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Your ability to see and understand why they would end it, is the intervention and in someways a gift.
I am fairly existential and I believe death is part of life. So I lean into my own existential work and how I feel being in proximity with someone who is may be moving towards their own death.
Therapy is sacred space, hospice, and this part is hospice therapy is kind of the inner sanctum imo.
Self care is so important when you sit in and with suffering in particular with end of life. It can really impact you and it's very sticky.
Depending on your own beliefs, values etc can also play a role in transference.
Sounds like you are doing a beautiful job bearing witness.
Bingo, you hit it with this comment. I also use the existential tools I learned while working in hospice to help terminally suicidal clients cope. Straddling the line between liability and client self-determination is an endlessly difficult task. I hope OP has the space to practice robust self-care, this is intense and heavy work.
Compassionate care & being with them in their suffering is what I focus on. I try to conceptualize enduring SI as a chronic illness. I super appreciate ProjectLETS and their anti-carceral approach. I also use my personal therapy sessions for support when it gets hard. In session, I try to imagine a container big enough to hold the weight of their suffering for both of us. & for now, I’m holding this with you OP.
I also conceptualize SI as a flight response from life and try to notice the relief that clients experience when they can be candid with me, without worry about consequences. To be fully authentic in their pain, and their trust is a gift. It’s also helpful (for me and clients) to explore their perception of the difference between not wanting to live, and wanting to die.
Of course I am transparent about my ethical responsibilities and lean towards community care in place of hospitalization. I talk about being in therapy as a commitment to sticking around a while and use language like “I hope you stay for now”.
I just had a client that fits this description finally succumb to their illness. And that is how I see it. They have an illness that is often terminal. We just never know if it will be terminal or not. Not everyone's illness is compatible with life. It sucks but is true for so many. I did the best I could with that person and gave them the best care possible. Wasn't enough but not because I'm not enough. Their illness was terminal.
I have one on my caseload currently. I have thought on it quite a bit. Client is really working hard and trying to manage their illness. I am doing the same in supporting them, seeking frequent consultation with their other providers, researching new approaches as relevant and maintaining transparency with my client about my concern as well as ongoing collaboration so they are still in the driver seat of their treatment and their life. Regardless of outcome, my time with this client is a privilege for me on a professional level and more importantly, just as a human that values connection.
This is how my mother went. She needed life sustaining treatment but didn't want it, and we had to enforce her wishes because she could no longer communicate them herself in a way the medical staff could understand.
I have a twisted view that some might say. I believe the only thing in life we truly have control over is whether or not to end our life. Who am I to say someone shouldn’t ? Of course, I want to assist clients in overcoming/ managing symptoms, finding meaning and purpose, embracing the fucking absurdity of life. I lean on Camus and/ or Frankl a lot in my work with many clients. And of course I don’t want to lose any client by suicide whether in treatment or after leaving services. I know it would devastate me. Yet, I also believe is people’s right to determine their own life. If they are suffering and tried everything, who am I to force more suffering on them.
i don’t find this twisted, i find it pragmatic and existential. i’ve worked with some folks who have endured severe, embedded and often inter-generational trauma. it is my job to support, to reduce harm, to shine light on hope and just to be present, but i think there are some things that folks live through that can seem (and feel) worse to them than death and i’m not here to judge that.
I primarily work with grief, and along with that chronic illness. I have a client that I can see going down that path due to a progressive, painful, and rare illness. The vast majority of people with this illness die by suicide and personally I do not find euthanasia morally repugnant, but I still try to focus on future goals, positive protective factors, and support systems when I check in about how they’re feeling about their prognosis.
I have only seen one case that I think I genuinely felt this way. It wasn’t really a worry of if or a crisis, it was just a feeling of “eventually”. A coworker of mine in inpatient had a patient with extremely treatment resistant depression. I worked with them briefly when my colleague was on PTO or vacation.
Meds, every therapy you could think of, inpatient, acute, IOP and nothing helped for years. Lovely family and support system. Not even a slight improvement in almost a decade by the time we saw them. Just an endless cycle of depressive episodes to acute then stabilizing and back home. This client could count on their hand the number of days they don’t remember being extremely depressed in the past two years. Not even happy, just enough energy to get through the day and enjoy something.
It was heartbreaking watching them try to hold on for family and just be completely miserable and exhausted 24/7. Kids were always so upset not being able to understand why they were never happy. It’s been a few years since I’ve seen them and always wondered if they made it.
