Joan Freeman of Pieta House in conversation with Thérèse Gaynor

Thérèse Thank you so much for meeting me again Joan especially when I know how busy you are so maybe we’ll just get stuck in and see where it goes…

I understand that while Pieta House officially opened in January 2006 you had begun the work of creating the centre some years before that.

Joan Yes, sadly I had a personal experience of loosing someone I love to suicide and the shock of this left me devastated. I went through a grief process that anyone who loses someone to suicide will experience but I felt I had to do something. I started reading everything I could on suicide and after a long time of reading and researching I knew that I had to find a way to be a voice that changes how society thinks about suicide and self harm. So with the support of my husband, and a mortgage we bought this place, here in Lucan.

Thérèse And in making this decision you chose the name Pieta House, can you say a little about what influenced you using la Pietá?

Joan  Well, the sculpture of the Pieta created by Michelangelo is the inspiration and I don’t know if you know this but it’s the only sculpture that’s signed by him and it’s signed going across her sash. There have been lots of replications of the sculpture with our Lady holding and cradling the dead lifeless body of her grown son but none of the replications captured what Michelangelo captured and the story is that her shoulders are very broad and her lap is very deep so that she could cradle this grown man, after all, he still was her baby. But not only that, what the others couldn’t capture was his depiction of her majestic acceptance of her son’s death. Her face is very serene where as in other sculptures you’ll see that her face is quite tortured looking and so, while the original does capture human suffering there is a serenity to it. As the story goes, he signed this one because of what he had captured in the expression of our Lady cradling her beloved son and he didn’t want this mistaken with the tortured expression assigned to her by other sculptures at that time.

It was one of those light bulb moments for me, and as I said, because through my own personal loss I was thinking what can be done to help people and I was driven by guilt to be honest. So, when I was reading about Michelangelo and La Pietá, I thought that’s what we need to help the broken lives of people and it’s funny you know; throughout the years since, that image of a mother holding her dead son keeps reoccurring all the time.

Thérèse Are you saying that it was directly because of your feelings of guilt that you did do something?

Joan Well, I think that guilt is attached to every death regardless of whether it’s suicide, we all can feel some amount of guilt but with suicide it’s more so because you’re feeling so helpless and you’re wondering could you have prevented it. And in my case I’m sure I could have prevented it but I wasn’t aware of how to prevent it.

I used to meet my family member every couple of weeks and we’d sit talking for a couple of hours and you know I thought I was great for doing that and when I think of how tortured she was and how she suffered… so that will never go, that terrible guilt over her suffering.

Thérèse Clearly I can see how upset you are as you speak about your family member and remember their suffering…

Joan Nine years on, it’s as fresh today as it was the day it happened.

Thérèse And even through your loss, it’s quite wonderful to hear you say that you feel you could have prevented it.

Joan That’s why I started here because I thought it can be prevented, suicide can be prevented. Certainly she would have attempted it again had she survived, there’s no two ways about it but that’s because she wasn’t given the right help. If she had gotten the right help she would have survived.

Thérèse And what for you is the right help?

Joan Talking… talking is the right help, compassion, respect, dignity – all those are the right things to help somebody – not to be afraid as a therapist because there is nobody more afraid than the person who is suicidal so you don’t want to add your own fear to the pot. While we might feel afraid for a client, we can’t be afraid for ourselves when we’re with them and this difference is very important.

I have no doubt that it can be prevented because we have an innate need to survive, in all of us there is an instinct to survive and so we’re going against nature. Suicide isn’t about dying; it’s about ending pain and ending despair.

Thérèse I’m thinking about a particular situation for a family where the family truly feels they had no sense of anything beforehand, no indication of despair or hopelessness – is there something different about an impulse response, impulse suicide?

Joan Each situation is different and it’s difficult to know because so many things could be going on; environmental factors; situational factors; if there was alcohol or drugs involved this could make it an impulsive act. Or it may be about looking at the weeks beforehand, did something in particular happen or into the future, was something significant about to happen… might the person have felt trapped in a situation not knowing how to get out of it… so many possibilities and when anyone is in pain they’re grasping for some sort of explanation.

There is what we call a suicidal trance which can last for up to about fifteen minutes. I have often spoken to people who said you know everything was fine, went home and without even knowing what might have triggered them, they would go into this suicidal trance. It’s like tunnel vision where you’re not looking at anything other than that tragic step at the end of those few minutes. It’s not that common but it can happen.

Thérèse If it’s okay I’m going to move our conversation toward the therapeutic work you do here. As a psychologist Joan, do you believe that solution focused therapy is the most effective approach when working with someone who is suicidal or is self harming? And did your application of this approach help when you were looking for funding and support?

