Suicide and attempted suicide have been on the increase in the last decade. Concern over suicide has also increased over the years. Suicide among teenagers and younger children has become a major concern in mental health.
Many reasons for suicide and attempted suicide have been put forth. We hear a lot about the external factors that are major contributors to the cause of suicide. These factors, including drugs and alcohol, loss and grief, divorce, peer pressure, reduced job opportunities, economic competition, and world tension have all been used to explain the suicidal scenario. The external, contextual, environmental, interactive factors are probably stronger stressors now than in previous decades. Yet, most teenagers seem to handle these stressors well. All of life is within a context. How we handle the impact of various stressors might be a more important consideration than the stressors themselves.
The writers of the third force of psychology, Abraham Maslow, Carl Rogers, Victor Frankl, William Glasser, and many like them, as well as world renowned family therapist, Virginia Satir, postulate that human beings are driven by two forces in life. The common force which we ofien hear about is our drive to survive. With it is a second force, namely. the force to evolve, to grow, and to develop. These two forces are considered to be positively directional, and result in fulfilment, peace of mind, and happiness. In Satir terms, these forces also motivate us to develop higher self-esteem, personal responsibility, the ability to make choices, and greater congruence.
This view of people sees us as having a life energy that strives to help us realize our potential and, in ultimate terms, moves us towards self-actualization.
Much of psychology, outside Qf the mechanistic and behavioural views of Freud and Skinner, has accepted reality as a process of meaning-making through personal choice. In essence, we create our own joy and our own misery.
Looking at the Satir Model more closely within this optimistic, positively directional view of development of potential, we might build a picture with which we can understand the dynamics of and, possibly, be more successful in preventing suicide.
The Satir Model, as developed by Virginia Satir, combined the interactive and intrapsychic processes. The model, therefore, looks at the family-of-origin and family context, as well as the internal, personal experiences of a person.
If life, at the most basic level of existence and essence strives to help people to become, to develop, to grow, to self-realize, then we must question what happens externally and internally with a person to have them choose death instead.
The Satir Model, like other models, stipulates that we all have basic needs that require attention. Keeping within her positive mind frame, Satir calls them "yearnings." They are similar to the basic drives suggested by Glasser, Rogers, and Maslow: to love and be loved, to be accepted, to be acknowledged, to be validated, to belong, to be worthwhile, and to have "meaning". According to Satir, if these yearnings are fulfilled, then the human being can achieve the goals of becoming a positive choice maker, being more responsible for one's internal and external world, being more "whole" or congruent, and experiencing higher self-esteem.
The Satir Model has some basic premises that might fit in our exploration of suicide. Satir believed that human beings have the internal resources they need to survive and grow. She also believed that internal change is always possible, even if we do not have control of our external world. She taught that the problem is not the problem, but how we cope with the problem is usually the problem. She found that most people choose familiarity over the discomfort of change, especially during times of stress. She also advocated that therapy needs to focus on health and growth possibilities instead of pathology.
Additional Satir therapeutic beliefs, in brief, are:
parents often repeat the familiar patterns from their growing up times, even if the patterns are dysfunctional.
people are basically good; they need to find their own self-worth and their treasure as worthy human beings.
healthy human relationships are build on equality of value, even if roles are different.
feelings belong to us and we all have them; we need to manage them and enjoy the positive ones.
the past events cannot be changed, but the impact which the events have on us in terms of behaviour, feelings, perceptions, expectations, yearnings and our experience of Self can be changed.
much of our life operates below the conscious awareness and understanding level, especially when under stress.
we are all manifestations of the same life force and we can be connected at that level during meaningful, deep moments of therapy.
the symptom is the carrier of the external and internal dysfunction.
successful coping is the manifestation of a high level of self-worth and failure to cope is the manifestation of a low level of self-worth or self-esteem.
Satir identifies four ways in which we cope with stress which are dysfunctional. She refers to these are placating, blaming, analysing (super-reasonable behaviour) and distracting (irrelevant behaviour). According to Satir, people learn these ways of coping with stress within relationships as a way to survive and protect ourselves.
Placating is used to cope with stress when a person discounts him/herself and pleases others in order to get their approval, acceptance and/or love. This person usually avoids conflict and hides his/her hurt and anger from others. Often, on the surface, they seem pleasant and helpful, but inside they may resent being unappreciated and taken for granted.
Blaming is used to cope with stress when a person discounts the experience of another person by criticizing and controlling them in order to feel better about him/herself. This person expects others behave in ways to help him/her to feel worthy. Often, on the surface, they seem angry or demanding, but inside they may feel lonely and misunderstood.
Analysing, or super-reasonable behaviour, is used to cope with stress when a person keeps things on a rational level, ignoring or discounting the feelings of him/herself and others. On the surface, this person may seem insensitive and detached, but inside they often are easily flooded by emotion and may feel afraid and insecure.
