I always found it helpful to have clients who were intellectually up to it to read James Hillman's Suicide and the Soul, which argues for the perspective of the soul or psyche as over against the positions taken by theology, sociology, law, and medicine. I think empathy with the pain is always a good starting point---if someone listens to my pain and understands it, I'll feel more able to bear it.

It's a good book ... I think empathy is more relevant than sympathy ...

I have published on preventing this in youth.  During that research I came across some wonderful initiatives and amazing people who have made this their life work, namely Professor Rory O'Connor of Edinburgh University Scotland.  My own paper can be seen here and I would be very open to any kind of collaboration?  http://medcraveonline.com/JNSK/JNSK-04-00133.pdf

Generally, it is more important to show empathy than sympathy to suicidal clients. Even better, you want to offer hope that problems and difficulties can be solved together. I recommend "empathy + action" interventions with suicidal clients. Empathy alone ("I can understand how your pain is very tough to handle right now")  can lead to greater hopelessness over time if that is all you offer. Instead, combine empathy with action to lead to an increase in hope ("I can understand how your pain is very tough to handle right now. Let's explore what other options might help you feel some relief from your pain.") 

David Jobes Collaborative Assessment and Management of Suicide (CAMS) provides a very good program for how to help suicidal clients as does the work by Aaron T Beck and his Suicide Lab at U of Pennsylvania headed by Greg Brown.

Hi Dr. Padesky, Thank you for your input.  I chose the word sympathy, as it has less ego over the patient.  As if, the therapist cannot understand the depth of sadness the patient feels, but respect and recognize.  Rather than sounding as if the clinician was lessening their suffering.  I think this could be an urgent crisis response, to make the patient stop and think.

But I really like your suggestion of empathy plus action.  That is the true CBT approach and empirically proven with continued therapy.

I think the Beck programs are fantastic!

Hi Dr. Mahoney,  Thank you also for contributing to this.  I think compassion is wonderful, and should always be present.  But again I chose the word sympathy as a triage word.  Compassion is lacking connective energy.  It is more calming and continuous.

 Thank you also, Mr. Lew.  Some religions do not promote empathy.  Empathy makes a comparison of suffering.

The empathy and sympathy is toward suffering but not toward depression or suicidal thoughts.

Fascinating question - and thanks for the link to the Suicide Toolkit - Thoughtful video..... I tend to agree with the folks on this thread that empathy is more appropriate than sympathy which feels a tad belittling to me..... I have worked with many suicidal adolescents - a challenging group in this area....  when I can empathize why they might feel hopeless and like they have no other choices..... but that there might be part of them, perhaps a very small part of them that would still like to live, then I can work with that piece of them..... I have been fortunate that I have never lost a patient to suicide although my husband did lose a 13 year old schizophrenic who jumped out of his  hospital room... So whatever we want to call or label it, I think it is about connecting with the individual who is having these thoughts, ideas or close to actions..... and letting them know people are around to "hold" them until they can get through those dark moments.

First I need to make a sensitive assessment about what the patients time frame is and whether or not there is a real plan. Recently a physician made such a claim in the first session and she sounded desperate and revealed she had a plan. In this case I had the " sense" that this was not the first time she had thought of killing herself and it had "happened" to her when she was a child, but I waited till the end of the session to tell her. My statement helped forge a connection. I think that most of the responses above are " cognitive " and not about the empathic judgement (Unc) in the session. One time I said to a patient , " why are you coming to see me? "Another man was masochistically manipulating his insulin pump and it became clear that he "wanted" to make me powerless to stop him. I have never had a suicide while in treatment altho I think one woman who as an adolescent used to stand on her window sill for hours may have spared me and killed herself after she left. Empathy is multilayered and separate:  it is feeling for, recognizing and mirroring and having the same feeling (?) I once gave a paper recollecting all the suicides that were in proximity to me when I was growing up Oddly the invitation was on the anniversary of the Japanese attack on Pearl Harbor and I began with that  unconscious oddness. I also had a patient who showed up for a session to find his prior therapist had killed himself 

All interesting thoughts.  I think the empathy piece will occur in the way the therapist chooses to answer.  The therapist will imagine a script with the suicidal person, and how the patient will respond to the therapists communication.  Those word choices will be based on empathy.  The sympathy is the outward expression toward the patient.  But this is all in relation to the existing contexts of knowing this person.  I had a professor that taught us, say to the patient, "Tell me, teach me..."   

The right thing to do is provide counsel and save lives. If you are suggesting a type of "calling their bluff" or playing devil's advocate, that can be risky.  Some patients may take that as a lack of caring and further opposition to their plight.

Suicide cannot be undone - it is a permanent solution for a temporary situation.

I am biased - as an inpatient psychologist most of the folks I encounter have seriously attempted or considered suicide.

People need a way out of the corner they are painted into. pragmatics are important.

As a way to build upon an intellectual base, I would suggest reading Linehan, et als "reasons for staying alive when you are thinking of killing yourself" (1983).

Sorry I don't have access to the exact reference but the title is "What would you say to the man on the roof"

This is a good place to start and it provides material for discussion in therapy.

I would add discussing ways to reduce risk factors for suicide - we have been doing this at reading hospital since 2010, and cross-checking against admissions/coroner's reports. Data is still being analyzed, but I can share the intervention form if you so desire

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