Marie: When he said that, I got the feeling that he is as crazy as I am!

Cathy: When Marie was talking about suicide I thought about how fantastic it is to have something in life that's worth dying for. So it would be important to search for the thing that would really be worth giving your life for, and to take the time to do that.

Marie: I would go along with that; I would feel good about it. The question is «What can I do with that next?» I'm really hoping that you can tell me what to do after that.

The important thing about the responses that Cathy and Jim made is that they both accept the idea of suicide. It's a good pace, and establishes rapport. And now since they've accepted that she is going to kill herself, they move on to when and how. Cathy's response is really a natural extension of the how part. «If you are going to do this, you may as well do it well. It's far too precious a thing to do just on the spur of the moment.» With this kind of patient, the outcome of exploring what she's going to die for is that you will get to the intent behind the suicidal behavior. Typically the suicidal patient will never give you a positive statement. They can't. They are committing suicide out of desperation: they would rather be dead than continue living with the kinds of experiences they are presently having.

What Cathy and Jim have suggested is a kind of shock treatment to gain rapport. You follow that with a statement presupposing that the only justifiable way to die is for something which is positive. What you will end up getting is some positive intent behind the suicide, and then you can approach that intent in a variety of ways. That sequence is particularly nice.

Bunny: I did that with a client who was talking about a part of her that wanted to die. I said «How wonderful that you are looking for heaven on earth.» Then we went into what heaven on earth would be for her, and she was much less depressed after that.