Sometimes mental illness is terminal. We wouldn't expect oncologists to never lose patients despite their best efforts. Why is mental health different?
Suicide doesn’t mean a wasted life and it doesn’t mean that all the care and effort and treatment “didn’t work”.
Honestly, feeling the eventuality of someone dying by suicide or overdose is not that impactful to me. It generally means that the person I’m seeing has a pretty advanced form of whatever condition they experience (like stage 4 cancer vs stage 1). It is really important to me to hold hope for everyone I see because man, people are fucking resilient and shock me everyday with perseverance. But if it’s helpful for you, sometimes there is a way to strike a balance of hope and almost palliative care?
Sitting with either what you or the client feel is inevitable (which, stigma aside, it sure is!) without dismissing it, talking about the struggle, the pain, and how living in spite of it all is working or not working. What are those pieces of joy, what might be a slight improvement, what sucked a little less because of XYZ, what was funny, how peaceful sleep was- etc. The treatment goal doesn’t have to be remission.
A Bob Dylan line popped into my head as soon as i started reading this thread: “He who is not busy being born is busy dying.”
Restated a bit more wordily by Robert Bolt:
> Death comes for us all; even at our birth-- even at our birth, death does but stand aside a little. And every day he looks towards us and muses somewhat to himself whether that day or the next he will draw nigh.
I work with suicidal people, and while i take my role in supporting their safety very seriously, I also understand that death comes for us all. Suicide is just one way to die among many. I will do everything in my power to treat the underlying illness of which their suicidality is a symptom. I will follow the law and my ethical code by mandating hospitalization when necessary to ensure their safety. And when people kill themselves it is tragic and heartbreaking. However people die of other illnesses too and their medical team understands that some of their patients will die of the disease they are trying to treat.
The increased numbers of suicides is alarming and should be a signal that something in our society is very very wrong. Suicidal individuals should be helped to stay alive in any way they can receive.
And.
Suicide has existed among humans for centuries. It is an extremely human phenomena. We will never eliminate it completely, nor should we try. It is the ultimate exercise of control over one’s own destiny in the face of absurdity.
One must imagine Sisyphus happy.
The leading cause of death in this world is birth. How and when someone leaves this world is not up to me. I do the best with what I have, and the rest is up to universe.
As a practitioner: Former hospice SW and current grief/trauma therapist here. I can relate & it's hard. The thought of someone taking their own life while they still have potential is heartbreaking. I take great pride in the interventions I've taken part in and the additional days/months/years I've helped enable for more folks than my younger self could ever imagine.
I've had suicidal clients thank me for understanding and reflect that it's enabled them to keep living better while they have time. It's also bought time. I've lost hospice patients, but none due to suicide. I think it's because the autonomy and lack of pressure to act.
That said, folks have the right not to live in excruciating pain (physical or emotional).
The best I can do is help someone process how to make the most of their time here and potentially extend it. If they choose to end it, hopefully, they'll complete their living goals, truly take it until they cannot anymore, and minimize the trauma to others in their methods.
As a human and an individual who has experienced SI daily since I was young: I won't put this weight on a therapist (regarding suicidality). I'd discuss values and goals for enjoying my time... but ultimately, I anticipate that I'll take the reigns and call it when that time comes. My anticipation is that I'll be old (90s based on genetics), but illness or societal deterioration could dictate otherwise. This is a choice thing, and I would hope the intentional and well rationalized decision would mitigate the damage.
I really relate to this as a therapist. I work in a family practice setting where most of my colleagues are in the medical field. Those colleagues have their own struggle with coping with suicide and the possibility of it, understandably. I struggle with the thought that even with all the intervention and support, humans still have autonomy and choice. I too do everything in my power to support that individual and intervene with emergency options when needed but yet deep down have this lingering thought of who am I to determine someone has to continue on when I’m not the one living their life? I think it’s the hardest aspect of working in this field. I try to hold onto the many positive outcomes I’ve encountered where people have come out of crisis stabilized or found purpose that allowed them to keep going. You’re doing great work, it is clear how much your care about your clients!
