STEPS TO PREVENT SUICIDE

Steps and Procedures to Prevent Suicide and Heal Depression

and Verbalizing Your Inner Dialogue College of Mental Health Counselling http://www.collegemhc.com 1-250-590-2882 email collegemhc@gmail.com

Daniel Keeran, MSW Numbered steps to assess risk and prevent suicide are listed, and detailed cognitive approaches within a psychodynamic framework are described for helping people with depression.

Steps To Prevent Suicide

By Daniel Keeran, MSW, RSW The College of Mental Health Counseling at www.collegemhc.com urges the general public to learn and distribute these steps to prevent the suicide of friends and family members.

Please print or distribute this report throughout the internet and send it to all your contacts and friends.

This procedure is adapted by permission from Effective Counseling Skills written by Daniel Keeran, MSW, for counselors and for the general public found here http://www.amazon.com/Effective-Counseling-Skills-therapeuticstatements/dp/1442177993 Just as CPR has been promoted to save lives, it is vital that the general public knows how to recognize suicide risk and prevent suicide. Here are the steps: 1. Notice if the person appears quiet and withdrawn, oversleeps, has crying episodes, has loss of appetite and energy, appears dishevelled, the gaze is downward, the voice tone is flat, consistently negative comments, irritability, or says things like, "Life's not worth living," or "I hate my life," etc.

2. Ask: "How would you rate your mood right now on a scale of zero to ten with zero meaning life's not worth living and ten meaning life is great?"

3. If the person rates the mood as 5 or under, ask: "Have you had any thoughts of suicide or of harming yourself?" * 4. If the person indicates yes, go to the next step. If the person says, "I don't know," hear this as a "yes" to the question in #3.

5. Ask: "Have you thought about how you might end your life?" If the person says yes, the risk is increased.

6. Ask: "What have you thought about as how you might do it?" If the means is ineffective or non-lethal, such as cutting wrists, risk is lower. If the means is lethal such as using a gun or jumping from a bridge, etc., risk is higher.

7. Regardless of the means, ask: "Can we agree together that if you have thoughts of killing yourself, you will speak to me personally (not my voice mail) before carrying out a plan to harm yourself?"

8. If the person says "no" or "I don't know," to the question in #7, say: "What I am hearing is that you are in a lot of pain right now and thinking of ending your life, so I am wanting you to go to the emergency room right now and get some help to feel better right away. Will you go? I will make sure you get there safely. Is there a family member or someone I can call to go with you?" Or tell the person you will go with them yourself.

9. Arrange for the person to be accompanied to the emergency room, and call ahead to tell emergency staff you are coming.

10. If the person refuses, then ask the person to wait there with someone while you call police in another room to report that the person has threatened suicide with lethal means. Ask the police to come and accompany the person to the emergency room. *Note: If the person rates the mood as 6 or over, after feeling consistently depressed, and he now reports life is great (perhaps smiling), the risk may be increased because he has decided to end his life and has made all arrangements.

More practical counseling skills are available through online courses at http://www.collegemhc.com

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Counseling for Depression All rights reserved. Daniel Keeran, MSW, RSW Daniel Keeran, MSW, has been a professional counselor and therapist for over 30 years. He has provided counseling and training to thousands of professionals and the public through his private practice, seminars, and training courses.

For deeper understanding and healing childhood experiences affecting adult life and relationships with self and others, see the reader-friendly http://www.amazon.com/Effective-Counseling-Skills-therapeuticstatements/dp/1442177993 Depression can be caused by chemical changes in the body, physical illness, and different types of loss. Very often, depression and anxiety are the result of self-defeating life patterns forming unhealthy neural pathways that can be healed by incorporating caring self-talk and by supporting self-worth and assertiveness. We tend to do to ourselves and to others that which was done to us in childhood. Now as adults we must give to ourselves all the healthy things we needed from healthy parents. Here are some things to do to change the inner-dialogue foundations of depression and anxiety: Step 1. Write down the negative things you think about yourself, others, and your circumstances.

This activity will bring to your conscious awareness the negative thinking and self-talk that is common to many kinds of depression and anxiety. The negative and self-critical self-talk demoralizes the ego and manifests as feeling down, blue, sad, anxious, fearful and self-doubting. This low mood and anxiety then affect sleeping, eating, and low energy.

Common examples of negative self-talk are: I am incapable, I can't do it, I am unlovable, I am a failure, I failed again, I can't do it, No one wants to talk to me, No one cares about me, etc.

Step 2. Write down statements that are self-caring, nurturing, reassuring, supportive, and validating.

This exercise helps to identify the opposites of the negative self-talk: I can do it, I have strengths and abilities, I am caring and kind, I can get what I need and want, I deserve to be happy, I can succeed, I am just as important and valuable as anyone else, My pain is normal for what I have been through, etc.

