Learning to Listen Bravely

Brave Idea: Associate Professor Stacey Freedenthal says that one way we can help to prevent suicide is to listen bravely, especially when another person is sharing information that is difficult to hear. In her latest book, “Loving Someone with Suicidal Thoughts: What Family, Friends, and Partners Can Say and Do,” she discusses the concept of listening bravely, covers signs of suicide risk, shares treatment options and answers common questions, such as how best to talk to a loved one about their suicidal thoughts. Freedenthal has worked in the field of suicide prevention since 1994. She has written more than 80 articles for her website, SpeakingOfSuicide.com, which has received more than 5 million visitors in the past decade. She also has published scholarly articles about the measurement of suicidal intent, risk and protective factors for suicide, and other topics related to suicidality. In addition, Freedenthal has a small psychotherapy and consulting practice and provides training and consultation to social workers and other professionals who treat clients at risk for suicide.

Resources:

SpeakingOfSuicide.com 

Get the Book: Loving Someone with Suicidal Thoughts 

Get the Book: Helping the Suicidal Person 

Loving Someone with Suicidal Thoughts: A new book by Prof. Stacey Freedenthal helps people talk about suicide 

Suicidal thoughts are often hidden. Here’s how to talk about it. 

Listen:

Transcript:

Kim Bender:

Welcome to episode 13 of the Brave Ideas for Social Change Podcast Series, produced by the University of Denver Graduate School of Social Work. The series draws on GSSW faculty expertise for fast-moving discussions on emerging research practice and policy innovations to disperse social change. Today’s guest is associate professor Stacey Freedenthal, who’s here today to discuss her recent book, “Loving Someone with Suicidal Thoughts,” and the concept of listening bravely. Professor Freedenthal has worked in the field of suicide prevention since 1994. She's written more than 80 articles for her website, SpeakingOfSuicide.com, which has received more than 5 million visitors in the past decade. She also has published scholarly articles about the measurement of suicidal intent, risk and protective factors for suicide, and other topics related to suicidality. In addition, Professor Freedenthal has a small psychotherapy and consulting practice and provides training and consultation to social workers and other professionals who treat clients at risk for suicide.

Before we get further into this conversation, I want to let our listeners know that this podcast discusses approaches to suicide prevention. If you or someone needs help in dealing with a suicidal crisis, call or text 988 to reach the Suicide and Crisis Lifeline. You'll also find helpful resources on Professor Freedenthal's website, SpeakingofSuicide.com.

Kimberly Bender:

Suicide is a leading cause of death in the United States and is the second leading cause of death for people ages 10 to 14 and 20 to 34, according to the Centers for Disease Control and Prevention. This is such a vital, timely conversation. Stacey, thanks for being here.

Stacey Freedenthal:

Thanks for having me, Kim.

Kimberly Bender:

Let’s dig in. Your latest book, “Loving Someone with Suicidal Thoughts: What Family, Friends and Partners Can Say and Do,” was released this past January. Can you tell us a little bit about the book, who it’s for and what it’s about?

Stacey Freedenthal:

Sure. Well, my first book was “Helping the Suicidal Person: Tips and Techniques for Professionals.” And as the subtitle suggests, “Tips and Techniques for Professionals,” it was geared towards mostly mental health professionals, but also other professionals who might find themselves in contact with someone with suicidal thoughts. This book, in contrast, is geared towards friends, family and other loved ones. No degree required, no training required. It addresses common experiences when someone you love has suicidal thoughts. It addresses common feelings like fear, confusion and even more uncomfortable feelings like anger.

The book also talks about challenges that can arise, for example, if you feel manipulated by somebody who says they have suicidal thoughts. And I specifically say, if you feel manipulated because somebody can feel manipulated, and that doesn't mean the other person is manipulating them. And the book talks about how to ask questions. A lot of people, they just say, “What do I say?” And so it talks about how to ask questions about suicidal thoughts, how to listen, how to respond, and what to do to help the person stay safe and feel better.

Kimberly Bender:

Stacey, given how prevalent suicide is, can you say a little bit more about why it’s still so difficult to talk about?