I have a client who I feel this about and just want to say your post and all the responses are making me feel so seen. I try to remember that I can do everything I can but ultimately they have the autonomy to make decisions for themself. But it’s very tough
This is such an incredible topic. I have a lot of experience with this concept in a number of ways, and ultimately all I can really say is that it's a unique situation in which concerning yourself with it is not a feasible ideation. You can be for someone as a professional, a friend, family, or as a partner (probably the most challenging to cope with if you expect a life together). Ultimately, the choice to take one's own life is something that anyone else around them has an obscenely limited amount of control over. Be there as you can be there, don't make a thing of it for them. Hopefully it changes, but maybe it won't. Maybe it'll take decades longer than either of you would have guessed. At the end of the day, it's not your responsibility because you simply and literally cannot be responsible for it. People who have no interest whatsoever in dying die every day. Our lives and deaths are not something we only have so much control over. You can love a person, you can support a person, and that's about all you can really do.
Thank you for asking this question, and for your consideration, concern, and approach for the situation.
I work primarily with cancer patients, many of whom are terminal (but not always). One of the patients was my first crisis intervention call. I know it was the right thing to do and I do believe the patient would have died by suicide without intervention. Their phone was misplaced while they were hospitalized and I believe they became homeless, which was a definite possibility without hospitalization anyway. I primarily work through phone calls and never could contact them again. I could see some notes through EHR that at least they were still alive, but it would not surprise me if they weren't. I have a strong suspicion that eventually the depression will become terminal. At some point, you just have to know you did your best, and like other commenters have said, the disease can become terminal and you just don't have more treatment options. It sounds like you are doing great work. ❤️
Not a therapist (BS in psych, MSW in progress) but I worked as an RC in an inpatient detox for teenagers with SUD and often find myself feeling the same way. Statistically, a fair amount of the clients that I formed such valuable connections with will eventually die either by suicide or overdose, or end up in prison. It’s fucked.
I can relate. A lot, actually. One of my clients has been in and out of the hospital and psychiatric holds for well over a year. Multiple attempts in one year and countless more times when they seriously considered attempting suicide again. Everyone on their treatment team and in their family is doing their best to keep them safe. I don't want them to die and I'm not sure if anyone can keep them safe forever. They have so much trauma in their past and self-harm, sport addiction and an active eating disorder have been their only coping skills for most of their life and despite trying to teach them other skills, those are still their main ones and they still say they have no trauma history. Everyone on the treatment team is running out of ideas and the hospital will no longer keep them for more than 48 hours as their stays there don't seem to help other than keeping them safe for a period of time.
As a therapist I believe we do so much work with people healing from trauma whether it be physical or sexual abuse where people at some point in time did not have agency over their own bodies. I believe that in the end we support and validate that people have agency over their own bodies and are empowered to direct their own lives. I think it’s also a western physical disease model concept that it’s ok to end your life early while dealing with a physical disease (ALS, advanced cancers etc.) but if we cannot see the physical pain or illness, we instantly believe that someone ending their life is wrong including schizophrenia and other mental disorders that are excruciating daily. We support and provide resources, coping strategies and a space to voice feelings without judgement as well as safety plans and risk assessments but in the end, you either believe someone has agency over their own lives and bodies or or you don’t. Whether it’s “right” or “wrong” is not a judgement we can make on our own observation of the situation from the outside. It’s also a cultural norm to view death as always negative when many cultures including native cultures view it as a passing to the other side and is not always a negative or sad concept but an inevitable part of life. Sometimes we see this working with family members of someone who passed after long battles with physical or mental challenges where a part of the family member is relieved that the person’s suffering has ended and feel shame for their feelings not aligning with the dominant cultural viewpoint of death. When coming up against these concepts while working with people I try to be conscious of cultural humility, personal agency and the notion that “all behavior makes sense in context”
I have a client who has struggled with suicidal ideations for years. I think we should always have hope for our chronic SI clients. Their life could be changed in a positive direction by a new treatment or changed life circumstance (such as living in a new country and culture). I will never give up on this client and I encourage them to never give up, as well.
Please followed the sidebar rules. r/therapists is a place for therapists and mental health professionals to discuss their profession among each other. If you **ARE NOT A THERAPIST and are asking for advice this not the place for you**. Your post will be removed in short order. Please try one of the reddit communities such as r/TalkTherapy, r/askatherapist, r/SuicideWatch that are set up for this. This community is ONLY for therapists, and for them to discuss their profession away from clients. **If you are a first year student, not in a graduate program, or are thinking of becoming a therapist, this is not the place to ask questions**. Your post will be removed in short order. To save us a job, you are welcome to delete this post yourself. Please see the PINNED STUDENT THREAD at the top of the community and ask in there. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/therapists) if you have any questions or concerns.*
Your ability to see and understand why they would end it, is the intervention and in someways a gift. I am fairly existential and I believe death is part of life. So I lean into my own existential work and how I feel being in proximity with someone who is may be moving towards their own death. Therapy is sacred space, hospice, and this part is hospice therapy is kind of the inner sanctum imo. Self care is so important when you sit in and with suffering in particular with end of life. It can really impact you and it's very sticky. Depending on your own beliefs, values etc can also play a role in transference. Sounds like you are doing a beautiful job bearing witness.
