“Courage is not the absence of despair; it is, rather, the capacity to move ahead in spite of despair.”
– Rollo May
Jes had been dragged to see me by his erstwhile but still loyal girlfriend. Mandy had been along for a few sessions herself before finally getting Jes to see me.
She smiled sadly.
“You don’t really want to be here, do you, Jes, but maybe Mark can help…”
Jes had been well and truly battered by life. After losing his left leg in a motorbike accident, he’d become depressed.
Things had brightened up for him as he adapted and met his loving (but now ex) partner Mandy. Six months after meeting they’d moved in together.
“Jes seemed happy… but then you lost your job, didn’t you Jes.”
Physically present, but mentally over some distant horizon, Jes eventually nodded.
Mandy continued, now with the pain of personal sadness.
“He started drinking heavily and just sat in his room all day. Finally…” – and here she swallowed slowly – “he told me to leave. That’s when he told me he didn’t want to be with me anymore.”
Despairing clients often despair of everything, even of what they love.
So why did Jes end it with Mandy?
“I’m just a burden to others!”
It seemed clear to me that Jes’ reason for finishing with Mandy was not that he no longer loved her but rather that he felt like a terrible burden to her. And sure enough, in our very first one-on-one session he told me that he’d broken off the relationship not because he didn’t love her but because he did.
Sometimes clients feel that others will be better off without them. This may indicate danger. Feeling like we are a burden for others is a risk factor for suicide.1 But there was another worrying sign, too.
Sometimes when clients reach a point of despair, the complete loss of hope, they might start to give important things away.2
Mandy told me Jes used to love his vinyl record collection but had recently started getting rid of formerly prized items. He’d also given away his once treasured guitar. But he was also ‘getting rid’ of people – most significantly Mandy.
“You should find someone better than me!” he had apparently said to her when she’d asked him for the nth time why they had to separate.
The fact is, if you’re on a downward trajectory you don’t always want to take others with you.
Jes was slow to say much initially, but ultimately he did open up a bit.
Lost in the valley of despair
“She’s better off without me!”
Of course Jes had every right to end the relationship, but breaking something bad off because it’s not right for you and finishing something because you feel you don’t deserve it are two different things.
I was able to ascertain that Jes’ mood didn’t swing much; he didn’t feel agitated or labile, just “frozen” and “paralyzed”.
It takes motivation to act to kill oneself so, in a strange sort of way, the fact that Jes didn’t feel able to do anything may have been a suicide preventative. There does seem to be at least a moderate association between suicide attempt and emotional agitation as opposed to simply feeling flat inside.3 Agitation can lead to impulsive actions, and extreme agitation may be a predictor of impulsive suicide attempt.
When a client is in deep despair, I want to discover whether suicide is something they are considering or, worse, actively planning. I broached the subject with Jes, but in a certain way.
Is it a plan or just a possibility?
Some people believe that we should never raise the spectre of suicide with clients unless they do first. But if there seem to be some risk factors then it can be a relief for a client to air their feelings. I broached the topic with Jes in a very roundabout way.
“Jes, what do you feel would be the best solution for your feeling so despairing right now?”
His eyes sank floorward. He sighed like a punctured balloon.
“If I just wasn’t here!”
“And how wouldn’t you be here?” I asked.
“If I just vanished or killed myself!”
“Is that something you’ve ever thought about or planned to do?”
For the first time, tears moistened his clouded eyes.
“I mean, I would end this suffering… and the world would be better off too!”
“And what about Mandy? Would she be better off?”
“She doesn’t think she would be now, but she would be in the future!”
Jes assured me he had no plans to go through with it. He didn’t actually want to kill himself… he just didn’t want to be here.
Often, suicide is not so much about wanting to die but not wanting to live.
I used some of the following strategies to help Jes find the light again. I hope they prove useful to you when faced with a client in extreme despair.
Step one: Validate their feelings
There are few things worse than feeling misunderstood. Arguing with someone with low self-esteem as to why they should love themselves may be well intentioned, but it shows an insensitive dismissiveness of their reality.
We always need to join a client’s reality first before we can help them to some other place. Take the analogy of the blind lady and the busy traffic.
Helping in ways that actually work
If you see a blind old lady trying to cross a busy street and you want to help her get across, do you yell positive instructions to her, tell her why she is wrong to worry about crossing that chaotic street, and cheerfully tell her to get a move on?
Do you gently go and join her where she’s at, and lead her over to safety one careful step at a time?