Stacey Freedenthal:

There are a lot of reasons. It is very difficult for many people to talk about. And one is that there’s a common fear that asking someone about suicidal thoughts will give them the idea to start thinking about suicide or that it’ll make them feel worse. And we’ve got quite a few research studies that have been done on this, and they consistently demonstrate that this generally isn't true. I say generally, because there is a small portion of people who will say that momentarily, it’s upsetting to think about or talk about their suicidal thoughts, but they also say those feelings pass really quickly. And there’s actually evidence that asking and talking about suicidal thoughts helps, so we really need people to keep that in mind.

Another reason why people don’t want to talk about suicide is because there’s a lot of negative social messages about it, a lot of stigma. I’m sure you've heard some of these negative messages, “Suicide is selfish,” or “Suicide is a sin,” et cetera. And then another thing that makes it hard to talk about is the enormity of the topic itself. And it's scary also because it's about death, and it's very scary to talk about death in general — especially an avoidable, premature death like suicide.

Kimberly Bender:

Thanks, Stacey. The bigness of this topic and the stigma associated with it, makes a lot of sense. And I know in a recent Washington Post column that you wrote, you shared that about half of people who die by suicide don’t reveal their intentions beforehand. I wondered if you could talk a little bit about what signs people should be looking for, for someone that they care about that might be struggling with suicidal thoughts?

Stacey Freedenthal:

Sure. Major signs would be if someone says that they're having suicidal thoughts, obviously, or if they've made a suicide attempt or have been witnessed making preparations, like writing a note or giving things away in a way that's incongruent with their life situation. But a lot of people [don’t] speak directly about their suicidal thoughts, but they may give indirect hints, like they may say, “I feel like giving up,” or, “I wish I could just sleep forever.” And there are opportunities when somebody says something like that to ask questions like, “What do you mean?” or, “Hey, are you okay?” And another question could be something like, “Some people who make statements like that actually are thinking of suicide. Are you having suicidal thoughts?” And I know a lot of people have a fear that the person will get mad, but in my own experience, not only as a therapist but as a friend and family member of people who have had suicidal thoughts, I haven’t really encountered anger.

But usually the way people respond is matter-of-factly, and they’ll say, “No,” or they’ll say, “Well, actually, yes.” Other signs to watch out for would be statements that reflect hopelessness or despair, changes in behavior like social isolation, increased substance use. And then again, as I said, outright suicidal statements.

The best way to know someone has suicidal thoughts is to ask. And as we discussed, it can be scary to ask. And there’s a popular self-help book called “Feel the Fear and Do It Anyway.” And I really like that phrase, so I recommend feeling that fear and asking anyway.

Kimberly Bender:

That’s really helpful. And so even as professional social workers, if someone does disclose that they’re having these thoughts or feelings, talking about suicide can be really hard. For those who haven’t had professional training, these conversations probably are even more challenging. When talking with a loved one who might be thinking about suicide, what do people need to keep in mind? What should they be doing or what should they not be doing in those conversations?

Stacey Freedenthal:

[That’s] a really good question. One of my favorite quotes is, “Be curious, not judgmental.” If, [someone] has suicidal thoughts, be curious about what’s going on. What’s happened to have them think of suicide? Too often, the immediate response of people — and in both professionals and lay people — is to just jump into a series of yes/no questions. Someone says, “Yes, I do have suicidal thoughts,” or, “Oh, things are so bad, I think of killing myself.” And then often the immediate response that the listener has is, “Do you have a plan? Do you have the means? Are you safe? Do you intend to act on your suicidal thoughts?” et cetera. There’s 20 questions that people can ask, and those questions are important eventually. But first, it’s important to really just listen to the other person, show empathy and learn what’s going on.

I also want to say, people often have an urge to talk someone out of suicidal thoughts. This is a natural and understandable urge because it’s horrible to know that someone you care about is having thoughts of ending their life. But it’s also important to listen bravely. And by listen bravely, I mean to give the person the space to say what they feel without you immediately rebutting them.

In my book, I define listening bravely as asking the questions whose answers you fear and listening to what’s hard to hear. And so that would mean not saying things like, “But you have so much to live for,” or, “How could you think of hurting the people you love like that?” Or any number of things I hear people will be told. “But you’re so young,” or, “It gets better.” Which, these are all well-intentioned phrases, but they can create a disconnect because they’re not giving the person the space to say what they’re thinking and feeling without worrying about your reaction.

