Gestalt Therapy Approaches to Crisis

Intervention With Suicidal Clients

Lin Young
David Lester, PhD

Suggestions are made based on the concepts of Gestalt therapy for areas that can be
explored in clients who are in crises. Rather than being a passive counselor, simply
reflecting back to the client their verbal and nonverbal communications, there are
specific areas that might fruitfully be explored by a more active crisis counselor, including
acknowledging the clients’ suicidal ideation and their psychological struggle, exploring
their suicidal plan, exploring their anger and underlying loneliness, helping them
become aware of their repressed emotions and ambivalence, and exploring options.
[Brief Treatment and Crisis Intervention 1:65–74 (2001)]

KEY WORDS: Gestalt therapy, crisis intervention, suicide, telephone counseling.

The major influence in the development of crisis

concepts of transactional analysis (Orten, 1974)
intervention techniques has been person- and learned helplessness (Rosenthal, 1986).
centered therapy (Lester & Brockopp, 1973),Nevertheless, the person-centered approach to
and, more recently, cognitive-behavioral ther-crisis intervention remains the predominant
apy has been applied to crisis intervention (Dat-
technique taught to crisis interveners working
tilio & Freeman, 1994; Roberts, 1995, 2000).in The
suicide prevention centers. However, a per-
most recent development has been the integra- son-centered approach is not suitable for every
tion and application of strengths-based solu-client in crisis, and it is important to provide ad-
tion-focused therapy to crisis intervention ditional tactics for crisis interveners to utilize
(Roberts, 2000). Suggestions have also beenfor clients who do not respond well to a person-
made for orienting crisis intervention using the
centered approach.1 The present paper suggests
ways in which Gestalt therapy can provide a
framework for crisis intervention.
Gestalt therapy, developed by Perls, Heffer-

From The Samaritans, South Fremantle, Australia (Young)

and the Center for the Study of Suicide, Blackwood, NJ
(Lester).
Contact author: David Lester, PhD, RR41, 5 Stone-
gate Court, Blackwood NJ 08012-5356. E-mail: 1. Both person-centered counseling techniques and
lesterd@stockton.edu. simple cognitive therapy are found by some clients to
be very frustrating, especially if they have some
© 2001 Oxford University Press knowledge about systems of counseling.

