Introducing Jake

Jake is 19 years old and comes to see me in a third sector setting for young people. He is well-dressed, articulate and thoughtful. He is seeking out counselling he says, because he is feeling “crap” and it has been like this for some time. He tells me he lives with his mother, who is very supportive, his father having left the family home many years before. He lives with his younger sister but has no contact now with his father. He tells me he specifically wants to see a male therapist because there are no men in his life he can talk to. As the agency requires, he has completed an assessment form before seeing me, which includes questions about risk. He has scored zero on risk, indicating no thoughts of suicide and self-harm.

We begin the session with introductions, and 1 invite Jake to tell me his story, which he does. It is a sad story of loss - a grief and anger for his missing father; the death through an accident of a friend 4 years previously; and his overwhelming sense of loneliness, of truly being on his own in the world. He tells me that while he loves his family dearly, he could never talk of his feelings with them “because guys just don’t do that, people just don't understand”. He is lost, adrift, and struggles to find his words.

Early responses to Jake

I am struck by the paradox of Jake: of someone so strong outwardly, yet so young inside and struggling with a searing distress. Also, of someone wanting to be heard, but having been taught that male words for feelings are not acceptable. 1 must tread warily because if 1 expect too much from him too soon, he might not return. 1 must find his language of strength while, at the same time, offering an implicit permission to speak of himself.

1 ask him about this assessment form and note, given how he is feeling, he has indicated he does not feel suicidal. 1 am tentative here, but it also strikes me that suicidal thoughts might well be present for him. He nods and says “yes, that’s not an issue for me”. 1 want to be reassured but I am not. But I have asked the question and, in doing so, am hoping 1 have opened a door if he ever wishes to walk through it.

Subsequent sessions with Jake

We get on well and he comes to the next, and subsequent sessions. I have found a shared humour, and we laugh a lot. I feel a little guilty about whether 1 am colluding with an avoidance of his feelings, but the laughter feels relational and intimate and a bridge across which we have found a mechanism to truly speak to each other. Then he stops laughing and the eye contact breaks. He says that I asked him a couple of weeks ago about suicide, and he said he was okay. 1 say yes, 1 remember. He says he is not okay and thinks of suicide often; he feels that no one would miss him, even though he knows they would.

1 am tempted to refer back to his strengths, but see that Jake has said the unsayable and 1 must be brave and stay with this uncertainty. 1 acknowledge what he has said but it does not feel enough. 1 say “How much have you thought about killing yourself Jake? Have you thought about what you would do?” It feels brutal, to the point and I know the phrase “killing yourself’ was not his phrase. But I also remember how easy it is to not say the difficult things and, in avoiding them, take Jake away from them too. I am metaphorically holding my breath, wondering if 1 might have prompted him into thinking more, leading him to the edge. He says no, he hasn’t got that far, but he is pleased he has told me. Me asking him so straightforwardly at the beginning did not make him think about suicide, but did enable him to think about his suicidal thoughts - if 1 know what he means. I say I do; he begins to cry, and I feel terribly sad too. We talk a lot about suicide, and it seems now the door has been opened, all sorts of things can now be talked about. He talks of shame, of having previously been silenced, of hurt, and of not knowing how to live, rather than wanting to die. It strikes me how closely liberation and annihilation can often sit so closely together.

Further reflections

Jake and I worked together over several months and, in that time, his thoughts of suicide ebbed and flowed, like some terrible tide he sometimes wanted to avoid bathing in, but at other times needed to immerse himself in. It would have been so easy from the outset not to have asked Jake about suicide, given his negligible scores on the tick box tools. But I also remind myself that it is often the task of the practitioner to name the difficult things, knowing that the client will decide whether to go there or not. I am also reminded of the big myth about suicide: that by asking about it we might prompt the thought in the other’s mind. I know that is not the case, in that asking about suicide, at worst, will leave the level of risk unchanged. At best, it will provide an opportunity to talk about it and, in doing so, the risk of acting on the thoughts can be diminished. I was further reminded too that there isn’t a suicidal “type”, as Leenaars (1994) calls it, the “bump on the head” (p. 90) that is the definitive indicator of the person who is likely to end their life by suicide. Rather, in moments of crisis or despair, we all have that potential.