Joan No, nobody asked anything about the approach we’re using, but the longer I go on in this, I think that an awful lot of therapy needs to be that way. I’ll give you a prime example – I was giving a talk in Belfast and a nun came up to me afterward and said; I’m living in a community where the average age is eighty and I’m the youngest and for the last few years I’ve been finding it increasingly difficult to cope with that. She said; I’ve been going for therapy and I haven’t been getting any better and having just heard you, I now know why – because I’ve been dealing with the past all the time, mistakes of the past and so I’m stuck. I’m going there every week to talk about all the things in my life, one thing after another and what I need to be doing is looking at where I am now. And that’s how we work, we look at the present and the future and with whatever is coming up we try to apply the solution focused approach.

Even if you think about couple counselling, if you keep going over the last twenty years, raking up the past and for what. If my past isn’t what’s affecting my present then why would I need to rake it up? You know, if my husband were to consider some of the crap I gave him over the past thirty years it would just destroy our relationship. I think we need to re-think sometimes our approach to therapy, everything doesn’t have to be analysed to death and the idea of long-term therapy needs to be considered and re-considered based on the present and what the issues in the present are.

Thérèse Without minimising any persons experiences from their past I guess you’re suggesting that one’s past has relevance only in as much as it may be affecting one in the present.

Joan I’ve often heard someone say that a trauma they experienced in their past isn’t a problem for them right now, and when they come to us in crisis feeling that somehow they have to talk about the trauma, they have to go to the past in order to move to the future and I don’t believe that’s necessarily the case.

Thérèse So what is it about solution focused therapy that you believe makes it the most appropriate and effective approach to use when working with the issues of suicide and self-harm?

Joan There are a few things we do when making an assessment – we look at three distinct areas of the person; emotionally, physically and spiritually and what we mean by that is potential. So physically we look at whether they are eating, sleeping, physically active – are they for example, physically washing themselves and so on. Emotionally we consider if they are in a relationship; how that relationship might be or has a relationship just finished, do they have support from friends and family and so on. And then spiritually; what gets them out of bed every morning; are they working, are they unemployed or are they in a job that they don’t like which they’re exposed to for maybe eight hours a day, are they involved in their community – have they a reason to get out of bed in the morning…

Thérèse So you place the psychological wellbeing within the spiritual?

Joan Yes its part of this. There is also another exercise we do when we do an assessment and we call it the nine boxes – where we divide a person’s life into nine boxes which can add up to a very contented life if they are wholly involved in the aspect of each box. There is a friendship box, a family box and one of the most important boxes is; giving back – because when we give back, we stop looking at ourselves and look outwards and that’s when we’re distracted and less absorbed with ourselves but it’s also when we’re feeding our soul because we’re doing something for somebody else and that makes us feel really good.

So it’s that type of approach that we would use and remember it’s only crisis that we’re dealing with, it’s not long term therapy. If someone is here because of a relationship breakup, we’re not here to fix their relationship; we’re here to help them to get strong enough to fix their relationship.

Thérèse And you’re experience and the success of the work of Pieta House and the Centres you now have around the country it seems that this approach is hugely effective.

Joan Yes it is. While we might see someone for up to twenty sessions, often it is for far less. We’re working with people in crisis and we’re responding to them within the context of that crisis. We have four houses now in Dublin and one in Limerick and we’re looking to open in Cork and Galway this year and it’s vital that this work continues.

Thérèse I’d like to come back to something you spoke about earlier, fear and the possible response of a therapist when a client discloses suicidal thinking. Most of those reading this journal are therapists and whether one is experienced or relatively new to the profession it is always useful to have guidance when dealing with suicide.

Joan I think that for every therapist or professional who may have someone tell them that they are suicidal – that before you even get to a situation where a client or patient is disclosing that they are suicidal, they need to sit with someone else, perhaps their supervisor and consider the question – what would I feel if someone disclosed they were suicidal? Speak it out first of all and what you’ll probably find is that they think they have to save that person’s life and that can feel like such an enormous pressure because what if they don’t, what if they die – how am I going to live with the guilt of that.

What we have to realise is that this person is telling us something not for us to save their life but for us to listen and to be able to discuss it because once it’s said, that person’s anxiety, that need, that urge starts to decline. So, while as a therapist you don’t normalise it, you talk about the reasons why the person wants to die and very quickly ask them to talk about the reasons why they want to live and even if they only give one reason then that’s what you encourage them to hold on to.

Thérèse And if they can’t find a reason?

Joan Then you try to go back over aspects of their life, and this may be the only time you’ll go back over their life and help them to identify at least one thing that they achieved. And I think that no matter what’s going on, that statement; this too shall pass, is a lovely statement and for them to believe that reminding them of possible difficult times they’ve gone through before and survived them. To give the person hope, hope is the most important thing – you know that not only will they survive this but they will learn skills to prevent this from happening again or to cope with whatever happens.