65
YOUNG AND LESTER Gestalt Therapy Approaches for Suicidal Clients

the line,
new and context,
Goodmanand the (1951),
neurotics
has enjoyed
fail to recog-ato self-regulate.
always novel,For and example,
so assimilation
if the clientinvolveshas cre-
nizemodest
their distortions. some ative
inneradjustments
conflicts, the by counselor
the organism. should Whenever
not
The
popularity
self is your sincesystem
its description,
of contacts but with
a search
the try tothe
ofreduce
personorand removethe environment
these conflicts. interact,
Conflict there
environment
The Gestalt at Journal
any time. located
Healthyno articles
people iden- dealing
is a ismeans
contact. of growth.
The person The can
counselor’s
be seentask as the is to
agent,
tify with
with suicide
their self prevention,
and are able andtoa perceive
database search heighten
or thethe environment;
client’s awareness and so Perls of bothrefers sidesto ofthe
choices
of The within
Gestalt
their Bibliography
contact. Unhealthyfound nopeople citations
his conflict
contact so boundary
that they asmay
foreground,
feed on the the immediate
envi-
are (Lester,
alienated 1991).
from Despite
their self. this,
Unhealthy
Gestalt people
therapy ronmental
environment
of- material as theand field,
comeand to athecrisis
contact
point as a
try to
fersconquer
some guidelines
their own spontaneity,
for counselors believe
engaging withinmutual
inthe safety
interaction.
of the therapeutic environ-
theycrisis
are restricted
intervention andthat without
may choices,
be suitable andfor ment.
some Gestalt
The sharper therapy a conflict,
is concerned the greater
with analyzing
the
limitclients,
their assimilation
and the present of new paper
experiences.
will describe The
struggle,
the structure
and theof more
the likely
actualthe experience
outcome of willthe
set some
of identifications and alienations one hasbe is positive
con- for the client. Working through con-
called
of these
one’s guidelines.
ego. O’Connell (1970) provided flicts tact
enables
a and providing
people tothe grow.
clientNeurotics
with awareness
have be-of
Since
generalGestalt
orientation
therapyfor aims
thetocrisis
increase
intervener
thecome from
bothneurotic
the foreground
partly by and attempting
the field. toTheresolvecoun-
con-a Gestalt perspective, but he did not develop conflicts
selor prematurely,
is not only concerned leaving awith great what dealisof being
tactspecific
and thetechniques
awarenessor ofsuggest
the contact issues between
that ma-must
experienced, but on how it is being experi-
the be
person
addressed.
and theOthersenvironment,
have made therapysuggestions
works
terialenced;
outside notofon their
what awareness
the person and says,
employing
but how he
on the
aboutego. the
The psychodynamics
goal is to train of thesuicidal
ego bybehavior
invit-
elaborate
says it.defense
The goal mechanisms
is to heighten to avoid
the contactintense and
ing from
and encouraging
a Gestalt perspective.
it to experimentFor example,
with experiences.
Dal- brighten the awareness of both the experience
awareness,
drup, Beutler,
to make Engle,
it more andaware
Greenbergof the(1988)
envi-Many of contact
conflicts and stem
the from
boundaryearlydisturbances
situations leftexpe-
ronment
notedand the ofrole
physical
of anger responses
in motivating
withinsuicidal
the unfinished
riencedand by theunresolved.
person within They the affectcontact.
present This
body behavior.
of the person. Once the ego has its senses behavior
translatesbecause into thea fuller
clientexperience
repeatedly andtriesapprecia-
to
revived It is
andgenerally
is making accepted
better contact,
by crisis therapy
intervenersfinish
istiontheofsituation
the contact in current
and ansituations
awarenessthat of howare in-
finished;
that clients
the clientin crisis
can take are farover
morefrom likely
the to coun-
not
re- dividuals
accurately disturb
differentiated
their contact from boundaries.
the past. En-
selor.
spond to therapeutic interventions than those ergy is Asdiverted
people grow from and growth-producing
assimilate newactiv- experi-
The
who roleareofrelatively
the therapeuticstable withsituation
their is dissatisfac-
to pro-ity asences,
a result they ofhave
confusion
to make andcreative
raised levelsintegrations
of
videtion
clients
(e.g., with
Brockopp,
safe opportunities
1973). The to moreexperi-
intense
anxiety.
of One of the tasks of therapy is to un-
ment the by opening up their awareness. Perls iscover thisthese
new unfinished
material with situations
the old and material.
support This of-
awareperturbation
that the major of clients,
difficultythe more
is to release
likely they the
theareten
person
involvesin resolving
destroying them. theTostatus
complete quo, ther-
the for-
clients’
eventually
healthytopower reachof closure,
creative a viewpoint
adjustments, that
apy,merisclients
ways need
of perceiving
to becomethe awareworld. of The
how person
the
without
consistent
havingwith them Gestalt
mimictherapy.
the counselor’s con- unfinished
needs to situations
aim for aaffect bettertheirintegration
decisions of and
all the
ception of reality. The aim is growth, not correc- behaviors
material, in the
not present
a mere reshuffling
context. Once of the thecompo-
un-
tion. Can society tolerate people regulating finished nents. situation
This process is completed,
may easily thearouse
traumafear is and
themselves with less regard for societal norms lessened
anxiety, andfor is itless
is scary
likely toto change
repeat in one’snewset situ- habits
and values? Perls feels that society can tolerate ationswhen outside
the new of the material
client’s demands
awareness. that one needs
more self-regulation than occurs at present. When to. Thewe psychologically
experience conflict, healthy we person
need todoes rec- not
Gestalt
The Theory situation is safe. It allows ognize
therapeutic shrinkthatfrom boththat opposing
task, whereas
forces are neurotics
within us. avoid
clients to experiment with lowered levels of People restructuring
typically do their
notperceptions
tolerate their and ambiva-
habits and
anxiety
Perlssince
(Perlsthere
et al.,is 1951)
a clearfocused
invitation upon to dothelence
so hold
inter- (awareness
to their old of perceptions
polarities) and of reality
projectthat oneare
without judgment and recrimination.
action between the organism and the environ- Clients aspect
do likelyof to
theirbe conflict
distorted onto
by the
the unfinished
environment. trau-
not ment.
flee from anxiety but remain aware of both
2 Organisms live by maintaining the dif-
Both matic
aspects experiences
of the conflict of theneedpast.to 3 When
be neurotic
their anxiety and their responses
ference between themselves and the environ- to it. The role
integrated
people do enter new experiences, these experi-
of the counselor is to increase awareness
ment. They assimilate parts of the environment of into
the ences
the whole,
are unlikely
with awareness.
to be perceived
When accurately
self- in
client’s responses, while providing
and reject others and, therefore, grow, some- enough sup-
regulation is not in place, individuals are likely
porttimes
for the but client to continue. at the expensetoofproject
not necessarily, the their major life conflicts onto the per-
Perls believes that
environment. Thethe parts organism
that arecan be ceived
assimilated are regulatory bodies (parents, spouses, soci-
trusted ety, etc.). This projection creates a reliance on