Bingo, you hit it with this comment. I also use the existential tools I learned while working in hospice to help terminally suicidal clients cope. Straddling the line between liability and client self-determination is an endlessly difficult task. I hope OP has the space to practice robust self-care, this is intense and heavy work.
It's beautiful, but heavy, heavy work. Self compassion is such a vital necessity to our own recovery from bearing witness in my experience.
This is such a beautiful reply. Thank you for this perspective
Compassionate care & being with them in their suffering is what I focus on. I try to conceptualize enduring SI as a chronic illness. I super appreciate ProjectLETS and their anti-carceral approach. I also use my personal therapy sessions for support when it gets hard. In session, I try to imagine a container big enough to hold the weight of their suffering for both of us. & for now, I’m holding this with you OP. I also conceptualize SI as a flight response from life and try to notice the relief that clients experience when they can be candid with me, without worry about consequences. To be fully authentic in their pain, and their trust is a gift. It’s also helpful (for me and clients) to explore their perception of the difference between not wanting to live, and wanting to die. Of course I am transparent about my ethical responsibilities and lean towards community care in place of hospitalization. I talk about being in therapy as a commitment to sticking around a while and use language like “I hope you stay for now”.
i love this, thanks for sharing your resources & perspective.
Project LETS is great
I just had a client that fits this description finally succumb to their illness. And that is how I see it. They have an illness that is often terminal. We just never know if it will be terminal or not. Not everyone's illness is compatible with life. It sucks but is true for so many. I did the best I could with that person and gave them the best care possible. Wasn't enough but not because I'm not enough. Their illness was terminal.
I'll always remember a supervisor saying, "For some people, mental illness is a terminal condition."
And we help them manage while they are able to.
This is so well put. Thank you for this.
I have one on my caseload currently. I have thought on it quite a bit. Client is really working hard and trying to manage their illness. I am doing the same in supporting them, seeking frequent consultation with their other providers, researching new approaches as relevant and maintaining transparency with my client about my concern as well as ongoing collaboration so they are still in the driver seat of their treatment and their life. Regardless of outcome, my time with this client is a privilege for me on a professional level and more importantly, just as a human that values connection.
[удалено]
This is how my mother went. She needed life sustaining treatment but didn't want it, and we had to enforce her wishes because she could no longer communicate them herself in a way the medical staff could understand.
I have a twisted view that some might say. I believe the only thing in life we truly have control over is whether or not to end our life. Who am I to say someone shouldn’t ? Of course, I want to assist clients in overcoming/ managing symptoms, finding meaning and purpose, embracing the fucking absurdity of life. I lean on Camus and/ or Frankl a lot in my work with many clients. And of course I don’t want to lose any client by suicide whether in treatment or after leaving services. I know it would devastate me. Yet, I also believe is people’s right to determine their own life. If they are suffering and tried everything, who am I to force more suffering on them.
i don’t find this twisted, i find it pragmatic and existential. i’ve worked with some folks who have endured severe, embedded and often inter-generational trauma. it is my job to support, to reduce harm, to shine light on hope and just to be present, but i think there are some things that folks live through that can seem (and feel) worse to them than death and i’m not here to judge that.
Right from your second sentence I thought of Frankl
I primarily work with grief, and along with that chronic illness. I have a client that I can see going down that path due to a progressive, painful, and rare illness. The vast majority of people with this illness die by suicide and personally I do not find euthanasia morally repugnant, but I still try to focus on future goals, positive protective factors, and support systems when I check in about how they’re feeling about their prognosis.
