Inviting Death to Tea: Trauma-responsive Care for Assessing Suicidal Ideation and Behavior

Abstract
Inviting Dea to Tea focuses on exploration of the following questions:

How does assessment change when a plan and means are always present?
How do we balance a person’s dignity and autonomy with our ethical obligations to keep people alive?
How do we take care of ourselves when the attempt at this balance leaves us in a place of deep uncertainty about whether or not someone will live through the night?

Many models of suicide assessment discuss ideation and behavior as discreet events that are resolved through various techniques and the therapeutic relationship. However, for those who have experienced significant trauma(s), thoughts of death are more often a constant companion that is maintained to escape from incredible pain. This workshop encourages participants to actively engage with those who take the risk to share their stories of pain, fear, and a wish for the moments of suffering to end. Further, to be authentically present with a human who often feels trapped between the desire to die and society’s messages that these thoughts and urges are examples of “weakness.” Finally, we will discuss how common methods of evaluating suicide risk under-acknowledge therapeutic power imbalances, and how this can replicate abuse dynamics if not adequately addressed. Together, we will engage in vulnerable conversations about judgments, at the individual and societal level, with the focus on understanding how our thinking and engagement can be affected by bias.

This workshop will discuss how a history of trauma, particularly repeated experiences where escape is not possible, can affect the assessment and treatment of persistent suicidal ideation and behavior. Emphasis will be placed on understanding suicidal ideation and behavior as a communication strategy within a traumatized system, including curiosity about whether various parts may serve protective or regulatory abilities. Particular attention will be given to dissociative abilities, including how to increase the likelihood parts agree with plans to remain alive. Strategies for eliciting information across self-states, building collaborative suicide coping plans, and integrating stabilization techniques will be discussed, with a recognition how clinical care can be experienced as dangerous for those who have been harmed within relationships. Finally, participants will also be encouraged to consider how our reactions (e.g., fear, protective tendencies) interacts with our power in the therapeutic dyad and can influence our relational resonance and decision-making.

Inviting Death to Tea is a trauma-responsive relational model of suicide assessment, grounded in intersectional, feminist, and systems theory. It emphasizes the importance of common factors r and neuroscience-informed responses to traumatic event(s). In addition to discussing the foundational elements of responsive therapy for complex trauma and dissociation, this presentation will offer an expansion to the Triphasic Model (Herman, 1992), recognizing the complexities of building a therapeutic relationship when terror is present. We will discuss reasons to be thoughtful about the use of common words, such as safety, building a deep understanding of the risk associated with talking about the thoughts and behaviors that are most often relegated to the shadows.