2. More recent works on Gestalt therapy, aside from

those cited in the text, include Polster and Polster 3. Perls presumably uses the term “neurotic” as de-
(1973), Korb, Gorrell, and Van De Riet (1989), and fined in the older versions of the Diagnostic and Statis-
Wheeler (1991). tical Manual of the American Psychiatric Association.

66 Brief Treatment and Crisis Brief

Intervention
Treatment and
/ 1:1 Crisis Intervention
Summer 2001 / 1:1 Summer 2001 67
YOUNG AND LESTER

the projected party to provide resolution andregarding

re- their suicidal thoughts and despair.
moves from the individuals the power to resolve However, individuals who are suffering from a
their own conflicts. high level of perturbation and have a history of
For Perls, the way to psychological health lies
maladaptive behaviors and unsatisfying rela-
in the harmonious integration of all aspects of tionships do not rapidly feel relief from dis-
one’s self. Therapy aims to increase awareness cussing their situation and need more intense
and to teach the client to trust in organismictherapy.
self-regulation. Awareness will assist in resolv-
ing issues. The body is wise and, left to itself,
will heal itself. The counselor does not aim to di-
rect clients, but rather to free them for growthExploration of the Suicidal Plan
that is self-directed. This is central to the devel-
opment of an internalized and potent locus of Discussing the client’s plan for suicide is typi-
control. Thus, the implication is that people will
cally used as an assessment tool, but it has far
self-regulate, be responsible for their own be- more important aspects. If the counselor can
haviors, and seek constructive relationships provide acceptance and support as clients talk
within their environment. Seligman’s work on about their plans, this is likely to build a trust-
learned helplessness indicates that people, evening relationship, establish a stronger sense of
when they have an internal locus of control, connection,
can and bring invaluable awareness to
perceive themselves as powerless or withoutthe clients. Clients will have a greater under-
choice in important situations. The responsibil-standing of the gravity of their situation and
ity and potency gained from self-regulation become more willing to engage in a therapeutic
places an enormous responsibility and freedom relationship. Clients will be able to discover a
upon the individual. External regulation re- largely dissociated part of the self and begin to
moves responsibility and choice, and individu- integrate rather than simply suffer. Exploration
als are, in a sense, victims of their immatureof death and funeral fantasies can assist them to
abil- integrate death concepts, reduce the romantic
ity to achieve self-regulation. They may, there-aspects of suicide (as it is discussed in a down-
fore, perceive their lives as limited by enforced
to-earth manner), and facilitate awareness of re-
or limited choices. venge (and other) aspects involved in their sui-
cidal desires. An opportunity to gain insight
into the unconscious forces that are motivating
them toward suicide is often uncovered in their
death/funeral fantasies.

