Pre-Hotline Suicide Prevention


Pre-Hotline Suicide Prevention

By: Grace Norberg, LMFT

With the recent tragic deaths by suicide of Kate Spade and Anthony Bourdain, the topic of suicide has been trending on social media. This is both good and bad, because talking about suicide in a direct, open way can open doors for people contemplating it to seek help, but it is also true that a suicide can trigger clusters of other suicide attempts. I have seen many posts on social media recently in which brave, compassionate people are sharing their own struggles with mental illness and thoughts of taking their own lives. This is refreshing to see, and forges connections between people in a way that the commonly portrayed “highlight reel” of people’s lives does not. This is a start to the many things we can do to address one of the leading causes of death in the US, which is suicide.

I started my career in psychology conducting research for renowned suicide researcher and psychology professor Dr. Thomas Joiner at Florida State University. I completed an Honors thesis about suicide in people with anorexia because I was struck by the fact that this population has the highest rate of completed suicides of any mental illness and I wanted to know why. Dr. Joiner has written several books, including Why People Die By Suicide, about the components of this cause of death, which are 1) perceived burdensomeness- thinking others are better off without you, 2) thwarted belonging- feeling like you don’t fit in or have support from others, and 3) acquired capability- having experienced physically or psychologically taxing experiences that make you more likely to be able to go through with a suicide attempt.

During this time, I also worked for the National Suicide Prevention Lifeline, and learned techniques such as exploring the side of a person that wanted to die and the side of them that wanted to live. I also learned the basis of the counseling skills that I use today- reflective listening, empathy, and validation; skills which show that you can truly hear and understand a person’s pain, express that they are not crazy for having those feelings, and that they are not alone. I also learned that those who call a hotline are usually not those that are truly in danger of dying by suicide- it’s the people who never reach out. Suicide is often an impulsive act that is carried out when a person is at the depths of their negative feelings about themselves and about life, and they have the means to kill themselves readily available.

I believe that suicide prevention starts before the Lifeline phone conversation, the 911 call, or a stay at the psychiatric hospital. It starts with seeing someone alone and reaching out to them, telling people how much they matter to you, listening to people without thinking about yourself or what you’re about to say, and asking someone you’re concerned about in a direct way if they have ever thought about taking their life. It also starts with recognizing that depression is a presence that isn’t who you are, but rather a state of being that distorts reality by telling you that you have no one, you are worthless, and life is too much trouble. Prevention starts with confronting the depression by seeking support from family, friends, a support group or a therapist.

I have been listening to Kevin Hart’s book, I Can’t Make This Up: Life Lessons, about his difficult childhood and path to success, and came across this quote that feels relevant to anyone who feels hopeless, worthless, and bogged down by life’s tragedies. “Life is a story. It’s full of chapters. And the beauty of life is that not only do you get to choose how you interpret each chapter, but your interpretation writes the next chapter. It determines whether it’s comedy or tragedy, fairy tale or horror story, rags-to-riches or riches-to-rags. You can’t control the events that happen to you, but you can control your interpretation of them. So why not choose the story that serves your life the best?” It sounds delusional in a way, but that is the power of the human mind to create its own reality.

It also helps to have a purpose, a reason for living this life. Even people who have been through the worst hardships can turn that suffering into purpose, like Garrett Greer, who broke his neck in an accident and became paralyzed, then used his injury as motivation to become a professional poker player and create a platform to inspire other quadriplegics. The creator of a life-changing therapeutic technique called DBT, Marsha Linehan, used her own suffering from Borderline Personality Disorder to help others with similar problems. Singer Demi Lovato had a severe eating disorder and now uses her music and social media to spread body positive messages. Your purpose doesn’t have to be grand or overly ambitious; it can be as simple as helping just one person, finding what you’re good at and giving that talent away, or seeking happiness in your daily life.

Choosing Change: 5 steps to enacting lasting change in your life

A therapist is usually thought of as a professional whom someone goes to when they need to talk or vent about issues or life stressors. However, the way I was trained at the Family Institute at Northwestern University was that the purpose of therapy is to help people change. There can absolutely be some use in talking and venting, but therapy with a concrete, actionable goal can accomplish so much more. Being in a position to ask others to be brave and change, I am also deeply committed to changing myself. I know intimately the pain and struggle that comes along with realizing you are unhappy with your life, and the challenges associated with attempting to transform it.

