Marie: Well, there was something else that I said: «I really know I want to kill myself.» His response to that was «Good! I'm really glad you know what you want.» Then I responded «Well, if you appreciate that, why do you lock me up here? I don't like it that you send the police for me when I swallow pills.»
OK. That's the complaint. All of you take a moment to figure out a content reframe you might make to that input, and then Jim can tell us what he did… . OK, now go ahead, Jim.
Jim: I said to her «You know, I have never really understood suicide before. We really don't know what goes on with people like you, and you are offering me an unprecedented opportunity to learn. What I would like to do is cooperate with you, but what you have proposed is too simple, and I won't learn enough. What I would like to do is make your death more complex, so that I can really learn about it.»
She was obviously very surprised by what I said. She just went «Tchew!» and inhaled suddenly, and her stomach sucked in.
Marie: When he said that, I got the feeling that he is as crazy as I am!
Cathy: When Marie was talking about suicide I thought about how fantastic it is to have something in life that's worth dying for. So it would be important to search for the thing that would really be worth giving your life for, and to take the time to do that.
Marie: I would go along with that; I would feel good about it. The question is «What can I do with that next?» I'm really hoping that you can tell me what to do after that.
The important thing about the responses that Cathy and Jim made is that they both accept the idea of suicide. It's a good pace, and establishes rapport. And now since they've accepted that she is going to kill herself, they move on to when and how. Cathy's response is really a natural extension of the how part. «If you are going to do this, you may as well do it well. It's far too precious a thing to do just on the spur of the moment.» With this kind of patient, the outcome of exploring what she's going to die for is that you will get to the intent behind the suicidal behavior. Typically the suicidal patient will never give you a positive statement. They can't. They are committing suicide out of desperation: they would rather be dead than continue living with the kinds of experiences they are presently having.
What Cathy and Jim have suggested is a kind of shock treatment to gain rapport. You follow that with a statement presupposing that the only justifiable way to die is for something which is positive. What you will end up getting is some positive intent behind the suicide, and then you can approach that intent in a variety of ways. That sequence is particularly nice.
Bunny: I did that with a client who was talking about a part of her that wanted to die. I said «How wonderful that you are looking for heaven on earth.» Then we went into what heaven on earth would be for her, and she was much less depressed after that.
«Heaven on earth» of course, is a way of defining a very general secondary outcome: the positive intention that suicide will achieve. You are essentially relabeling «suicide» as «trying to achieve heaven on earth.» Any time your relabeling can include an idiom like «heaven on earth," it will have an extra force to it, because it appeals to both brain hemispheres simultaneously. It is one of the few language forms computed in both hemispheres, so it has an extra power to it. Her complex equivalence for «heaven on earth» will be essentially the goals which you can now work toward in other ways than having her commit suicide. That's a really nice way to lead into a situation which is appropriate for the six–step model of reframing.
Man: When your client talks about committing suicide, how about saying «Wonderful!»?
Again, that's fine as a first step, particularly if all your nonverbal analogues support what you say. One way to interrupt a client's pattern is to do something totally unexpected. One of the least expected responses to suicide in this culture is to compliment him and agree and approve of such a statement. Agreeing will interrupt him, and it will also get immediate rapport with the part of him that made the statement. This is not a complete maneuver, but it's a good way to change the focus of what's going on. You don't want to stop there, especially when you are dealing with life and death matters. You need to go on immediately to utilize this opening to explore outcomes. «Who would you like to find your body?» «Have you composed your suicide note? Would you like to have me edit it for you?» These are ways of specifying the outcome that this part of him is trying to gain for him by suicide.
So these are only first steps in a complete therapeutic intervention. They are simply ways of interrupting and changing the frame in which the person understands his behavior, giving you a lot more freedom to maneuver. That's the whole point of reframing, anyway: creating freedom to maneuver. If a person has behavior X, it's a very specific behavior. It has actual sensory components: seeing, feeling, and hearing. If you try to change that piece of behavior directly, it will be very difficult. However, if that piece of behavior, with all its specificity, is suddenly seen or felt or heard to be in a larger context, a larger frame, you can discover that what you are really committed to is not the specific piece of behavior, but to the outcome that behavior is supposed to lead to in your world–model. Then suddenly you have a lot of room to maneuver. You hold the outcome—the goal that you are trying to achieve—constant, and recognize that this particular pattern of behavior is only one way to achieve it. There are many other ways to achieve «heaven on earth.»
Let me remind you that we almost never take a response away, except temporarily. There may be a context in which even murder, suicide, etc. is a good choice. I'm not willing to play God to the extent of removing any choices from a person; I simply want to add additional alternatives which are somehow more congruent with the person's conscious understanding of what he wants to achieve. I don't want to take away the ability to engage in the «inappropriate behavior» because it may become appropriate at some other time in some other context.
However, with a suicidal client it's quite appropriate to temporarily take away the choice of suicide. I recommend that you be very explicit at the beginning of your work with her. «I agree that it is better for you to die than continue living the way you are. I believe that I can assist you in changing your life in ways that make life worth living. I will accept you as a client only if you give up the possibility of suicide for three months. At the end of that time, if you still believe that suicide is appropriate, I'll even help you do it. Do you agree to that?»
That's what I do verbally. As I do that, I read the client's nonverbal responses, to be sure that I have full unconscious agreement. Anybody who tries to commit suicide is dissociated enough that she wouldn't consciously know whether she was going to commit suicide anyway or not.
After using NLP for three months the situation will be so different that the issue of suicide probably won't even come up again. I will bring it up myself, just to make sure, and because I've made an agreement.
Milton Erickson often used a contract like that. He would then point out that since she has been planning suicide anyway, she may as well go out in style. «How much money do you have in the bank?» «Oh, $5,000.» «Good. By Wednesday you will have consulted a hair specialist, and someone who is competent to teach you to dress appropriately.
You look gross! You will also consult someone who can teach you how to walk and talk and meet people, both in social settings and in interviews.» She can't object to spending money, because soon she will be dead, so it won't matter. He uses her planning to be dead as leverage to move her into new behaviors that he knows will make suicide unnecessary.