of needing to get something done now. Psychache is a little harder to lower, but I have found that having an understanding ear that is open to my thoughts of darkness, no matter how truly dark my thoughts get, is what helps lower my pain.

My therapist then uses Holden’s psychache scale to assess my psychological pain. I find it comforting because it means she is understanding what I am going through and how much of dire straits I am in. And sometimes when you put a number to pain, you try and work to lower that number so your pain is not so great.

Not all therapists will agree to use these assessment tools. My therapist was willing to work with me and use these assessments, even when I had no clue what I was doing. I had to do the legwork to get an understanding of them. If you have an open therapist, bringing up these assessments and how to use them might be useful. But not all therapists will do this because they don’t have time or the inclination to learn something new.

This year is my twentieth year with my psychiatrist. I knew from the beginning she was different than any other doctor I had ever met. She listened to me. She helped me take charge of my treatment. She didn’t tell me that this medication should be jammed down my throat in order to help me. In fact, it was the opposite. I was telling her what medications I wanted to be on. No doctor does that except for one who has a level of trust like we do.

She followed the Aeschi model to a T even before the concept was formally developed. There have been many hospitalizations, many trying times with me over the years, but she always was there to lend a sympathetic ear when I was at my worst. She always believed in me when I didn’t believe in myself. Even now, she often asks when am I going to write my book, my story. I tell her I am working on it, but it is slow progress.

3 Comments Join the Conversation

  1. Hi,
    As a suicide attempt survivor, I am particularly interested in women and suicide. I am a nurse so am familiar with clinical research, yet there seems to be a real void in looking deeply at women and suicide. So much information is on men (who of course complete more suicides due to use of more lethal methods) and teens, but women attempt 3X more than men. I DO NOT believe the old adage that “we are just seeking attention”. I am looking for your stories on suicide, exploring the thoughts and feelings leading up to your attempts and your recovery stories after attempts. I am committed to this personal research effort as I hope to gain some real insight and data on women and suicide and to publish this in the future. It is time to really bring into the light the issues that lead women to attempt suicide and to use that knowledge to promote more effective prevention interventions for women.


  2. As a survivor myself and working in EMS I am finding it hard to explain or camoflage my attempt scars that are on my arm, any suggestions? There definitely needs to be more data collected on suicide amongst women; I read an article on the CDC that stated an increase of 32% among women, as compared to 27% for men.


    • Angelina, I am retired firefighter /EMT and i too have scars. Don’t be embarrassed by them, use your scars as a teaching tool.what better way to make people understand than someone who has been through it themselves. The scars are your arm means you are strong, a survivor. Don’t ever be embarrassed by them. Just because you work in EMS doesnt mean your not human. If your co-workers ask about them, tell them it was your past and has nothing to do with your present, your scars don’t define you. I hope this helps you.


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