Rather than immediately rip apart Jes’ reality by telling him he was dead wrong and he did have things to live for, what an all-round smashing guy he was and how fantastic life is, I simply sat with him for a while and fed back some of what he told me.
- “That must feel terrible!”
- “Do you sometimes find it hard to get out of bed in the mornings?”
- “Losing a job can feel like losing a part of your identity!”
- “I can’t even imagine what it must have been like to have your leg amputated!”
That wasn’t me being negative, but rather me crossing the street to join him on the other side before we got moving.
Clients can feel further lost when we minimize or dismiss their agonies.
But of course, if all we do is validate our clients’ feelings then it may be akin to just standing with the blind old lady on the busy street and nothing more. She still wants and needs to get to the other side.
Step two: Remind them there’s no shame in suffering
Jes felt bad for feeling bad. He felt guilty. Forlornly he told me how he knew other people were worse off than him and he was a “terrible person” for feeling so bad.
“It’s all so boring and self-absorbed!” he told me bitterly.
Likewise, we have needs for emotional wellbeing, including needs for meaning and purpose, challenge, but also a sense of safety, connection to others, and so forth. When life stops completing these needs for us, when we ourselves prevent them, or when they become blocked by others as in the case of abuse and bullying, then we inevitably suffer… and there is no shame in that suffering.
“By throwing away healthy relationships,” I suggested to Jes in a general way, “people further block the completion of their innate human needs.” I didn’t tell Jes he shouldn’t have dumped Mandy, I simply talked about “people” so that Jes could choose, or not, to apply this to himself.
The idea of universal primal needs appealed to Jes’ cognitive mind, but I wanted to appeal to his emotions too.
Step three: The classic self-compassion question
I asked Jes whether it was his fault he’d lost his leg in the motorbike crash three years before.
“Not at all! I was hit by a drunk driver. It was in the news at the time!”
“And was it your fault you lost your job?”
He wasn’t so sure about that, as he had been feeling a bit down and wondered whether it was the reason why he wasn’t working as well. I asked him whether his former employers had said they were letting him go because he didn’t work well enough.
“No, they were making lots of redundancies as the business wasn’t doing so well.”
Now I asked him the classic self-compassion question.
“Jes, I want you to think about what you’d say, and ways you’d try to help a really good and valued friend had they been the victim of a drunk driver and lost their job, even if those things had been somehow 100% their fault.”
Jes thought long and hard. Finally he said that he’d offer support, hug them, and “take care of them every day”. He’d tell them life could be good again, that people loved and liked them – and that he loved and liked them.
I left it at that. I didn’t suggest Jes should apply those sentiments to himself; I just let him fill the gaps himself.
We should aid client self-compassion any way we can. Many clients struggling with feelings of despair may also struggle with self-judgement and -criticism.
It’s important to encourage self-compassion and help clients reframe negative self-talk. Encourage them to treat themselves with the same kindness and compassion they would offer a friend or loved one.
This can sometimes be done within therapeutic trance, by having clients be their own wise advisor and friend.
But before I did this, I ascertained with Jes something fundamental.
Step four: Explore their values and goals
When clients are feeling lost or hopeless, it can be helpful to explore their values and goals. What is most important to them? What do they want (or did they want) to achieve in life? By exploring these questions, you can help clients regain a sense of purpose and direction, which can be incredibly empowering.
“What matters most to you in life, Jes?”
He said that he felt love was the most important thing and that work was also important to him – feeling he belonged.
I gave him a list of value words and got him to give each a value from 1 (very unimportant) to 10 (very important). He answered like this:
- Courage: 10/10
- Popularity: 4/10
- Decency: 10/10
- Honesty: 10/10
- Looking good to others: 2/10
- Being fair to others and oneself: 10/10
- Being rich: 6/10
- Being loving: 10/10
- Doing valuable work: 10/10
Jes seemed to quite enjoy the exercise, and I tasked him to just re-read this list each night before he went to bed.
At one point, half a dozen sessions in, I evoked the feelings of having first realized he was in love with Mandy and asked him about her qualities.
Next up, I taught Jes to relax and focus on the present.
Step five: Teach mindfulness
Feelings of despair often arise when clients dwell too much on past perceived failures or worry about future challenges or bleakness.
We can help clients stop and simply be by teaching them mindfulness.
Jes’ second session took place on a particularly beautiful spring day. He’d been lamenting the past and seeing no real future.
“What about now?” I asked him suddenly.
“What do you mean?” was his nonplussed reply.
The What About exercise
“Well, what about the colours from the light on the wall behind me? What about the warmth of the sun coming through the window? What about the sensation of your breath right now as you breathe into a calmer, more relaxed state of mind and body?