Gestalt Approaches to Crisis

Intervention

Exploring Anger
Acknowledgment of Suicidal Ideation
The act of suicide can be viewed from a psycho-
analytic perspective as a retroflected expression
Clients need to talk openly about their thoughts
and feelings regarding suicide, while feeling of anger. Yet many suicidal clients are often un-
safe and accepted. Many clients will give mildaware of this aspect of themselves. When they
clues or hints in order to check whether the are able to fantasize the pain and anguish that
their parents/partner/children will go through
counselor has the courage and alertness to dis-
after their suicide, they can be encouraged to
cuss these issues. Some clients need only this—
time with someone who is present, receptive, explore and own their anger (or sadness). It is
and respectful, with whom they can talk openlyuseful for them to gain a sense of their power

68 Brief Treatment and Crisis Intervention / 1:1 Summer 2001

 Gestalt Therapy Approaches for Suicidal Clients

and their anger so that they no longer perceive clients. When this is not possible, their risk fac-
themselves as merely victims. On the other tors escalate, and they are forced by their unre-
hand, clients who are openly acting-out anger solved pain to return to the situation or to harm
are likely to discover their more vulnerable emo-
themselves.
tions and feel some compassion toward them-
selves.
Angry thoughts need to be explored with care
Awareness of Ambivalence
since outbursts of rage can fuel angry thinking.
Anger is a “mover emotion,” designed to help Many suicidal clients are quite intolerant of the
people protect themselves. Angry thoughts can conflicting forces within them. They are con-
be employed as a means to avoid other fused, and they mistrust and cannot tolerate
emotions. their own ambivalence toward living and dying.
When people are hurt or threatened, anger isRecognition
of- that it is possible, and indeed nor-
ten their first response, and to avoid the vulner-
mal, to hold opposing thoughts can reduce their
ability and pain associated with sadness they cognitive dissonance. It can also provide time
can continue on a circular treadmill of angry and initiate the process of integration. They do
thinking and blaming. Talking over the reasons not have to make a decision right now, and they
for anger usually does little to dispel it, evencan take the time they need to establish re-
though venting these thoughts may be tem- sources, support, and skills to integrate their po-
porarily satisfying. A good strategy is to en- larities. An exploration of the opposing forces
courage the client not to repress anger, but nei-
assists them to explore whether they want to die
ther to act upon it prematurely. A workable or whether they wish to escape their turmoil,
strategy is to locate the sensations of anger pressure,
and or confusion. When the counselor in-
stay in touch physically with the sensations un-quires about their motivation for suicide, the re-
til the energy dissipates. Differentiating be- sponses conform to Shneidman’s (1996) com-
tween angry thoughts and the experience ofmonalities of suicide—the purpose of suicide is
anger is important when working with suicidal to escape unbearable psychological pain. This
clients because their angry thoughts withoutone issue—the wish to escape pain and confu-
the experience of the emotion will easily recycle
sion—is vital and needs clarifying. A clear di-
without any new insight. Their angry feelingsrection for the counselor and client can become
can then prematurely move into unsafe actions the foreground—to address the unbearable
turned inward onto the self and/or possibly pain.
others. If they could radically diminish their inces-
When they can experience their anger physi- sant thoughts and tensions, they would most
cally and express some of that to the counselor,likely choose life. If they do reach their crisis in
clients will frequently discover their grief andthis conflict during therapy, they will be in a
sadness. Motivating and activating clients’ safe and supportive place with the counselor,
anger can seem very useful and energizing, and al- this is most likely to occur when the client
though, when they are not able to allow theiris very close to suicide. Working with polarities
sadness to arise and be experienced, they be- and holding the awareness of both polarities (as
come trapped with their anger and are unable to as the motivations behind the opposing po-
well
let go of damaging relationships and situations.larities) will create integration and awareness of
In other words, anger is an agent of change but,the choices between these polarities. It can also
when change is initiated, grief for the loss offacilitate
the awareness of repressed memories of
relationship must be able to be supported byim- the
portant events that have propelled the client to-