Kimberly Bender:

You write about this concept of listening bravely in some depth in your book, and I wonder if you could tell us a little bit more about what that means and why it’s so important to do?

Stacey Freedenthal:

Yeah. Brave listening is really setting aside your own agenda and being curious about what the other person is saying. And it’s really a less clinical term for what clinicians call active listening and reflective listening. Like I said before, I define it as asking questions whose answers you fear, which requires bravery, and then listening to what’s hard to hear without immediately jumping in with those instinctive responses we might want to have, like giving advice, trying to change their mind, doing other things that can shut the person down rather than open the conversation up. And I want to acknowledge, it can be really hard to sit with someone and to really hear them talk about the problems they’re having and the pain they’re feeling without immediately trying to make it better, which is just instinct. And that’s why it requires bravery to really hear and try to understand them in their darkness.

Kimberly Bender:

Brave listening is such a powerful way to frame something that can feel so vulnerable, but these tough conversations about suicide, they’re not just a one-time occurrence — we’re not asking the question and then just moving on.

Stacey Freedenthal:

No. I think there’s a wish that it would be a one-time occurrence, and I think this is something that can be hard for someone with suicidal thoughts as everyone expects them to get over it quickly. And that’s the public messaging about suicide, too — that if someone has suicidal thoughts, they need to get help. And then the implication is they won’t think about suicide anymore. But in reality, these tough conversations can have to happen again and again, depending on where the person is in their life, really — whether they’re dealing with trauma, stress, mental illness, whatever the situation is — [it] may not end right away. And their despair or hopelessness or psychological pain may persist. And there’s actually people who have suicidal thoughts for decades. And so there’s a need for an ongoing conversation around it.

Kimberly Bender:

Your book includes a chapter titled “Fostering Hope,” and hope is something that so many people struggle to hold onto these days. What advice do you have and where do you find hope in this work that you’re doing?

Stacey Freedenthal:

Great questions, because I find often that discussions about helping people who have suicidal thoughts focus on the tough parts, and then we leave out the hope and the hopeful parts. In the book, I talk about different ways to foster hope, and I’ll just name a couple of them. One is to ask questions in such a way that helps people look back on times they’ve experienced similar problems or similar feelings and how they got through those, or to think of things that they want to do or see or have in the years to come that they can encourage themselves with. I give an example of one person in the book who created a hope kit, which I talk about in the book. It's something that you create, sometimes called a hope box, where you put tangible reminders, or visual reminders, I should say, of things to hope for in the future. And this person had hopes that she would become a grandmother. And so she put — I think, if I'm remembering correctly, which I know sounds strange since I wrote the book — but I think that she put her daughter's baby shoes in her hope kit to remind herself that she may become a grandmother in the future.

As for me and my hope, what really helps me is a number of things. One is, 99.7% of people who have suicidal thoughts — and by this I mean that they report seriously considering suicide — 99.7% do not go on to die by suicide. A larger proportion does attempt suicide, but of those who attempt suicide and survive, 90% do not go on to die by suicide. I think it’s really important to remember that most people get through this.

And I always hesitate to say that, because I don't want to minimize the fact that a large number of people do die by suicide. Almost 50,000 people in the United States end their own life each year, and that’s 50,000 people too many. And roughly 15 million people have serious suicidal thoughts. So I’m grateful for the 14,950,000 who are able to make their way through. The last thing I would say about what gives me hope is, this is just an incredible opportunity to be real with someone and to sit with them in a time where just being present can be helpful. Being present, listening bravely, trying to understand what’s going on can have tremendous power, and that’s a precious opportunity, and I savor that.

Kimberly Bender:

Thank you so much, Stacey, for all the work that you’re doing to understand and prevent suicide and for sharing so much of that with us today.

Stacey Freedenthal:

Well, thank you, and thanks again for having me on this podcast

Kimberly Bender:

For help in dealing with a suicidal crisis, call or text 988 to reach the Suicide and Crisis Lifeline. You’ll also find helpful resources on Professor Freedenthal's website, SpeakingofSuicide.com. Subscribe to our Brave Ideas for Social Change Podcast for more conversations like this. Learn more at socialwork.du.edu/change.