I have only seen one case that I think I genuinely felt this way. It wasn’t really a worry of if or a crisis, it was just a feeling of “eventually”. A coworker of mine in inpatient had a patient with extremely treatment resistant depression. I worked with them briefly when my colleague was on PTO or vacation. Meds, every therapy you could think of, inpatient, acute, IOP and nothing helped for years. Lovely family and support system. Not even a slight improvement in almost a decade by the time we saw them. Just an endless cycle of depressive episodes to acute then stabilizing and back home. This client could count on their hand the number of days they don’t remember being extremely depressed in the past two years. Not even happy, just enough energy to get through the day and enjoy something. It was heartbreaking watching them try to hold on for family and just be completely miserable and exhausted 24/7. Kids were always so upset not being able to understand why they were never happy. It’s been a few years since I’ve seen them and always wondered if they made it.
Damn. That's bleak
It was hard to see as a therapist, I couldn’t imagine how it felt for them day to day.
Sometimes mental illness is terminal. We wouldn't expect oncologists to never lose patients despite their best efforts. Why is mental health different?
That's such an interesting outlook. Thanks
Suicide doesn’t mean a wasted life and it doesn’t mean that all the care and effort and treatment “didn’t work”. Honestly, feeling the eventuality of someone dying by suicide or overdose is not that impactful to me. It generally means that the person I’m seeing has a pretty advanced form of whatever condition they experience (like stage 4 cancer vs stage 1). It is really important to me to hold hope for everyone I see because man, people are fucking resilient and shock me everyday with perseverance. But if it’s helpful for you, sometimes there is a way to strike a balance of hope and almost palliative care? Sitting with either what you or the client feel is inevitable (which, stigma aside, it sure is!) without dismissing it, talking about the struggle, the pain, and how living in spite of it all is working or not working. What are those pieces of joy, what might be a slight improvement, what sucked a little less because of XYZ, what was funny, how peaceful sleep was- etc. The treatment goal doesn’t have to be remission.
A Bob Dylan line popped into my head as soon as i started reading this thread: “He who is not busy being born is busy dying.” Restated a bit more wordily by Robert Bolt: > Death comes for us all; even at our birth-- even at our birth, death does but stand aside a little. And every day he looks towards us and muses somewhat to himself whether that day or the next he will draw nigh. I work with suicidal people, and while i take my role in supporting their safety very seriously, I also understand that death comes for us all. Suicide is just one way to die among many. I will do everything in my power to treat the underlying illness of which their suicidality is a symptom. I will follow the law and my ethical code by mandating hospitalization when necessary to ensure their safety. And when people kill themselves it is tragic and heartbreaking. However people die of other illnesses too and their medical team understands that some of their patients will die of the disease they are trying to treat. The increased numbers of suicides is alarming and should be a signal that something in our society is very very wrong. Suicidal individuals should be helped to stay alive in any way they can receive. And. Suicide has existed among humans for centuries. It is an extremely human phenomena. We will never eliminate it completely, nor should we try. It is the ultimate exercise of control over one’s own destiny in the face of absurdity. One must imagine Sisyphus happy.
The leading cause of death in this world is birth. How and when someone leaves this world is not up to me. I do the best with what I have, and the rest is up to universe.
As a practitioner: Former hospice SW and current grief/trauma therapist here. I can relate & it's hard. The thought of someone taking their own life while they still have potential is heartbreaking. I take great pride in the interventions I've taken part in and the additional days/months/years I've helped enable for more folks than my younger self could ever imagine. I've had suicidal clients thank me for understanding and reflect that it's enabled them to keep living better while they have time. It's also bought time. I've lost hospice patients, but none due to suicide. I think it's because the autonomy and lack of pressure to act. That said, folks have the right not to live in excruciating pain (physical or emotional). The best I can do is help someone process how to make the most of their time here and potentially extend it. If they choose to end it, hopefully, they'll complete their living goals, truly take it until they cannot anymore, and minimize the trauma to others in their methods. As a human and an individual who has experienced SI daily since I was young: I won't put this weight on a therapist (regarding suicidality). I'd discuss values and goals for enjoying my time... but ultimately, I anticipate that I'll take the reigns and call it when that time comes. My anticipation is that I'll be old (90s based on genetics), but illness or societal deterioration could dictate otherwise. This is a choice thing, and I would hope the intentional and well rationalized decision would mitigate the damage.
