Understanding Suicidal Ideation and Self-Harm and How Counseling Can Help

The topics in this article are sensitive in nature and are brought up in sessions quite often. Some clients are really hesitant to bring this up out of fear or embarrassment. This is true for Christians as well.

In this article, I aim to provide you with some information so that you will better understand what you or someone you know is struggling with and will have a better understanding of how counseling can make a difference.

These actions are an attempt to deal with something emotional. When we are in physical pain, we know what to do. If you have a headache, you take a pain medication, and if you have a cut, you put a Band-Aid on it.

But with emotional pain, there is no Band-Aid or pain medication to fix, relieve, or cure it. We sometimes attempt to look for ways to escape. Someone begins to struggle with suicidal ideation or self-harm when that load becomes unbearable.

What is suicidal ideation?

According to Merriam-Webster, the definition of “suicidal ideation” is “the act of thinking about or a state of preoccupation with ending one’s own life, the act of considering or planning suicide.”

What is self-harm?

“The act of purposely hurting oneself as by cutting or burning the skin as an emotional coping mechanism.” I believe some ways are used for self-harm that may not initially feel like harm or be seen as a problem.

How does counseling help?

• Counseling provides a safe place to talk about and work through personal thoughts that are difficult to share with friends or family.
• Increase your awareness of contributing factors
• Assist you in gaining healthy coping skills and stress management
• Support you through it.

I have developed a number scale to assist me in determining where clients are in their struggle.

Stage 1 – the thought is fleeting, in one ear and out the other.

Stage 2 – The thought is there, and then you tell yourself, “No, that’s a bad idea.”

Stage 3 – The thought comes in, and you really struggle to get it out.

Stage 4 – You begin contemplating your options and making a plan.

Stage 5 – An attempt is made.

No matter where you are in this progression, now is the time to begin addressing it and getting some assistance. Depression, suicidal ideation, and self-harm are often hidden from even those closest to you. When the true struggles are hidden, the person struggling then feels like no one notices them or their struggle, but they have withdrawn physically and often emotionally from those around them who do care.

As a counselor, I want to honestly know where you are. Some weeks you may be at stage one, and then the following week you may be at stage three or higher.

Clients are afraid to bring up these topics to close friends, family, or even their counselor for fear of criticism, judgment, or fear of being placed in a psychiatric hospital. The fear of worrying family members or friends can also keep people from sharing it with those they love. Counselors are not prescribers, but sometimes it is good to receive and discuss your concerns with your primary physician to rule out physiological causes for your depression.

Where do I start?

When we are really struggling with something, we sometimes don’t know how to pray or what to say. I am sure you have asked Him for help with the depression, anxiety, and thoughts that are overwhelming you. But have you said to Him, “God, I need you.” “God, I invite You to take over my mind, guide me, and direct me to see myself as You do.” “Lord, I am struggling and don’t know what to do next.”

When you don’t know what words to pray, say His name: Jesus. Pray “God, I can’t do this alone and invite You to ‘search me, God and know my heart, test me and know my anxious thoughts. See if there is any offensive way in me and lead me in the way everlasting.’” (Psalms 139:23-24)

This verse reminds me to bring my anxious thoughts and depression to Him. Just as earthly parents, we want our children to come to us when they are hurting in any way; our Father wants us to do the same and to talk to Him about it.

Think of concrete things – Our brains are created to think of concrete and abstract separately, meaning that we can’t think of both at the same time. Since this is how we are made, we can work to focus on concrete things when we are struggling with emotional thoughts or thoughts of harming in any way.

These can include, but are not limited to, physical activities like walking the dog, baking, fishing, and describing your environment around you. What do you see and what can you touch? 2 Corinthians 10:5 says, “We demolish arguments and every pretension that sets itself up against the knowledge of God, and we take captive every thought to make it obedient to Christ.”

Philippians 4:8 says, “Finally, brothers and sisters, whatever is true, whatever is noble, whatever is right, whatever is pure, whatever is lovely, whatever is admirable – if anything is excellent or praiseworthy – think about such things.” The apostle Paul was the author of both of these passages.

Do you think that he struggled with his thoughts? I do. Although we don’t know what he struggled with specifically, it is evident that he knew that he needed to turn his thoughts toward God. Remember you are “fearfully and wonderfully made” even when you don’t feel that you are. (Psalm 139:14) Take the first step and make an appointment to see what God will do as you begin your journey of healing and renewed joy.

The counting-down technique helps to switch your thoughts from the emotional to the concrete. Counting down instead of up automatically slows down your breathing because it is natural to count down slowly. You can count down from ten as many times as it takes to slow down your breathing.

People who are struggling with these thoughts more often than not don’t want to end their life but want IT to stop. Our goal as counselors is to determine what “it” is. It may be feeling inadequate, unappreciated, trauma-related, or an unhealthy self-image, just to name a few.

Focus on the Family is a Christian organization that provides a Christian worldview through radio, magazines, books, and other resources. Focus on the Family lists some of the thoughts that contribute to suicidal ideation and self-harm.

“Things are never going to get better”

Statements that use the words “always” or “never” are dangerous. When we invite Jesus to walk with us, He will guide us through the journey and give us strength. True change is only possible with God.

“I need to be punished”

Some begin to believe that they deserve to harm themselves to “pay” for what they have done wrong. No one deserves to be punished in this way.

“God has abandoned me”

Loneliness and feeling like God doesn’t listen or care comes from a deep depression and pulling away from God and others. God promises in Scripture, “He will never leave you nor forsake you.” (Deuteronomy 31:6)

“I’ll never be able to change”

This is anxiety speaking. Feeling like you will never change is the fear of working to change and not being successful at it. There are plenty of examples in Scripture of people making major changes in their lives. Saul went from persecuting Christians to sharing Christ in a bold way as Paul.

“I’m unlovable”

This is an internal message that “plays” in your head, which tells you that you don’t deserve to be here or be loved. Psalms 139:14 reminds us we are ‘fearfully and wonderfully made.”

“I feel like God won’t forgive me”

The feeling that God won’t forgive you has nothing to do with God and all to do with your perception of yourself as being worthy of forgiveness. God sent His one and only Son to die for your sins. He didn’t send His Son for some but for all. John 3:16 says, “ For God so loved the world that He gave his only begotten Son that whoever believes in Him will not perish but will have eternal life.”

Suicidal ideations and self-harm typically do not “come out of nowhere.” Sometimes we are experiencing depression and cannot label it as such, or do not realize the severity of it, dismissing it as “stress.” It builds and becomes a random thought, and then occurs more frequently, and then becomes a fixation.

For Parents

Teens can feel that they can’t share this struggle with their parents for fear of rejection by minimizing it, reminding them what they should be thankful for, or for fear of their parents sharing it with family or friends, or having them admitted to a hospital. If you see signs of depression, be willing to start the hard conversation. If they are not willing to open up to you, encourage them to attend counseling and to find someone they can trust.

Next Steps to Overcoming Suicidal Ideation or Self-Harm

Whether you are a teen or an adult, I don’t want you to walk through this alone. God is with you, and I would be honored to walk alongside you. I have seen many clients who have experienced a lighter load just by sharing their inner thoughts and struggles in this area. I want to guide you through the path to change your perspective of yourself and how God sees you.