“And perhaps you can direct your attention to the sounds of those birds singing outside… And maybe you can be aware of the new spring warmth on your skin…”
I taught him self-hypnosis and suggested that at least once a day he stop and focus on the here and now – “because that’s what life is,” I suggested. “Simply here and now.”
I also peppered our sessions with therapeutic metaphor.
Step six: It’s always darkest just before dawn! (Use metaphor!)
Outside of hypnotic trance I talked about despair generally. I used Socratic questioning. Could it be possible, I wondered, for a person to despair even when they’re close to rescue or success? Could someone be infinitely more valuable and precious to others than they themselves believed or knew because of the state of mind they’re in?
I didn’t answer these questions, just put them out there as primers to metaphors.
The king learns from the spider
“You may be familiar, Jes, with the tale of Robert the Bruce and the wee spider.
“Legend has it that King Robert, while sitting in a cave feeling hopeless and dejected after a miserable and failure-filled year of being King of the Scots but unable to defeat the English invaders, was captivated by the sight of a tiny spider trying to spin its web.
“The web was almost finished when a drop of moisture destroyed the web. Undeterred, it started anew. Next, a vicious blast of wind tore down the almost-completed web. Time after time the spider kept trying patiently, never giving up, until finally the web was complete.
“Robert the Bruce was inspired by the efforts, patience, humility, and unwavering faith of the spider. The King of the Scots saw himself reflected in the spider’s struggle. After watching the spider finally succeed, Robert was inspired to return and fight the English despite overwhelming odds.”
I was surprised to see the merest hint of a smile on Jes’ usually sad face – coupled with a shy tear that rolled softly down his cheek.
Being in a cave is, of course, a metaphor in itself. As is ‘finding your way to the light’. I described how Robert the Bruce was finally able to ‘leave the darkness’ of the cave and face the world again, how he’d been helped in such an unexpected way, and how, reflecting Jes’ initial scepticism about coming to see me, Robert the Bruce had gained what he needed in a way he probably didn’t believe was possible before it happened.
I spoke, too, of frozen ground looking dead in winter only to produce abundant colour and life in springtime – the ‘hope of nature’ had been there all along! – and many more metaphors besides.
As Jes began to emerge from his own cave, something else was needed.
Step seven: Encourage action
When I was 18 I had an old rustbucket jalopy of a car. It was certainly a status symbol… just that the status was very low!
Anyway, it got to the point where I always had to park it on a steep hill facing down, because the only way to start it was to turn the ignition key and let it roll silently down the hill until eventually (with enough frantic prayer) the engine kickstarted and it finally got going.
So too, sometimes, with human motivation
It’s important to encourage clients to take action, no matter how small. Often the motivation comes after,not before, the action.
When we feel overwhelmed or hopeless, it’s tempting to give up and stop trying. But even little actions can make a big difference. Consider how simply observing a spider changed the course of history, at least if the legend of Robert the Bruce is to be believed.
Encourage clients to take small steps towards their goals, and celebrate their progress along the way.
Behavioural activation has been shown to be highly effective for depressed clients. I and Jes were lucky in that Jes did follow the small actions I asked him to take.
Because he’d enjoyed the deep relaxation so much, he developed some hope that he could feel better, which began to motivate him to do things. He reflected on his values each night before going to bed, and practised the mindfulness techniques I taught him.
With help, Jes cut down his drinking by at least 90% and began to walk and exercise again. He even began to buy back some of the vinyl records he’d sold!
So by validating our clients’ emotions, encouraging self-compassion, exploring their values and goals, focusing on the present moment, using therapeutic metaphor, and encouraging action, we can help our clients emerge from despair.
With time, patience, and support, clients can overcome even the most difficult challenges and live fulfilling, meaningful lives.
A question about a question answered with a question
One day Jes shocked me when he asked me out of the blue: “Should I ask Mandy to marry me?”
I thought for a second.
“Is she a good woman, and do you love her and does she love you?”
“Well, I guess you’ve answered your own question, Jes.”
How to Lift Depression Fast with Mark Tyrrell
You can train online in how to use solution-focused brief therapy for depression with Mark. Through a combination of video lessons, exercises, Q&As and worksheets, you’ll learn how to identify the root causes of your clients’ depression, challenge negative thought patterns, and create personalized action plans for recovery. With Mark’s guidance and support, you can take your practice to the next level and provide your clients with the best possible care. Join the course today and start transforming the lives of those struggling with depression. Read more here.
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