I really relate to this as a therapist. I work in a family practice setting where most of my colleagues are in the medical field. Those colleagues have their own struggle with coping with suicide and the possibility of it, understandably. I struggle with the thought that even with all the intervention and support, humans still have autonomy and choice. I too do everything in my power to support that individual and intervene with emergency options when needed but yet deep down have this lingering thought of who am I to determine someone has to continue on when I’m not the one living their life? I think it’s the hardest aspect of working in this field. I try to hold onto the many positive outcomes I’ve encountered where people have come out of crisis stabilized or found purpose that allowed them to keep going. You’re doing great work, it is clear how much your care about your clients!
I have a client who I feel this about and just want to say your post and all the responses are making me feel so seen. I try to remember that I can do everything I can but ultimately they have the autonomy to make decisions for themself. But it’s very tough
This is such an incredible topic. I have a lot of experience with this concept in a number of ways, and ultimately all I can really say is that it's a unique situation in which concerning yourself with it is not a feasible ideation. You can be for someone as a professional, a friend, family, or as a partner (probably the most challenging to cope with if you expect a life together). Ultimately, the choice to take one's own life is something that anyone else around them has an obscenely limited amount of control over. Be there as you can be there, don't make a thing of it for them. Hopefully it changes, but maybe it won't. Maybe it'll take decades longer than either of you would have guessed. At the end of the day, it's not your responsibility because you simply and literally cannot be responsible for it. People who have no interest whatsoever in dying die every day. Our lives and deaths are not something we only have so much control over. You can love a person, you can support a person, and that's about all you can really do. Thank you for asking this question, and for your consideration, concern, and approach for the situation.
I work primarily with cancer patients, many of whom are terminal (but not always). One of the patients was my first crisis intervention call. I know it was the right thing to do and I do believe the patient would have died by suicide without intervention. Their phone was misplaced while they were hospitalized and I believe they became homeless, which was a definite possibility without hospitalization anyway. I primarily work through phone calls and never could contact them again. I could see some notes through EHR that at least they were still alive, but it would not surprise me if they weren't. I have a strong suspicion that eventually the depression will become terminal. At some point, you just have to know you did your best, and like other commenters have said, the disease can become terminal and you just don't have more treatment options. It sounds like you are doing great work. ❤️
Not a therapist (BS in psych, MSW in progress) but I worked as an RC in an inpatient detox for teenagers with SUD and often find myself feeling the same way. Statistically, a fair amount of the clients that I formed such valuable connections with will eventually die either by suicide or overdose, or end up in prison. It’s fucked.
I can relate. A lot, actually. One of my clients has been in and out of the hospital and psychiatric holds for well over a year. Multiple attempts in one year and countless more times when they seriously considered attempting suicide again. Everyone on their treatment team and in their family is doing their best to keep them safe. I don't want them to die and I'm not sure if anyone can keep them safe forever. They have so much trauma in their past and self-harm, sport addiction and an active eating disorder have been their only coping skills for most of their life and despite trying to teach them other skills, those are still their main ones and they still say they have no trauma history. Everyone on the treatment team is running out of ideas and the hospital will no longer keep them for more than 48 hours as their stays there don't seem to help other than keeping them safe for a period of time.
As a therapist I believe we do so much work with people healing from trauma whether it be physical or sexual abuse where people at some point in time did not have agency over their own bodies. I believe that in the end we support and validate that people have agency over their own bodies and are empowered to direct their own lives. I think it’s also a western physical disease model concept that it’s ok to end your life early while dealing with a physical disease (ALS, advanced cancers etc.) but if we cannot see the physical pain or illness, we instantly believe that someone ending their life is wrong including schizophrenia and other mental disorders that are excruciating daily. We support and provide resources, coping strategies and a space to voice feelings without judgement as well as safety plans and risk assessments but in the end, you either believe someone has agency over their own lives and bodies or or you don’t. Whether it’s “right” or “wrong” is not a judgement we can make on our own observation of the situation from the outside. It’s also a cultural norm to view death as always negative when many cultures including native cultures view it as a passing to the other side and is not always a negative or sad concept but an inevitable part of life. Sometimes we see this working with family members of someone who passed after long battles with physical or mental challenges where a part of the family member is relieved that the person’s suffering has ended and feel shame for their feelings not aligning with the dominant cultural viewpoint of death. When coming up against these concepts while working with people I try to be conscious of cultural humility, personal agency and the notion that “all behavior makes sense in context”
I have a client who has struggled with suicidal ideations for years. I think we should always have hope for our chronic SI clients. Their life could be changed in a positive direction by a new treatment or changed life circumstance (such as living in a new country and culture). I will never give up on this client and I encourage them to never give up, as well.