Using Targeted Strategies for Suicidality on a Hotline
By Molly R. Finkel, B.A.
The following blog was written by a research assistant who had been exposed to CBT in her job. She had recently attended the Depression and Suicidality workshop at the Beck Institute.
As a volunteer counselor on a hotline, I frequently help people who are in extreme distress and in states of elevated emotional intensity.
I often find myself using cognitive and behavioral strategies such as applying the cognitive model, testing hypotheses, evaluating the evidence or the helpfulness of a belief or behavior, restructuring dysfunctional thinking, and relaxation and mindfulness interventions.
On a recent hotline shift, I received a call from an acutely suicidal young woman who phoned while driving home from work. For weeks she had been having constant thoughts of crashing her car, and these thoughts continued as our conversation began. After agreeing to pull over and park, she told me about her previous suicide attempt several years before her recent sexual assault. She had not told anyone besides me that she had been ruminating about suicide and was adamant about not wanting to seek in-person therapy. I knew that this single anonymous phone call would most likely be my only contact with her.
So I instituted a strategy I had just learned: discussing her reasons for living.
First, I asked her if she would be willing to take some notes on her iPhone while we talked. When she agreed, I began to inquire about areas in her life that could be meaningful to her or could provide her with a reason for living. She began to mention important and loving family members. I asked her to describe each one to me. For example, she said her brother was caring and attentive, and that he would always listen to her. She also included her job as a preschool aide and her desire to travel in South America as reasons for living. As we developed this list, it was clear to both of us that she had many important reasons to stay alive. I could also tell, even over the phone, that she was beginning to believe that perhaps she could have a better life.
After discussing some of the positive aspects of her life (although she had difficulty perceiving these as positive due to intense hopelessness), she told me that she felt relieved to tell someone about her suicidal thoughts for the first time. I asked her if she would consider calling the hotline again to check in with a counselor (even though she might reach someone else) and she agreed to try—though she still wasn’t ready to seek face-to-face treatment. We also used problem-solving to strategize how she could get more sleep despite her busy work schedule (she had been severely sleep-deprived for weeks). And we brainstormed other possibilities for transportation when thoughts of crashing her car became too intense. She even thought of taking a ride-share home that night instead of driving.
Before our 50-minute call was over, I ran another idea by her. In the workshop, I had learned about making a “Hope Kit” or a digital “Hope Kit” through a smartphone app (Virtual HopeBox), which can be quite helpful for suicidal individuals at times of severe distress. I explained that she could download this special app on her phone and add meaningful photos of her best friend, her family, maybe pictures of the countries in South America she wanted to visit, and other keepsakes that could bring improve her mood. Once she understood the rationale for this intervention, she agreed to start collecting these photos on her phone and she committed to looking them over when she felt her worst.
I am so grateful to have attended the workshop at the Beck Institute before counseling this young woman. The skills I learned in those three days were truly invaluable to my work on the hotline and will continue to be to important for my work in the future.
CBT for Depression and Suicide
October 10-12, 2018