Brief Treatment and Crisis Intervention / 1:1 Summer 2001 69

YOUNG AND LESTER

ward suicide. During the exploration of theseawareness of their primary or deepest needs
polarities, clients will often express despair. To
and
be fully present, listen and support despair concerns. Intense listening on the part of the
when clients are in despair without reducing counselor
or is necessary to assist the client to un-
minimizing their despair is vital. cover these concerns. In Gestalt therapy, the
counselor is alert to deflection—the process in
which clients speak of a major issue or event
and
Acknowledgment of Their minimize their responses to that event (in par-
Psychological Struggle ticular, existential issues that include lack of
meaning, loneliness, fear of death and dying,
Many suicidal clients describe incessant and fear of freedom and making choices). Fre-
thoughts that pervade their waking hours and quently, clients have unresolved grief or in-
interrupt their sleeping. They seem trapped,tensely shameful issues that they are unable to
and we must not add more elements to theiracknowledge—to themselves or to the coun-
trap. selor. In the case of existential issues, they may
Rather we can facilitate awareness of their en- not have the words to express these deep con-
trapment. An opportunity to stand outside their cerns, or they may have accepted them as in-
struggle and observe how circular and self- significant since everybody experiences them.
defeating the process is can facilitate under-Although Gestalt therapy does not focus prima-
standing and awareness. Some time to be still rily on the content of what is said by clients, lis-
and operate fully in the present moment cantening to clients in their terms, with their con-
bring much needed relief. tent, will often reveal these issues. Some indi-
Some clients are keenly interested in a conflu-viduals fall into despair when faced with the
ent relationship with the counselor. Suicidal freedom of making life choices; others wish to
clients are so desperately lonely and rudderlessdie in order to join deceased loved ones, while
that their desire to seduce a potent individual others are bored and frustrated with their dead-
into their problems is powerful. Counselors ness and see no hope for release from their de-
must remain aware of this process, and the pro- spair. Many suicidal people consider themselves
cesses here are most frequently the clients’ victims, blaming their past experience of abuse
avoidance of emotional experiences by distract- or their parents/partners. These people are more
ing with talk about problems and suffering. The likely to seek a confluent relationship. Others
counselor needs to be interested in what it isare likeso very interpersonally isolated that they
for clients to be trapped in their problem, butseek help to decide calmly to commit suicide,
only empathically. Empathy must not changewithout wanting any connection at all.
into confluence. An urge to give in to confluence For suicidal clients, particularly those whose
will eventually give rise to despair on the part of
suicidality has been chronic and who have seen
the counselor when he or she tries to escapemany the counselors, it is important to help clients
confluent relationship and when clients manip- become aware of where they are and how they
ulate the counselor with suicidal threats or ac-stand to gain from being there. This is a
tions. sensitive
issue for suicidal clients, particularly if they
have the fantasy that the counselor can do
some-
thing to take their despair away and alleviate
their lonely struggle. If clients have seen health
care workers who let them down, they may have
Understanding of Major Issues