Distracting, or irrelevant behaviour, is used to cope with stress when a person needs to withdraw from overwhelming internal pain and fear, and from external connections with others. On the surface this person may seem unableto focus, he/she may act like a clown and seem quite disruptive. It is often very difficult to connect with these people in any deep or meaningful way.
The point is, without expanding further on these coping stances, people under stress will try to meet their needs and survive in a way that seems plausible to them at the time. Unfortunately, the coping often turns into one of these dysfunctional patterns.
To do therapy and bring about change, the Satir Model promotes and advocates the use of interactive processes which address the relational dynamics between and among family members, and the intrapsychic process of the individual.
The metaphor which Satir uses to access the internal process of the individual in order to bring about change is that of an Iceberg. The concept conveys the view that most of our experience is "below the waterline" of the iceberg, and if change is to take place, the therapist will need to access the internal parts of the person, not only at the surface level, but also at the subconscious level. This process usually requires considerable skill, first, to surface, and second, to transform the dynamics.
The picture of the Iceberg metaphor looks like this:
_____________Behaviour_____________
waterline Coping
Feelings
Perceptions
Expectations
Yearnings
SELF
What offen happens when we look at our clients is that we note all of the behaviours, the tip of the iceberg, and we proceed to focus on them. Behaviours common to at-risk adolescents include rebelliousness and defiance, alcohol and drug use, sexual acting out, withdrawal and isolation, delinquency, eating disorders, and school failure.
What this system advocates is looking below the "waterline" of the iceberg and surfacing and transforming the negative aspects of the client's experiences. For example:
1. Surface and transform negative feelings such as
hopelessness, worthlessness, guilt, depression,
sensitivity to criticism, fear,hurt, anger, and
rage.
2. Surface and transform perceptions of self and
others such as worthlessness, rejection,
abandonment, being a "loser", being unlovable,
being unacceptable, being "not good enough",
needing to be perfect.
3. Resolving unmet expectations to be accepted, to
be heard and validated, to be included.
4. Satisfying yearnings such as to be loved and
lovable, to be accepted, to be acknowledged, to
belong, to be connected, to be free to grow.
5. Being in touch with and accepting one's Self,
being in harmony within the Self and with others:
having peace of mind, wanting to live, having
high self-esteem, taking responsibility, having
meaning in life.
Using the Satir Model in treating clients, I suggest the following:
1. Have a philosophy that views people as wanting to
grow, develop, evolve, and live in a state of
internal and external harmony.
2. Have a philosophy that people have the resources
internally and, with help, available externally,
to cope successfully.
3. Make contact with the person (client) at a deep
level, as the Iceberg metaphor indicates.
4. See the whole system, at least the family members,
as part of the client, and work in a systemic
perspective internally and externally.
5. With good contact and rapport with the whole
system, set positively directional goals that
will help each member of the system meet their
psychological, emotional and perceptual needs.
6. Work on resolving the massive past unfinished
business in terms of impact on the client's
internal experience.
7. Teach people to be less reactive when needs are
not being met, to become responsible for their
reactions and then change to the point of taking
care of their own feelings.
8. Help clients resolve their unmet expectations and
take greater responsibility in their life
experiences.
9. Help build a positive supportive interactive
system for each client member.
10.Work constantly on change: changing the internal
process towards a positive, responsible,
meaningful life.
11.Transform the negative energies and internal
conflicts by integrating the various parts and
directing the life force towards wholeness,
harmony and meaningfulness.
With suicide prevention, the shift that therapists need to make is a third level of change which requires a new, deep decision to live. This does not mean convincing a client not to commit suicide; rather, it means helping the client to make a decision to live, to release the healing life energy and to reclaim and take responsibility for one's inner meaning of life.
Suggested Readings
Frankl, V.E. (1963). Man '5 Search for Meaning. New York: Pocket Books
Glasser, W. (1998). Choice Theory. New York: Harper Collins.
Maslow, A.H. (1970). Motivation and Personality. New York: Harper.
May, R. (1981). Freedom and Dignity. New York: Doubleday.
Rogers, C. & Dymond, R. (1954). Psychotherapy' and Personality Change. Chicago: The University of Chicago Press.
Rogers, C. (1961). On Becoming a Person. Boston: Houghton-Mifflin.
Satir, V. (1983). Conjoint Family' Therapy. Palo Alto: Science and Behavior Books, Inc.
Satir, V. (1988). The New Peoplemaking. Palo Alto: Science and Behavior Books, Inc.
Satir, V., Banmen, J., Gerber, J., & Gomori, M. (1991). The Satir Model. Family Therapy and Beyond. Palo Alto: Science and Behavior Books, Inc.
White, J. & Jodoin, N. (1998). Before-the-fact Interventions: A Manual of Best Practices in Youth Suicide Preventions. Vancouver: University of British Columbia.
parents often repeat the familiar patterns from their growing up times, even if the patterns are dysfunctional.