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The experience of learning to work with people who are feeling suicidal

There’s not much out there about what it is like to be an early career psychologist. There are books aimed at this demographic well worth a read (e.g. The Making of a Therapist, Letters to a Young Therapist), but they’ve all been written by people towards the end of their careers. I haven’t really found any birds-eye view accounts of what it is like to begin witnessing, learning and knowing things about this profession for the first time, or about the process of navigating all the personal and professional changes that all these firsts bring. The “Life as an Early Career Psychologist” section of this blog was inspired by this gap. This week’s post explores a very important issue for any early career psychologist: the experience of learning to support people who are suicidal. Given the topic, this post does mention suicide so if you feel it may be distressing for you, I encourage you to skip this one.

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“You should be a doctor” the other kids would say to me. Then I’d picture myself, scalpel poised, in the middle of surgery. Ugh!! It was never the blood and gore or years of study that put me off medicine. It was the fact that if I made one wrong move someone might die. Ultimately, I decided to become a psychologist… Because that required no degree of responsibility or that I work with people to help them stay alive, I say with tongue firmly in cheek!

My first experience with suicidality happened as an undergraduate psychology student on a work experience placement, well before any formal training to help with supporting people feeling suicidal. I would be lying through my teeth if I said that that experience had not at all anxiety provoking! Thankfully, my first instinct was to ask myself what do I need to do to keep this person safe? And so I made sure to seek support from the staff overseeing me who had the training that I had lacked.

Things were different when I began my formal postgraduate training to become a psychologist. By this time I had been taught about evidence based practices for supporting people who were feeling suicidal. And so, the next time I encountered someone contemplating suicide, my initial reactions were different, this time I thought about both the meaning of the disclosure and how best to respond. E.g. I am so glad this person has felt comfortable enough to tell me they are feeling suicidal. Am I doing everything I possibly can to get this person the support they need to help them stay safe?

While it is vital to understand the process of what to do when someone discloses suicidal thinking, it’s quite another thing fluently translating this knowledge into action to best support the individual in front of you. Hence, why psychologists are heavily supervised as they find their feet in this arena. Part of this process is about learning how you respond in these situations. I’d been worried I might become anxious and forget what to ask when faced with my first client who was feeling suicidal. I remember bringing these concerns to supervision and, as a result, I learned what I needed to do to remain calm and methodical.

Developing confidence in my approach to asking about suicidal thoughts and feelings didn’t happen overnight. There was just so much to consider. How should I go about assessing suicidality, especially for people who find suicidal thoughts, urges and behaviour difficult to talk about?  How do you go about weighing up what supports to offer and when?  This process got less clunky with time and practice and, as my knowledge of available support services and processes expanded.

My first experiences calling crisis lines and supporting people to present to hospital still stand out clearly though. In the moment I just did what I needed to do to help people keep themselves safe. At the end of the day though, I’d feel wiped out. So looking after myself in these high pressure situations was also a skill to be learned.  How could I balance my case-load and other responsibilities while responding to crises? What things did I need to do to prevent burnout? What did I need to do to look after myself when someone died by suicide? It was a lot of trial and error figuring out the best way to respond to these situations, and it looks different for everyone. You can’t truly know what you need and what works for you until you experience it firsthand but self-reflection and making educated guesses help.

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Developing all of these skills is an ongoing process. I’ve never felt, and will never feel, like I’ve 100% found my feet in supporting people feeling suicidal, or with any other aspect of my work as a psychologist. I’d be deeply concerned if I did feel that way, because that kind of thinking breeds complacency which can be dangerous. In my eyes, when you stop questioning your practice, you stop being the most effective psychologist you can be.

This continual learning and growth as a psychologist is what makes this job so challenging and so rewarding. And I suspect, that this challenge and growth is all the more amplified for those of us in the early years of our career. Not only are we coming to grips with the nuts and bolts of what to do in the face of great complexity, but we are learning about how we cope in often extreme situations, and how these experiences shape us personally and professionally.  I have noticed phenomenal changes myself in my first six months as a qualified psychologist both in my therapeutic approach, clinical reasoning and, in my perspective on life. During this time I’ve faced some incredibly difficult situations that have challenged me on every level. At the same time they have helped me to solidify why I do what I do; why I go about it the way that I do and, to learn about myself and what I need, to be able to do this work.

The one constant in my path as an early career psychologist, especially working with people who are suicidal has been hope. No matter the difficulties I face in doing this work, or the challenges the people I support are facing, I hold the hope that it will get better for them, that change is possible and, that what each of us does, however small, matters. Ultimately, I think that’s what allows me to work in this field, knowing that the challenges are more than worth it.

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Filed under A day in the life, Early career