Individuals can become stuck on constricted or

circular thinking, and this circumvents their

70 Brief Treatment and Crisis Intervention / 1:1 Summer 2001

 Gestalt Therapy Approaches for Suicidal Clients

a considerable investment in holding on to theirwilling to provide support but are met with re-
despair and struggle. However, when they real- jection or do not know what to do to be effec-
ize that they have been holding on to the feel- tive. This may be near to the clients’ awareness,
ings, and that consistent talking about feelingsyet not acknowledged. Their loneliness is sig-
is quite different from experiencing them, they nificant in terms of the therapeutic relationship,
have the beginnings of awareness. and it is invaluable to check the parallel pro-
Framing the major issues, their impact andcess—whether they are lonely now, with the
their time frame with the client, and checking counselor, and whether they are aware of their
that this is accurate, will assist in forming a pic-
resistance to contact with the counselor. It is
ture of the whole, set the scene for what needs likely that what they do with significant others
to is repeated with the counselor if they are chron-
be addressed, and define what is foregroundically for suicidal and, if they do not feel lonely
the client. For example, if the client believeswith the counselor, he or she needs to check
that the issue is that his wife has to come homewhether there is a degree of confluence already
or he will commit suicide, it is imperative to established.
help him differentiate between his inability to
cope with the emotions involved in losing his
wife and his desire to commit suicide.

Clarity in Their Responses to

Feeling Questions
Addressing Their Underlying
Loneliness When suicidal clients are asked “How do you
feel?” they frequently respond with a thought
or a state mistakenly believed to be a feeling.
The majority of suicidal clients experience lone-
liness as a central issue. Their loneliness may This creates confusion, and the clients’ ten-
not dency to repress emotions is reinforced. An ac-
be apparent to them, particularly when theyknowledgment of their response as a thought
have many superficial relationships or when and a return to a focus on their feeling (feelings
they consider loneliness to be a natural state— are sensed physically—emotion is the feeling in
in these cases, they may not raise the issue.action,
Ac- moving the energy through the body
knowledging their loneliness can make them and out to the environment to make contact) is
vulnerable since they need a counselor to con- essential. There is also the issue of “trained”
clients
nect with them. In order for lonely people to re- who can label their emotion without ex-
ceive attention, they need to present problems periencing it. Finding out how their emotional
to the counselor, preferably problems with no energy is impacting on them is imperative in
solution in sight. This is likely to be how theyGestalt therapy, and the accurate labeling is
look for attention from any friend. It is impor-merely a side issue. Many who are trapped in
tant to establish how lonely they are on an in- chronically maladaptive behaviors will display
terpersonal and intrapersonal level, and help resistance to experiencing emotions. Working
them recognize how they withdraw, psycholog- with their resistance—exploring what their re-
ically or behaviorally. Acknowledgment of the sistance is and the purpose of their resistance
(usually reported by clients as fears of disinte-
pain and suffering in their loneliness can assist
in developing a strong and clear connection.gration,
It going crazy or not knowing how to stop
their
will also alert the counselor to possible depend- crying) is empowering and provides
ency issues. In some instances, clients have greater self-awareness and will further enhance
rela-
tionships where the people involved are very

