Susan is a woman in her 50s who has come for therapy to try to find reasons to continue living. She recently lost her partner of many years and has no close family or friends. She has attempted suicide recently.
It is difficult to make psychological contact with Susan as it seems as if she avoids this by asking you questions about your life. How do you respond to Susan?
Susan would score high on the SAR (Suicide Assessment Risk) scale due to her previous history, lack of external support and sense of purpose. I would therefore talk openly with her about my concerns and my professional and ethical responsibilities to her.
As a CBT therapist my therapeutic aim would be to help Susan make sense of her situation in terms of the thoughts and beliefs she holds about herself, others and the world and how these might be making her current situation more distressing. Due to the recent death of her long-term partner, I would be aware of the various issues and processes associated with bereavement.
Cognitive Behavioural therapists believe in the value of transparency and of working collaboratively with the client. There are no theoretical or philosophical taboos against therapist self-disclosure. However, therapists are encouraged to consider the psychological purpose behind such questions. Given these factors it would be essential to elicit the meaning of these questions so that they could be worked with therapeutically.
As this is about self-disclosure I would start by considering the meaning behind the clients’ questions. For example, could Susan’s questions be a way of avoiding dealing with the painful feelings she experiences or could they be a way of exploring how other people find purpose in living? Perhaps they are a way of ascertaining whether I have any indling of what life is like for her? Susan has no close family or friends so her questions might also be a way of reaching out to another human being and this might relate back to longer-term issues of forming and maintaining relationships.
I would discuss the issue of self-disclose with my supervisor and we would consider our responsibilities in line with the BACP Ethical Framework. For example, items relating to keeping trust, client determination and self-harm and the need to ensure the relationship does not become detrimental to the client or the standing of the profession. In addition, the quality of care and the need to clarify and agree rights and responsibilities of both the practitioner and client at appropriate points in the working relationship would also need to be thought about.
At the end of the day the real challenge would be use the information gleaned from working collaboratively with the client, together with the insights gained in supervision to help form a therapeutically effective relationship with her.
I would begin with a smile, then share a mildly humourous self experience, then gently ask her, what does she feel and sense what human life is in comparison to other life!