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Health Care Providers > Addressing Suicide > Model Dialogue I

Model Dialogue I

The situation - Radha is an 18-year old girl. She had an overdose of ayurvedic tablets, which were prescribed to her brother who was suffering from some bowel problem. This was the information that was written on her indoor medical papers.
Technique 1 - Getting started
It is usually good to start the dialogue with introducing the centre, ourselves and why a need was felt to talk to the woman attempting self harm. The opening dialogue with the woman/girl need not focus on her attempt to end life.
Counsellor: Hi, Radha, how are you feeling?
Radha: I am ok.  (Doesn't look at the counsellor, playing with indoor medical papers.)

Technique 2 - Observing verbal and non-verbal communications.
Such observation may give more clues about her emotional state, comfort/ discomfort.
Counsellor: I am_______. I work at this centre. In this centre, we meet a number of women and girls of your age. They may be facing some kind of problems at home, but may not find any one to confide and share. Could you trust me and tell me if you are facing any problems at home? (Pause). It will remain only between you and me.
Radha: (Smiles awkwardly but says nothing).

Technique 3 - Starting the conversation with non-threatening issues.The counsellor has used day mapping as a technique of counselling.
The counsellor can gauge by the smile that she may want to share something, but not just yet. Hence it may be good idea to shift to some other issues connected to her life. The counsellor can ask the girl to elaborate on her time table at home such as when does she get up, what are the daily chores that she does, when does she get time for herself, etc.
Counsellor: Do you go to school?
Radha: My father_______. well I studied
till 5th in Marathi. Now I am at home only.
Counsellor: What do you do at home? Do you have friends?
Radha: I cook, clean. I have two brothers; I have to look after them too. Where is the time for friends?
This helps the Counsellor to get to know the girl better as well as puts the girl at ease by discussing aspects of her routine life. Through this dialogue, the Counsellor also made her own analysis that Radha liked going to school but has been asked to leave it. She is overburdened with responsibilities of managing the household and taking care of her younger brothers.

Technique 4 - Probing in the attempt to suicide sensitively
The Counsellor has to be aware of the fact that most women have inhibitions to talk about the attempt to end life. They feel awkward, ashamed of themselves. Some women also find it extremely painful to even recall the incident. Most relatives, friends, etc, would have preached to the woman about her wrong doings and also warned her about any such future ideation. Therefore, the Counsellor needs to explore the attempt gently and sensitively. It is pertinent that the Counsellor understands what led the woman to take this step.  
Counsellor: Radha, I know that most  people would have scolded you about this accident/event. But I have a feeling that your consumption was not an accident. I think that you are in pain, some pain that you are afraid to share with me. Can you trust me?
Radha: (remained silent for a few minutes, tears gushing through her eyes). I am in love with a Muslim boy Rafiq, but my father is against it. He says that he will get me married to some other boy soon. What choice did I have?

Technique  6 - Ventilation
When the girl is crying, it is important that the Counsellor does not jump to rescue her, but allows her to ventilate her feelings through crying.

Technique 7 - Asking open ended questions
Counsellor: Radha, How did you feel about your father's behaviour?
Radha: no.  He is my father and he is doing the right thing.

Technique  8 - Dealing with feelings of guilt and anger with empathy
Counsellor: I understand that you like your father, but you could also feel bad that he does not understand you. Do you think it is wrong to feel bad or angry towards your own father?
Radha: Actually, I get so angry at times, that I feel like crying, I feel horrible inside.
Counsellor: Radha, it is all right to feel angry towards people you love. The reason we may be feeling angry is because we feel controlled by them. At times this control over us gets too hard to tolerate
Radha: Ya.

Technique  9 - Sensitive exploration regarding her future
By this time, the counselling must try to explore feelings of shame, guilt, regret over having survived the attempt,  what is she thinking in terms of her immediate future.
Counsellor: You will be discharged from the hospital today evening. How are you feeling about going home?
Radha: I am wondering what everyone would say about me.
Counsellor: What do you think your neighbours or friends would say?
Radha: Everyone would stare maybe. My friends would ask me why I did it? I don't know, I am just uneasy about it.
Counsellor: I can understand that it may be difficult or rather awkward for you when you go back. But think about it this way, you have a second chance to live and you have to tell yourself that you have the strength to move forward. I know that it is tough to forget what has happened.
Radha: Yes.