Brief Treatment and Crisis Intervention / 1:1 Summer 2001 71

YOUNG AND LESTER

the quality of the therapeutic relationship. The

Working with clients, rather than against their
understanding that they are not expected tochoices,
do is imperative.
what is too difficult for them and the willingness
on the part of the counselor to be patient and re-
spectful toward their difficulty will enhance Experiencing Repressed Emotion
their self-respect and enable more trust to enter
the relationship. Feelings are the physical sensation that allow us
to touch and express our emotions. The tension
and numbness that results from repressing emo-
tion, and the confused circular thoughts that
Awareness of How the Client Is provide distraction from our emotional experi-
Repressing Emotions ence, are known as suffering. This suffering can
become unbearable in suicidal clients. They
It is useful for clients to become aware of howwant their suffering to cease. Ventilation of emo-
they repress emotions. Such awareness allows tion can reduce the impetus to suicide. Rather
them to make choices on when and where they than experiencing their life in the moment, sui-
will be able to express their emotions. It can cidal
also clients talk about their life in a past or fu-
bring awareness that they are active in repress- context and remain detached from their
ture
ing emotions when they are not aware that they emotions. The release that comes from releasing
repressed emotion will allow organismic self-
are doing so. This increases the clients’ personal
awareness and power. A focus on their bodilyregulation, and trusting the self will provide the
sensations such as muscular tension in the freedom to choose life or death with clarity.
throat, neck, shoulders, chest, fist, or jaw, orWhen
an clients can contact some repressed emo-
awareness of how they regulate their breathing and feel supported and accepted by the
tion
in order to block their emotional experience counselor,
will they may realize their pain is bear-
assist them in gaining awareness of how they able, and they can achieve closure. They have
block emotions. It will also provide them with survived the crisis and gained new experience
the opportunity to get in touch with their emo-and skills.
tions and eventually express them. When cli-
ents become afraid of being overwhelmed by
their emotions, they can be reminded of the pro-
cess they employ to block emotion. This process
is an asset that can now be employed by choice
rather than as an automatic, out of awareness,
function. Even when clients choose not to allowGrounding
their emotions to be released, they have begun
When they have experienced some of their re-
to experience another way out of their suffering.
For clients to perceive another way through pressed emotion and taken risks with the coun-
their struggle that is within their own controlselor, they may need a sense of groundedness
provides hope and a reason to “hang in there.” and connectedness to their environment. Coun-
They will, in addition, have a new experience— selors need to be able to provide clients with a
one of being seen, respected, and acknowl- sense of potency when the clients feel “out of
edged. It can be very useful to assist clients control”
to and to be able to ground and soothe the
explore and acknowledge the energy and confu- clients when intense experiences have occurred.
The clients need to acknowledge that some of
sion that it cost them to repress their feelings.
their tension has been relieved and that they
can
relax. They are able to center or, in other words,
establish an internal locus of control, and they
need to acknowledge this.

72 Brief Treatment and Crisis Intervention / 1:1 Summer 2001

 Gestalt Therapy Approaches for Suicidal Clients

line is essential (Roberts, 1995). One should al-

Acknowledgment of Their Relief
ways be provided to clients.
When clients acknowledge the relief they have
experienced by ventilating safely while in the
presence of another, they have learned some- No-Suicide Contracts
thing new, and they can relearn how to trust
others. We need to acknowledge that they have Near the close of the intervention, the indi-
taken risks and chosen to let go a little (or a viduals’
lot). suicidal intentions must be reassessed.
This is invaluable for self-efficacy—the belief Simple questions on how safe they feel with
that one has mastery over the events of one’s themselves right now and which supports they
life have available to them should they feel suicidal
and can meet challenges. Belief about one’s in the future are useful. A “No Suicide or Self-
abil- Harm” contract (Drye, Goulding, & Goulding,
1973)
ity has a profound effect on that ability. This is until their next appointment (and in the
also a good check of the efficacy of the thera- event of cancellation) is useful only if the client
peutic intervention—a client who feels calmer is
and less anxious and who is not troubled by fully
in- involved in the negotiation. This needs to
cessant thoughts is likely to have experienced in-
an effective intervention. clude an agreement to use the 24-hour service
in
an emergency or if something unforeseen occurs
with their appointment. “No Suicide Contracts”
Self-Acceptance and Understanding are never watertight. They do serve to place re-
sponsibility for initiating help onto the client.
Self-acceptance and understanding are essen- The validity of such a contract hinges on the re-
lationship between the counselor and the client.
tial. When clients gain perspective of their situ-
ation and are able to feel compassion for them-
selves, rather than condemnation, they are less
likely to self-harm. Instead, they can begin to
hope. When they have experienced receivingDiscussion
empathy at the very depth of their being, they
will be more able to be empathic toward others. The major difference between the approach sug-
Empathy is crucial for constructive intimate re-gested here and the traditional person-centered
lationships. approach (which has also been called the client-
centered approach and active listening) is that
the person-centered counselor simply listens to
what the client is saying and reflects back the
verbal and nonverbal component of the commu-
Exploring Options
nication. In the approach suggested here, the
This is a good time to inquire what it is that counselor establishes particular areas that need
to be explored by the client and is alert to ex-
clients need right now and what they would like
to do. They may well be quite clear on what ploring these areas in depth when the client
they
hints or raises the surrounding issues. Thus, the
can do to get through, how they can soothe
counselor using the present approach would be
themselves, where they can go for support, what
more active and interventionist than the tradi-
they will and will not be able to cope with, and
what is tenable for them. Follow-up appoint- tional “passive” crisis counselor.
The approach, based as it is on Gestalt ther-
ments are crucial. When individuals indicate
that they do not have anyone that they can con- assumes that the counselor remains sen-
apy,
fide in, apart from the counselor, a 24-hour hot-

