Abandon All Hope: Mere Psychotherapy, Part 5

There is nothing and no one to hide behind here. These are dangerous and sacred waters to tread in.

"Where there is no hope, it is incumbent on us to invent it." ~ Camus"

"Live right, he reminded himself, and have faith that good things will flow from you even if you never learn of them" ~ Irvin Yalom, The Schopenhauer Cure

What do you say to a fifteen year old who has made four legitimate suicide attempts in the last five months?  I have no idea, bu this is what I ponder as I pull into the driveway to meet Elliot.  Elliot is far from the first suicidal or traumatized patient I've worked with.  What feels different to me is that the "stakes" are higher.  There is no safety net of a hospital or clinic setting.  This is outpatient, in-home therapy.  I have a supervisor., but am seeing Elliot twice per week and am the "first responder" for all intents and purposes.

Elliot looks like an active, healthy, fifteen year old girl, donning sweatpants and an over-sized t-shirt, sitting sheepishly sunken into the couch as I collect clinical history form her father.  Elliot is actively suicidal, ha…