Step 3. Write down negative things parents said or communicated to you when you were growing up.

Here you can write down what you thought parents felt about you by what they said or did such as: I wish you were never born, I do not like you, I do not care about you, I care about alcohol more than I care about you, I do not want to be around you, You are in the way, You are a bother, You should be seen but not heard, You can’t do that, You could have done better, You will never amount to anything, Don’t cry, etc.

Step 4. Write down things you needed or wanted parents to say to you as a child.

Here you can write the things you wanted or needed parents to say or do such as: I love you no matter what happens, I am so glad you are in my life, You can succeed, It's OK to cry when you're hurt, Everything will be OK, I felt the same as you sometimes, Imagine the possibilities. You are good at that, You are so helpful, You are so kind and caring, etc.

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Step 5. Write down what you would do or say if you saw another child being treated the way you were treated in #3.

If you heard someone say mean things to a child or slap a child, what would you say? Maybe you would say things like: You have no right to say that, Be nice to the child, The child needs your love, You need to support your child and be reassuring and caring and loving and affectionate, You need to be encouraging, etc.

Step 6. If you had all the positive things as a child that you needed from healthy parents, how do you imagine your life might be different today?

If your parents had said encouraging, caring, and supportive things to you as a child, how do you imagine your life might be different today? This step helps you formulate and create a vision for how your life can be different in a healthy way. Depression that comes from negative self-talk is a form of self-abandonment and self-abuse. The ultimate self-abuse and self-abandonment is self-harm and suicidal thinking. Conversely, hope, optimism, selfworth, and self-confidence form the basis of a stable mood and sense of security, safety, confidence, well-being, inner peace, personal power, and happiness.

Step 7. Now you must be for yourself all the things that you needed your parents to be for you: encouraging, nurturing, loving, caring, supportive, and reassuring.

This means you need to say to yourself and be for yourself all the positive things you needed from healthy parents.

If no one else can give you the caring that you need, who does that leave? Ultimately, you are the one who must care for you. So this means you must choose healthy people to be in your life, and you must be supportive of yourself and of that other healthy caring person you have chosen to be in your life. In this way you will be caring of yourself. Another important piece is to stand up for yourself and support yourself when you are treated badly by others.

Step 8. You must be assertive.

Stand up for yourself by saying things like: I don't like your tone, I deserve more respect than that, I deserve a raise in salary, I feel annoyed when...., etc. Take care of that little boy or girl who was abused and mistreated. That little boy or girl is still inside you and needs your protection. Be for yourself now what you needed then as a child. Will you stand up for him or her? When will you start?

The reader can acquire in-depth understanding and healing of childhood experiences affecting adult life and relationships, through a professional and confidential online course by the author at the College of Mental Health Counseling.

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Verbalizing Your Inner Dialogue A Cognitive Therapy Approach

by Daniel Keeran, MSW Victoria, BC, Canada This new generation psychological technology can improve conditions in persons with normal or average cognitive functioning. The cognitive mental functions give humans a particular advantage in terms of creative solution development.

Humans are constantly engaging in a process of internal dialogue across a variety of subject areas. Mental distress may be at least partly remedied by verbalizing, understanding, and perhaps modifying the internal dialogue.

For persons suffering from chronic dependency as well as anxiety, depression, and relationship issues, the following technique may be useful: 1. Invite the client to talk about what they know will improve their situation and what could worsen their situation.

2. Identify the parts of the self as the knowing confident self and the unknowing negative self.

3. Ask the client to verbalize each part of the self in response to the other (like Golum in Lord of the Rings).

4. Discuss ways to strengthen the knowing confident part of the self. This is also the observer will part of the self that is able to evaluate and modify the dialogue and draw a conclusion that works best.

The above technique can be easily learned, recorded through journaling, and repeated as a core process in therapy in order to make the inner dialogue most conscious and useful to the client. This psychological technology can improve conditions in persons with normal or average cognitive functioning.

The therapeutic use of inner dialogue can focus on a specific issue or area of mental distress and invite the client to have a conversation between the knowing confident part and the negative self-doubting or unhealthy part.

Here is an example of an exchange using this inner dialogue approach: Client: I feel so inadequate and lacking in self-confidence.

Counselor: So, part of you feels inadequate and lacking in self-confidence. I wonder if there is another part of you, a knowing part, even a small part, that feels adequate and confident about some things.

Client: Yes, there is. I moved out here on my own. I have a job and pay my rent (client smiles).

Counselor: You are very resourceful, capable, and independent. You can strengthen the positive, capable part of yourself just by talking more about it. Tell me more.

In this example the counselor further supports the knowing supportive self by adding to the dialogue. The counselor can also invite the client to verbalize the inner dialogue between the positive knowing part and the negative doubting part.

Counselor: Now I want you to speak your negative thoughts and also your positive thoughts.