Brief Treatment and Crisis Intervention / 1:1 Summer 2001 73

YOUNG AND LESTER

sitive to the emotional and cognitive state of (Eds.), Crisis intervention and counseling by
the client and can make clinical decisions ontelephone
whether the client is able to integrate the mate-(pp. 89–104). Springfield, IL: Charles C. Thomas.
rial discussed and whether the experience and Daldrup, R. J., Beutler, L. E., Engle, D., & Greenberg,
L. S. (1988). Focused expressive psychotherapy:
ventilation of emotion will dissipate them. The Free-
approach places a great deal of emphasis on in- ing the overcontrolled patient. New York: Guilford.
tegration of polarities, ventilation and aware-Dattilio, F. M., & Freeman, A. (1994). Cognitive-
ness of emotion, and attention to loneliness, am-behavioral strategies in crisis intervention. New
bivalence, lack of constructive intimacy, and York: Guilford.
unbearable psychological suffering, which are Drye, R. C., Goulding, R. L., & Goulding, M. E.
all major factors in suicide. (1973). No-suicide decisions: Patient monitoring of
suicidal risk. American Journal of Psychiatry, 130,
Since clients differ in their ego strength, coun-
selors should initiate interventions with cau- 171–174.
Greenberg, L. S., & Johnson, S. M. (1988). Emotion-
tion, listening for cues as to how well the clients
ally focused therapy for couples. New York: Guilford
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Issues can always be flagged and put aside tem- Korb, M. P Gorrell, J., & Van De Riet, V. (1989)..,
porarily, to be returned to if and when the coun-Gestalt therapy: Practice and theory. New York:
selor decides that the clients can handle themPergamon Press.
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IL: Charles C. Thomas.
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O’Connell, V. F. (1970). Crisis psychotherapy. In J. Fa-
client and on exploring major blocks in dealing gan & I. L. Shepherd (Eds.), Gestalt therapy now
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(pp. 243–256). Palo Alto, CA: Science & Behavior
assumption is that people who have long histo- Books.
ries of being suicidal move away from the major Orten, J. D. (1974). A transactional approach to sui-
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57–63.
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As with Gestalt therapy in general, crisis in-Perls, F. S., Hefferline, R. F., & Goodman, P (1951)..
tervention using a Gestalt therapy approach is Gestalt therapy. New York: Julian.
Polster, E., & Polster, M. (1973). Gestalt therapy inte-
not suitable for those with severe psychiatric
grated. New York: Brunner/Mazel.
disturbance (Greenberg and Johnson, 1988).Roberts, A. R. (Ed.). (1995). Crisis intervention and
Some therapists would hesitate also to use time-limited cognitive treatment. Thousand Oaks,
Gestalt therapy approaches for suicidal clients, CA: Sage Publications.
but a Gestalt orientation may prove useful for Roberts, A. R. (Ed.). (2000). Crisis intervention hand-
some suicidal clients, and some Gestalt tactics book: Assessment, treatment and research (2nd
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74 Brief Treatment and Crisis Intervention / 1:1 Summer 2001