Natalie Staats Reiss, Ph.D., and Mark Dombeck, Ph.D.
Jeremy's story illustrates how psychotherapy and medication appointments tend to work. Both occur on a periodic basis. Individual psychotherapy sessions usually occur once a week, and last about 50 minutes. Medication management sessions may occur less frequently (e.g., once a month) and last for between 5 and 15 minutes. When people are in need of more frequent contact, multiple sessions per week are sometimes scheduled for a short period of time.
The content of a psychotherapy session (what you do during the therapy hour) will vary with the training of your therapist. However, certain things should occur regularly if your therapist is any good.
At each visit, your therapist should conduct a quick suicide risk assessment which brings the therapist up-to-date regarding how you are feeling right now. It is never a good idea to wait for a therapist to ask about suicidality if you are feeling suicidal. They may not ask until later in the session if you wait, and then you will lose much of your opportunity to talk about how you are feeling! Therapists are not mind-readers; you should never rely on a psychotherapist (or anyone else for that matter) to guess at what you're experiencing when it comes to suicide risk. If you are feeling suicidal, don't hesitate to introduce the topic as soon as you like.
As part of ongoing therapy work, your therapist will help you develop a list of short and long-term goals. The goals may include:
developing a strong support network of family members and friends
improving your problem-solving/coping skills (i.e., improving your strategies for handling stressors).
constructively addressing your presenting problem(s)
changing the thoughts that lead to suicidal feelings
talking through and coping with any history of abuse, trauma or domestic violence
taking care of yourself physically and mentally
Therapy goals should address problems in your life which have contributed to your suicidality. The more completely you can identify and address sources of stress, vulnerability and shame in your life that have led to your suicidal feelings and thoughts, the more likely you are to resist falling back into a suicidal crisis in the future when your life (inevitably) becomes stressful again.
Research suggests that Cognitive Behavioral Therapy (CBT) is often highly successful in treating suicidal thoughts and feelings. As the name suggests, cognitive behavioral therapy is form of psychotherapy that addresses problematic behaviors and thoughts that are linked to suicidality. CBT aims to teach suicidal people other ways of solving their problems and coping with stress by learning new ways of acting and thinking about themselves and their world.
A good cognitive behavioral therapist will help you form and carry out a plan to address the short and long-term goals described above. In addition, this type of therapist will specifically focus on your specific unhelpful (sometimes called dysfunctional) thoughts that are perpetuating your suicidal feelings. For instance, CBT sessions may be targeted toward increasing self-efficacy (or your beliefs about your ability to control external and internal stressors), decreasing hopelessness, increasing life satisfaction, and/or enhancing optimism. You may also receive training and practice in how to behave assertively, effectively interact in social settings, use strategies such as muscle relaxation and visual imagery to relax, and so on.
No matter what theoretical orientation your therapist employs, the psychotherapy recommendations will only work if you give them a fair chance and exert some effort and follow them. Getting better requires hard work. There also is no magic phrase that your therapist can say (or teach you say) to eliminate suicidality. Similarly, just showing up and sitting in someone's office is likely to fail.
Therapy doesn't have to be an open-ended process. Many of the modern "brief" forms of therapy are designed to be completed in a three to four-month period. Make sure to ask your therapist how long you should expect to wait before noticing clear and convincing evidence that treatment is working (and, be sure to use other strategies to keep yourself safe during this time period). If you find that therapy is not working after a few months, try a different therapist with the same theoretical orientation, or try a therapist with a different therapy approach. Don't completely write off psychotherapy if you have one negative or unhelpful experience.
During your inpatient hospital stay, during a triage meeting with a clinician, or during the course of ongoing psychotherapy, it may be recommended that you begin taking medications. Mental health medications (sometimes called psychotropics) are often used to treat many of the conditions that can lead someone towards suicide. For instance, if you are severely depressed or incapacitated by anxiety, antidepressants or anti-anxiety medications may be prescribed.
There is no "anti-suicide" pill. Psychotropic medications are a complement to psychotherapy rather than a substitute for it. Research suggests that the most effective way to achieve a long-lasting relief from suicidal feelings and thoughts is to develop a long-term relationship with a psychotherapist. Medications can control symptoms, but they do not teach you coping skills for dealing with future stressors and combating suicidal thoughts and behaviors. For more information about medications commonly used to treat mental illnesses, please visit the topic center on this site relevant to the specific mental illness you're interested in. For instance, if you are depressed, please visit the depression center to read more about different antidepressant medications.
As with psychotherapy, psychotropic medications may take some time before you notice a difference. For instance, antidepressants make take up to 6 or 8 weeks to build up to a therapeutic (i.e., effective) level. This lag time (when the psychotropics are building up in your system) is yet another reason to develop and maintain a good relationship with a psychotherapist. He or she can help you deal with suicidal thoughts, feelings and other symptoms while you are waiting for the medicine to "kick in."
Ask your prescribing doctor to explain how the psychotropic medication works, and how long you should wait before determining that it isn't working (or isn't working well enough). For the most part, there are usually a wide variety of medications that can be used to treat a particular disorder. It may require some tinkering (and some patience) to arrive at an optimal medication and dose for you. It may seem exhausting and overwhelming to stay on top of all of these doctors and treatments, so feel free to enlist the help of a friend or family member to help you.
Once you have found a helpful medication and dose, it is also important to maintain contact with your prescriber. Psychotropic medications are not like antibiotics. You don't simply take them for a specified period of time and then go about your business. Inform him or her of any changes that you notice (particularly negative side effects), as well as other medical conditions or medicines that you start taking. Also, clarify with your prescriber when and how you should stop taking these psychotropics. Some conditions may require short-term treatment, while others may need a more long-term approach. Suddenly discontinuing medications may create a serious worsening of your condition, which can also lead to suicidal thoughts and feelings. Do not discontinue medication on your own without discussing the decision with your prescriber.