What I have learned from DBT: Suicide

What I have learned about suicide from DBT is hard for me to portray with succinct phrases.  

The first lesson was that suicide must be off the negotiating table with the client.  With suicide as a legitimate option, it is very hard to move forward into building a life worth living.  

In looking at it scientifically, there is no evidence that suicide will make life any easier.  Common beliefs are that "all of my problems would be over if I were dead" and "my pain would stop if I killed myself."  Both lack evidence to support these claims.  Perhaps you could look at the dialectic, asking what would make life harder if you tried to kill yourself. 

The second lesson was that knowing the suicide and risk assessment protocols are essential, with both classmates and clients.  Knowing how to respond to these issues can save lives.  The questions can be awkward and seem like an attack, but I imagine that the benefit of helping the suicidal person get the care she needs outweighs the risk of awkwardness.

The third lesson is that mind-reading with sick people is not effective: "You only know until you ask" and are open to their point of view.  It can be harder with individuals with borderline personality disorder because masking emotions can be a part of how they regulate their emotions.  At times, the facial expressions reflect what the borderline individual wants you to see, like putting on a smile when you feel horrible and sad on the inside.  The internal state and the external expression may not always match, so it is important to probe and explore these emotions and emotional reactions.

I will look forward to adding to this list as I continue in my DBT training.  Until then, think about the lessons you've learned from working with suicidal individuals.  Let me know what you think!