Uncovering the Pain Beneath the Suicidal Thought

Mar 10, 2017

“May you have warm words on a cold evening,
A full moon on a dark night,
And a smooth road all the way to your door.”

Irish Blessing

Uncovering the Pain Beneath the Suicidal Thought

TISA Description of the Problem: Suicide is generally not so much a desire for death, as a positive state to be achieved, as it is a belief that only death can relieve one of the incessant pain that one is experiencing. In this sense the acutely suicidal client often sees no hope for relief other than death. If they could find relief from their pain, death would no longer be as appealing. In the following intriguing clinical interviewing tip, Kelly Norman, ACSW describes an interviewing technique that can help clients share the underlying pain that is driving their suicidal intent.

Tip: I frequently find that the following question uncovers important information in a sensitive fashion:

“You know, I talk to a lot of people who think about suicide, and they always say something like, ‘Kelly, it’s not that I want to die, it’s that I want _________?’ What would you put in the blank?”

I find that clients respond positively to this question, and it often opens a doorway to productive discussion of treatment focus.

TISA Follow-up: Kelly’s excellent question can also open the door to problem solving as well. Indeed, it may even open the door towards a new sense of hope as the clinician and client collaboratively explore problem solving and treatment planning regarding the patient’s core pains. When teaching clinical interviewing, I find it is valuable to repeatedly remind trainees of the importance of understanding the core pains beneath psychiatric symptoms, and Kelly’s interviewing tip is a concrete tool for doing so.

Tip provided by:

Kelly Norman, ACSW
University of Michigan
Psychiatric E. R. Services

TISA is a site dedicated to advancing the science and art
Of preventing suicide and teaching clinical interviewing