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An exchange with someone suffering from depression Counselor: If there’s a conversation inside you about the depression, how does it go? Speak the conversation out loud.

Client: I am a failure. Nothing I do is good enough.

Counselor: So that is the negative part of you that feeds the depression. There is another part of you, even if it is a small part, that knows more and that can see the big picture. What does that part say?

Client: I have been resourceful, independent, and self-reliant. I pay my own rent, buy my own food, hold a job, moved far from home, and have travelled to Europe on my own.

Counselor: Yes. Which part of you feels better than the other part of you: the negative part or the other part?

Working with different personality disorders The beginning of the process is to identify the central issue defining the personality disorder.

Personality disorders are understood as a pattern of behaviour beginning in childhood, causing subjective distress and affecting social and occupational functioning.

The central issue of each disorder is actually the voice of the negative unhealthy self that is larger or stronger than the positive confident self. The goal of therapy is to strengthen the positive confident self and thereby relieve mental distress. This occurs by bringing the inner dialogue into conscious awareness and by focusing attention on the positive healthy confident self by talking about, elaborating, and affirming it.

The negative unhealthy self is significantly fed by negative uncaring experiences during childhood, usually the parental relationship. A way to strengthen the positive self is to say, “What would you say or do if what happened to you happened to your own child?” and “If you were the healthy caring adult or parent in the situation you describe, what would you say or do for you, the child?”

This approach utilizes the person’s own cognitive ability and sense of empathy to create and define healthy choices.

Another approach is to say, “If you had power to change any three things about your childhood or family when you were growing up, what would they be?” and, “I wonder if you can imagine how you might be different today in some ways if things had been different as you describe.”

This approach helps the person use memory to identify significant unresolved issues from childhood that require healing as well as visualization in order to identify and strengthen the positive healthy self. A key to moving forward is to hold two opposite realities simultaneously, the reality of loss of parental caring or other loss and also one’s power to make healthy choices in thought and action now: “Maybe you could not choose what happened in your childhood, and you can choose what you do now.”

Paranoid Personality Disorder Central issue: No one can be trusted because they want to harm me in some way.

Common associated major negative life experience: Loss of caring and closeness in the parental relationship during childhood. Possibly physical or verbal abuse.

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Therapeutic statements supporting the healthy self: What happened in your childhood or your past that you think has contributed most to your distrust of others?ood I wonder if part of you knows what someone would be like if they could be trusted.

How much is your fear and distrust based on what you think about other people? If you could allow yourself to think differently about others, how might your fear be affected?

How would you feel toward others if you could believe that people are generally sincere and wellintentioned?

Schizoid Personality Disorder Central issue: No one understands me because I am different. I prefer to be alone.

Common associated major negative life experience: Loss of parental caring.

Therapeutic statements supporting the healthy self: When in your life did you first start feeling alone or of being lonely?

What happened in your childhood or your past that you think has contributed most to your desire to be alone?

I wonder how you might be different today if there had been something different in your life when you were growing up.

What is your image of the person you want to be? Describe this person for me.

Part of you prefers to be alone.

Another part of you has a different need or different idea about people. What does that part say?

Schizotypal Personality Disorder Central issue: I have odd or delusional thoughts but I may not recognize them as odd or delusional; no one can be trusted. Possible abuse or abandonment experience in childhood.

Common associated major negative life experience: Loss of parental caring; lack of social skill development in childhood.

Therapeutic statements supporting the healthy self: Part of you thinks what you described (the odd thought) is true, and maybe you need to have those thoughts for now.

Part of you believes no one can be trusted, and everyone wants to harm you in some way.

There is another part of you that may have a different idea about your thoughts and knows what you need and who you can be. What does that part of you say?

Antisocial Personality Disorder Central issue: I am willing to violate the rights of others to serve my own profit and pleasure.

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Common associated major negative life experience: Lack of parental discipline during childhood; loss of parental caring Therapeutic statements supporting the healthy self: Part of you is use to surviving on your own, believes sometimes you must take advantage of other people to look after your own interest, and that the end justifies the means. Is that accurate?

There is another part of you that feels a little guilty about taking advantage of others to meet your own needs. What does that part of you say?

Borderline Personality Disorder Central issue: I don’t have control over my emotions. “I hate you, don’t leave me.” I am afraid of abandonment.

Common associated major negative life experience: Abuse and/or abandonment during childhood.

Therapeutic statements supporting the healthy self: Part of you hates people, feels emotionally negative toward others, and also fears being left alone by others. Who was the first important person in your life who hurt or left you?

Another part of you, perhaps a small part, believes that you are capable of being OK and surviving even if people leave you. What else does that part know? Maybe that you can manage your emotions, especially your anger?

Histrionic Personality Disorder Central issue: I need the attention and approval of others in order to be happy. My worth depends on my physical attractiveness.

