When children are caught up in strong feelings or imminent fears, they need to be connected with positive potentials in the future. Such a connection is best made when you focus on simple concerts facts about the near future.
When I was the person who handled emergency service at the clinic on Fridays and encountered someone making suicidal statements either on the phone or in person, I would immediately begin relating to them in a personal, caring way. Then I would make an appointment with them for a therapy session on Monday and say I was looking forward to seeing them then.
Basically, what I did was give the suicidal person an obligation to stay alive and make a visit to the clinic in the near future. Since the patient and I had initiated a relationship during the first contact, he or she could feel an obligation to our newly begun relationship. And the expectation (to meet on Monday) that became a part of their reality could help carry them over the crisis of the suicidal feelings.
A story about Teddy belongs here. His grandfather had died the year before, so a number of nights each week Teddy stayed overnight at his grandmother’s house because she had a bad heart. He felt he was responsible for whatever happened to her on these nights.
One morning Teddy burst into my office telling me his grandmother had almost died the day before. She had been working in her garden and he was helping her. Suddenly, she felt a lot of pain in her chest and had difficulty breathing. She asked Teddy to go into the house and get her medicine. Teddy looked for the medicine in every place he could think of. Nowhere could he find her nitroglycerine tablets. He was so terrified, he said, his heart hurt and he wanted to throw up. Finally, he ran back to his grandmother, sure that she was dying and that it was his fault, since he couldn’t find her medicine.
He described to me how he had stood helplessly near his grandmother repeating, “Grandma, I love you! Grandma, I love you!” He was afraid because he couldn’t find the medicine she would think he didn’t love her.
Teddy said he didn’t mind the responsibility for his grandmother, but on a deeper level he felt his own helplessness. He needed to find a perspective to help him deal with his fears of not being able to live up to this responsibility. The reality was he was not able always to be there and be responsible for his grandmother would not die in her sleep without his knowing it, that even if he were awake and could find her medicine, the medicine might not always make the difference. I wanted, in short, to help Teddy realize he did not have the power to keep his grandmother alive, even if he did feel the responsibility. Nevertheless, this responsibility continued to weigh on him and, in fact, Teddy was known to be suicidal because of it. He was given to saying to me he wished he could die and go to heaven with his father and grandfather, and if anything happened to his grandmother he would kill himself.
At the end of the school year, when I knew I wouldn’t be seeing Teddy until the fall, I handed him a toy as a token of my caring and appreciation of the time we’d had together. Teddy said he had gift for me, too, but he’d forgotten to bring it.
“But I’ll bring it next year,” he added.
“Fine,” I said. I realized it was his way of saying, “If you want your gift, you’d better be here next year.” When I said I was looking forward to seeing him then, he said, “I’ll be here unless my grandmother dies. Then I’ll kill myself.”
I responded, “You can’t kill yourself, Teddy, because you owe me a present.”
He smiled a great big smile and said, “Oh yeah, that’s right.”
He had been promising to kill himself for so long he needed an excuse not to do so. He was obviously relieved to have an out: bringing my present to school next term.
Self-Esteem Principle: When children are put in touch with actual concrete things they can do, the overwhelming fear of responsibility can be removed or put into perspective.