You know there is something really wonderful in sitting opposite a person who is suicidal and them knowing that you really want them to live. There is something special about that because while you might say to them that their family wants them to live, they feel they are a burden to them and so they won’t really believe that whereas, the therapist can urge them to live and there is something very special about that. The therapist can get very intimate very quickly with a client because you’re talking about life and death but also the intensity of the work and seeing them so often does allow for that intimacy very quickly. We see client’s minimum twice a week.

Thérèse And I guess this creates a great container for the work. Over the years I’ve worked in organisations where we would have had a policy for responding to suicidal clients and so I’m curious given the remit for your work here, what is your response when someone is actively planning suicide?

Joan What we find here is that in the room someone will disclose that they are going to leave here and go kill themselves and what we do is to get their family in immediately and the family is the greatest resource that you can use. You know people think that we’re marvellous but the reality is that we’re here for one hour of that person’s day and so we must cultivate the family. We try to empower them and help them not to be afraid and it’s a bit like rallying the rescue squad. The person witnesses great concern from the family and great concern from us. We would never call an ambulance from here, ever as that goes completely against what we’re talking about here. If the family when they go home decide to do that then that’s their decision but we would never because we really believe that going to a&e and sitting there for hours is not really going to do anything for anybody other than perhaps cause more distress.

By distracting the person; bringing them home, getting other family and friends around, cups of tea, talking with the person, sleeping with them – all those sorts of things that families and friends can do, make a difference. Friends are very important, it’s not always going to be family but identifying key people who can and want to support them. Involving others is crucial and in many ways, the person doesn’t have a choice, for the simple reason that their life is on the line and confidentiality flies out the window when it comes to their life. In my experience it’s always the most wonderful action to take and it always makes sense. The family have the comfort that we’re still here to hear how they’re doing; they’re back the next day so they get all this continuous support.

We get emails from all over the place telling us about the sense of relief that people feel when their loved one, and them, have been met with an immediate response. And that’s not just for people coming here – I also get a sense of relief that if I knew anybody close to me feeling suicidal, I’d know where to send them.

Thérèse It seems that what has been created here is touching at the heart of Irish society and really making an impression to dispel the myths, the stigma, the fears and indeed the cases of death by suicide. And so while there is no doubt Pieta House is meeting a need and sadly, if you know what I mean, there is a need for more houses around the country.

Joan Well one of things we will be doing is having a strategy meeting to explore what we’re doing and get advice from the experts. I feel that every person is entitled to a Pieta service so we’re saying that if everyone could access one within 60 kilometres throughout Ireland that would certainly help. It’s not just about plonking therapists into a place; it’s educating the whole community, involving the whole community. For example, we’ve been asked to go into Roscrea which is only about forty minutes away from Limerick and we said we would as long as the town and that county took ownership of Pieta House. The easiest thing is to plonk a few therapists but we have to come up with the funds for it but they need to bring the service and create the service themselves. You can imagine how empowering that would be for that community. That’s the way we’re trying to operate now.

Funding is a burden, we get 20% from the HSE and we come up with the other 80% and while more would always be welcome, we wouldn’t ever want to be dependent on the HSE. And so working with communities – it’s very exciting to be invited to other places and it’s not just providing therapy, it’s creating social change. We’re changing the way people think of suicide and deal with suicide and that’s really exciting. And you know I never really knew that, I didn’t realise that we’re creating social change – and it wasn’t until some guy stood up in St. Pat’s hospital, some psychiatrist and said suicide will never be viewed the same way again since Pieta House opened. And I thought, really… and I was so humbled by that.

Joan Freeman is the founder of Pieta House, a centre for the prevention of self-harm and suicide, which was set up due to the lack of services in those areas. Pieta House is the only organisation in the country providing a free, professional, face to face, therapeutic service for communities in the acute stages of distress. Pieta House has successfully treated over 4,000 people since it opened its doors in 2006. The organisation hired more therapists this year to cope with the demand and now employs a team of more than 60 at its professional centre in Lucan, Co Dublin. With Outreach Centres in Tallaght and Finglas, Pieta House has also opened new centres in Ballyfermot, Dublin and Mungret, Co. Limerick earlier this year. Suicide and self-harm is on the rise in Ireland with over 500 people dying from suicide every year. Joan is married, and has four adult children. She completed her Masters in Psychology in 2005 and is a member of the Irish Association of Suicidology, the Psychological Society of Ireland and the British Psychological Society. She lives in Dublin, and in 2010 published her first book, Cover Up – Understanding Self-Harm.

IAHIP 2012 - INSIDE OUT 66 - Spring 2012