Common associated major negative life experience: Childhood abuse and learning to believe that value is associated with sexuality or external appearance. Lack of training in healthy values and beliefs during childhood.

Therapeutic statements supporting the healthy self: Part of you believes your worth depends upon your sex appeal and physical appearance.

There is another wiser part, even if it is a small part of you, that knows more about you and your worth as a person. What does that part say?

Narcissistic Personality Disorder Central issue: My ideas and abilities are superior to those of others.

Common associated major negative life experience: Parental abandonment or rejection by the father.

Therapeutic statements supporting the healthy self: Part of you thinks your ideas and abilities are superior, perhaps far superior, to those of others.

Another part of you thinks you may be an imposter or feels very inferior to others. What does that part say?

And part of you thinks others are capable of having important ideas and abilities. What does that part say?

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Avoidant Personality Disorder Central issue: I am afraid that others will criticize me in social situations.

Common associated major negative life experience: Critical parenting during childhood or bullying by peers or siblings.

Therapeutic statements supporting the healthy self: There is part of you that is afraid of criticism in social situations.

Another part of you is able to reassure you or encourage you. What does that part say?

Dependent Personality Disorder Central issue: I fear being alone and must subordinate my own needs and feelings to those on whom I rely.

Common associated major negative life experience: Dominating parenting that makes obedience and subservience a condition of caring.

Therapeutic statements supporting the healthy self: Part of you believes you must serve others in order to be accepted by them, and you must be accepted by them in order to be happy.

Another, knowing part of you believes you are worthwhile even if others do not accept you. This part wants you to be true to yourself and to assert your own needs and feelings even if others are displeased. What else does it say?

Obsessive-Compulsive Personality Disorder Central issue: I must control my environment and finances, because of my fear of chaos, disorder, or poverty. Things, working, and financial security are more important than people.

Common associated major negative life experience: Poverty or financial stress or financial loss during childhood.

Therapeutic statements supporting the healthy self: Part of you thinks you must achieve and maintain financial security even if you must sacrifice closeness and caring in your relationships with others. If that seems accurate, elaborate on this a little.

Another part of you believes people and the quality of your relationships are more important than things or even than keeping order.

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Online Mental Health Counsellor Training Course Description and Requirements Course Comments Copyright 2009 College of Mental Health Counseling. All rights reserved.

Prerequisites: 1) Sincere desire to increase self-awareness and to help others.

2) Reading comprehension and writing composition skills.

3) The ability to work independently and be self-motivating.

This online course is also suitable for individuals who may have been away from the traditional classroom for several years.

Objectives: 1. To acquire knowledge and skills in the process of counselling individuals and couples.

2. To increase the student’s self-awareness of issues and factors contributing to his or her current life and relationship.

3. To provide a foundation of knowledge and skills for doing professional counselling during supervision (see more details here) You Will Learn: 1. Completing and understanding the Clinical Assessment; steps for suicide prevention.

2. Skills to begin, deepen, and close the counseling session and the over-all counselling process.

3. Skills to heal grief resulting from different types of loss: death of a loved one, breakup of a relationship, divorce, loss of health, bankruptcy, and others.

4. Skills to help others adopt healthy communication, reduce hostility, solve problems, resolve conflicts, listen with empathy, and speak assertively.

5. Approaches to help couples resolve specific issues: infidelity, household duties, addiction, and others; understanding how childhood experiences affect adult life and the couple relationship.

Text and Materials (provided with tuition and sent as Word .doc files): *Effective Counseling Skills: the practical wording of therapeutic statements and processes by Daniel Keeran, MSW *Qualifying Examination for Professional Counseling Practice *Clinical Assessment Form Assignments: 1. Design and create a minimum of 100-120 short and long-answer review questions covering the scope and depth of the text and provide responses with page numbers from the text where the answers are found.

2. Complete the Clinical Assessment Questionnaire with yourself as the client.

3. Complete the Clinical Assessment Questionnaire with a volunteer client.

4. Qualifying Examination - Open-book with text, all materials, and full instructor support available, the exam is designed to be a comprehensive learning experience.

Time for completion: Estimating 2 hours per week day, allow approximately 4 to 6 weeks depending on individual learning style and pace. Time extensions are granted on request.

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The Certificate of Mental Health Counselling and Therapy is awarded upon completion of the above requirements.

To Register, please complete and send the Registration Form at www.collegemhc.com or request more information at collegemhc@gmail.com Instructor: Daniel Keeran, MA, MSW, has been a therapist and professional counsellor for over 30 years and author of Loss and Grief Counseling Skills, Counseling In A Book, Learn Empathy, and Effective Counseling Skills. With extensive experience in private practice and hospital settings, he has conducted many therapy groups and trained thousands of people from the general public as well as social workers, nurses, and other helping professionals.

COURSE COMMENTS AND EVALUATIONS

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