Technique 10 - Helping the woman reflect on her relationship
There is comfort established between the girl and the counsellor, and the girl has still not talked about her relationship with Rafiq. The Counsellor can try to explore this aspect and check for the girl's readiness to discuss the same.  
Counsellor: Are you worried about your relationship with Rafiq? What have you thought about it?
Radha: I don't know. Now my father would be stricter than before, I don't know, I haven't thought.
Counsellor: Radha, you have been through a lot in the past two days. You may need time to think about this relationship. Do you think taking some time would help you come to a decision?
Radha: But my father would get me married before that (protests).
Counsellor: Do you think it may be a good idea to talk to your father about this situation?
Radha: (still thinking)

Technique  11 - Safety assessment and safety planning
It is important to assess the safety of the girl and draw a safety plan along with the girl, lest such situation occurs again.  
Counsellor: I can see that you are still thinking, Do you want to come back to discuss this aspect later?
Radha: Yes, I need some time. I have still not thought about our relationship. But the thought of marrying anyone else is unbearable. I just cannot imagine
Counsellor: Radha, I can see that this situation is really very painful to deal. But however painful it may seem, you know that you can overcome it, isn't it?
Radha: I think so.
Counsellor: When a feeling of despair, anxiety or sadness comes to your mind, or you think that there is no good in living, the best thing is to leave that situation for a while. You can come to the centre and share your feelings now that you know me. If you cannot do that, just go out for a walk, meet a friend, listen to music. Remember all that we spoke of today.
Radha: Ya Ya, (seems hopeful) I feel I can come here.
Counsellor: Radha, can you tell me what are the painful situations you foresee?
Radha: Rafiq and I not getting married, my father beating him, I cannot bear to think of all this.
Counsellor: Such recalling is painful, but you know that an attempt to suicide can have health consequences that we may not realise. The consumption of rat poison, cockroach-killing chalk, phenyl, kerosene can be extremely damaging to the body and if the attempt is unsuccessful there may be a life-long impairment like partial loss of vision, problems in joint/body movements, paralysis at times and so on.
Radha: (looks away).
Counsellor: I am not trying to scare you but most of us are not aware of these health implications that is why I am sharing this with you.
Radha: Yes.

Technique 12 - Helping her recall important people whom she can turn to in a difficult situation.
Counsellor: Please seek help in such situations. We will always talk to you. Do you have friends in the community? Who are the people to whom you can turn to when you are feeling low?
Radha: There is Shama, but she is going to get married soon. The one good thing is that she will come closer to where I stay after her marriage.
Counsellor: Very good, can you talk to her freely?
Radha: Yes, but I wonder if we can after she is married.
Counsellor: We all know that marriage brings a lot of changes in our life and also responsibilities. But do you think that in a situation like this you can turn to her?
Radha: Yes, yes, my father told me she wanted to come to the hospital. My mami (maternal uncle's wife) is also very fond of me. I had confided in her about our love affair.
Counsellor: See, Radha, you have these people's support even in tough situations. 

Technique 13 - Helping the woman reconnect with life by asking her hobbies.
The counsellor can help the woman to think of ways to picking up threads of her life. This would help her feel confident. One way of doing this is by mapping her daily timetable.
Counsellor: What is your day like? What time do you get up?
Radha: I have to get up at 6 a.m. no actually 5. 30 a.m. I fill water with the neighbourhood women. I make some chapattis and vegetable for Raju and Sanju. They have to leave for school by 9.00 a.m. Then I am home all day, watching TV. Father does not like it if I go out.
Counsellor: There must be some things that you like doing a lot, can you tell me what they are?
Radha: Nothing much, I draw some silly flowers here and there, on the walls at times. I like to paint. Some of my friends also go for this embroidery classes. I try to pick up from them.
Counsellor: That is wonderful. I would really like it if you could make a greeting card and show it to us at the centre. If you are interested you could make some cards. There are some places where you can sell cards. You can also go and learn more designs from there.
Radha: (Her face brightened somewhat, shyly).  I could make one card and show.
Counsellor: I could talk to your father about this occupation.
Radha: (Her face falls). Father may not allow me to come. There is work at home also.
Counsellor: You can chalk your day in a manner that you get two hours on alternate days and meet us. I will talk to your father and tell him that this is a hospital procedure. However, this also means that you are taking the responsibility of coming to Dilaasa every alternate day, right?
Radha: I will try my best.
Counsellor: We also have meetings with women once in a while. You could come and attend them. That way you can also make friends with more people if you like.
Radha: Yes, I will try to come.  

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