Until I started working as a helpline counselor, I was unsure of what a stranger on the telephone could offer to someone who is suicidal.
The people on the other end of the line shared this hesitancy. They reached out with caution, not sure who would answer, if there would be judgment or what this stranger, this mere voice, could do for them.
Suicide as an issue is surrounded by a lot of shame. This acts as a barrier to seeking timely help. Accessing professional help is also an expensive affair in a country like India. Not only are the fees high but professionals have long waiting lists and are largely based in the big cities.
Helplines go beyond these barriers in offering an empathetic and supportive environment to those in distress. They provide something valuable to clients which is often absent in their offline lives: confidentiality, anonymity and unconditional support.
My training as a counseling psychologist did not prepare me to offer counseling over the telephone, nor to address suicide remotely. With a Master’s degree and some certifications in counseling psychology, I joined the helpline after a year of working face-to-face.
You can never be fully prepared
Upon joining, I was offered rigorous training in many domains including suicide prevention. I sat through multiple role-plays, although one can never be fully prepared for what awaits at the other end of the line.
Callers approached the helpline with varied presentations of suicide. For some, the thought of suicide would be an occasional visitor while for others it would be a consistent companion. For many callers, the helpline was a last resort before they acted on their plans.
Many myths and misinformation surround suicide. Some common ones include viewing suicide as an act of weakness, as attention-seeking behavior, mere threats or even a sign of mental illness. People fear asking directly about suicide as there is a misbelief that this will plant an idea in someone’s head.
Callers from all age groups, gender identities, and socio-economic strata would call the helplines. We would be flooded with calls in the evenings, special holidays like New Year’s Eve and festivals. These were the times when loneliness and despair would hit hardest.
I slowly learned the ropes. I had to learn that even though the clients were in a crisis, it was my job to contain that sense of urgency. I had to learn that my job wasn’t to fix what they were feeling but rather to understand them, help them feel more grounded, assist in seeing options and possibilities and support them in accessing those options.
Callers knew that there was no magic cure at the other end of the line but they wanted someone who listened to understand them and support them in navigating the complex terrains they found themselves in.
Reflections on what worked
Unconditional acceptance and validation: Callers would often be experiencing deep distress. When people are in a negative downward spiral, resolutions are inaccessible. Callers would carry shame, doubt and anger towards their lives and themselves.
Meeting people wherever they were with genuine empathy and acceptance helped build rapport. It gave the callers permission to feel whatever they were feeling below the veil of self-criticism and judgment. Often it would become a reason for them to hold on for just another day.
Seeing suicide as a way of coping: People see suicide as an act of weakness. However, it took all their strength to fight those thoughts. After numerous calls, I came to see that suicidal behavior was often a way of coping.
People thought this would end the pain and give them relief. They "coped" with their pain by seeing suicide as a "way out" from their situation. The empathic paraphrasing of suicidality as a means of coping helps regulate emotions.
Identifying resistance in despair: Clients' stories of resistance would often amaze me. Resistance did not always look like fighting a problem head-on and coming out on top of it but callers experiencing suicidal thoughts for months, yet holding on.
Or when they would feel severely hopeless yet still find the courage to dial a helpline number. They were no longer passive recipients of their life’s problems but active agents in resisting them.
Engaging with ambivalence: Ambivalence meant accepting that the callers wanted to end their lives yet had reasons to continue. This required a genuine conversation about what caused the suicidal thoughts and enquiring if there were any reasons to continue living.
Callers came up with reasons that took us both by surprise. They talked about promises made to their partner who had passed away, the family they would leave behind or a future they imagined away from their pain, where they were loved and cared for. These served as openings which would take us to terrains of hopefulness and possibilities of a future where the suicidal feelings did not dominate.
Building hope: Despair makes us forget that pain is temporary and can be treated. In my conversation with callers, we would thank them for reaching out. A person experiencing suicidal thoughts is often feeling cornered and out of options. We would talk about holding on for one more day, sometimes about what they did in the past when they felt this way. These actions created hope to hold on.
Support beyond psychiatry: Suicide in India is psychosocial. The risk of suicide stems from social locations, challenges and systems. Pills and therapy did not always help in addressing the distress that my clients experienced due to job losses, financial distress, domestic violence and discrimination.
For problems that emerge from structural and social determinants, solutions must come not from the person but from outside. Interventions would involve linking people to legal aid, job portals, shelter homes, loan waiver schemes, education scholarships, and NGOs that could offer support in accessing this practical support.
Finding a community: Callers would often be lonely in their journey, fearing judgment. Having someone witness and validate our pain can be healing. Callers would often find that having someone hear them out would reduce the intensity of suicidal thoughts.
As a counselor, I assured them that they were not alone. Though it was unclear how we would make our way out of the situation, I would assure them that we would do it together. It was critical to identify safe people in their lives and learn safe ways to share their feelings. Suffering is a human experience, but accepting it and allowing others to support it was often a transformational experience for many.
Coming back to self: Hearing stories of pain, despair and helplessness day in and day out becomes heavy going over a while. As therapists we are trained to listen with empathy, putting ourselves in the client’s shoes. On some days, I would go home and not participate in a single conversation with my family, because I would be so spent from the calls.
Taking time out to reflect on how my work impacted me was important in addressing the negative effects. It was the regular training, supervision and practising in a team that was a huge boon. Self-care is an important component of any practitioner working in suicide prevention.
Every call I attended was unique. Every narrative of distress and recovery resonates deeply with me even today. I often find moments on odd days and hope that they are doing well. Even today I carry those narratives with me. Some are heavier than others and some help me get through a difficult day myself.
(The author is a Mental Health Practitioner, works as a Consultant with Mental Health Agencies and as a Visiting Faculty at the Tata Institute of Social Sciences. This article was originally published under Creative Commons by 360info)
