Suicide and Schema Therapy
Jenny looks up at me... slightly teary... but now with a more determined, even steely look in her eye.
"Well, if I can't escape this pain ... then I guess I'll have to kill myself... there's no point being here..."
Most schema therapists will know what it's like to work with clients like Jenny who are at the end of their tether in trying to cope with their 'emotional pain'. Most of us don't escape living without some form of emotional pain, but for many clients, especially those with problems managing suicidal impulses, this emotional pain can feel more than they can tolerate.
Therapists can of course feel the weight of trying to help someone find a way through their (emotional) pain towards a life worth living. This week is Suicide Awareness Week, and it got me thinking about a question often asked at Schema Therapy training events...
What about Schema Therapy and Suicide?
Understanding such pain and the dynamics of disclosing suicidal ideation can be complex and varied from person to person. However, such behaviour can be interpreted through the schema mode lens. Clients like this, in referring to their 'pain', are referring to parts of themselves - modes - that hold the trauma and schemas that, when activated, are experienced as distressing and emotionally overwhelming - 'painful'.
When suicidal behaviours are present, it may be helpful for the Schema Therapist to consider one or more of the following modes involved in inciting the client to harm themselves.
Vulnerable Child > Helpless Surrenderer: At the centre of a suicidal "headspace" is the vulnerable child mode. Here, the client may feel a profound helplessness and hopelessness towards their pain and emotional suffering. “I can’t cope/ do anything”.
Vulnerable Child > Connection Seeker: A drive for connection-seeking drives the client towards seeking help and connection from others to distract or regulate the pain. The client's core need for attention and care is evident, but in this Mode, the client is unable to seek connection and support in healthy ways.
Punitive Inner Critic – So often driving the emotional pain alongside the vulnerable child the punitive critic kills off any remaining hope or energy for change “no-one could ever love you anyway…”
Angry Child Mode - here, the client feels a deep resentment and anger towards others around them and their predicament: "screw this life". Such deep frustration can increase risk, with the client spiralling towards impulsively acting on such notions.
Self-Soother Mode - tempts clients to act compulsively to distance themselves from the pain. It tends to often be more superficial in nature (e.g. non-suicidal self-injury, cutting, etc.) but can be dangerous in terms of the level of impulsivity.
The Detached Protector – A client in this Mode operates in an emotionally detached and numb way, fixating on the option of "ending it". They may take an extremely pragmatic and remote view of the circumstances at hand and numb the meaning and importance of intimate relationships of others around them.
Compliant Surrenderer - Clients who struggle with suicidal ideation coming from this Mode are always a concern. They may say, "I need to do this for my loved ones because I am such a burden". This kind of thing is always gut-wrenching to hear - that they feel their loved ones would be better off.
The difficulty with therapy is that we seek to lead our clients through their emotional pain. Our aims are to heal and assist them in getting their core emotional needs met. We may ultimately be teaching a better way to manage and regulate emotions - their pain. But this means getting them on board and convincing their coping modes to give therapy a shot. Ultimately, we have to balance the risk of 'going there' (in therapy) with the risk of not.