Since change is so uncomfortable, a saying of mine is that “change becomes a necessary step once we can no longer emotionally afford to stay the same.” Homeostasis feels familiar at least, even if it isn’t the happiest state. How many times have you said “I want to eat better,” or “I want to stop yelling at my kids,” but a few days later, there you are with the potato chips or screaming at the top of your lungs. Lasting change requires a number of things, including a heartfelt realization that it is necessary.

Here, I outline research-backed factors that can help you break out of that homeostasis and achieve your goals:

  1. Simply taking the first step toward change by attending an initial therapy session can make a huge difference. In a 2006 study in the Journal of Counseling Psychology, 88% of people’s presenting symptoms improved after just one therapy session. This doesn’t mean their goals were met completely, but something about the act of seeking and showing up to therapy helps. In my work, I notice the strength it requires to decide to seek help and fight feelings of fear and vulnerability to show up and talk to a stranger about your problems. I am a firm believer that all people inherently possess the inner strength necessary for change – but many of us just need the expertise and training of a therapist to help bring that out.
  2. The therapeutic relationship, or alliance, is touted among therapists as the most important ingredient in change. According to the book Common Factors in Couple and Family Therapy (2009), this alliance is comprised of tasks, goals, and bonds. Tasks are what the therapist tells you to do in the room or at home, such as practicing a new way of telling your partner about your needs or writing a gratitude journal. Goals for treatment should be set in the first few sessions but should also be reviewed periodically to see whether they are being met or have changed. Lastly, “bonds” are your feeling of connection with the therapist which can be derived from how much empathy you feel from them, their ability to remain nonjudgmental, or in plain terms, whether you like them as a person.
  3. Motivational Interviewing is a well-researched and effective therapeutic style. The essence of MI is helping people articulate their goals and ways they would like to change, in their own words. In my experience, it means more than if I were to just tell someone what to do. I am not you, so how can I assume to know what will work for you? In my own therapy, I have noticed that if my therapist starts lecturing me, my eyes start to glaze over. It’s easier to be invested in and remember the words that come out of your own mouth.
  4. We all have heard the saying that “10,000 hours of continuous practice are needed to become an expert” (Gladwell, 2008). Change takes practice. Couples that would like to improve their communication need to learn new patterns of relating. People with difficulty setting boundaries in their life might need to say no more often. We have all learned patterns and schemas, often in childhood, that direct how we view and take on the world. It is incredibly hard to change thoughts and behaviors we have held for such a long time. You must practice over and over, make mistakes, and still persist.
  5. Lastly, Dialectical Behavior Therapy has been found to be the most effective treatment for people with Borderline Personality Disorder and intractable self-harming and suicidal behaviors. The definition of dialectical is integrating opposites, which I believe is relevant to everyone. I encourage you to accept and love yourself the way you are now, but to also seek change. When I ask my clients what they are most afraid of in relationships or in life, it usually boils down to fear of not being good enough. Not a good enough mother, partner, friend, employee, boss, body, etc. I want you to reframe that and say, “I AM enough, AND I deserve to keep getting better”. Nathaniel Branden, a renowned therapist and writer about self-esteem, said, “the first step toward change is awareness. The second step is acceptance.

Taking the first steps to change may be what tips the scale of a revolution of self. After that, choosing the right therapist, articulating your goals, practicing new patterns, and loving yourself as-is can take you far.

These are just a few points important to me as a therapist, but I’d love to hear the ways in which you have helped yourself enact lasting change, or strategies you’ve provided to others in their journey to change.  Let me know in the comments!

~ Grace

Grace currently sees clients at our Ravenswood location.  She can be reached by phone at (786)239-5280.



Check out Grace's Psychology Today profile

The Secret to Happiness

Many millennials believe that being rich and famous will make them happy. However, the results of a 75-year longitudinal study of people's health and life satisfaction shows that the road to happiness is paved with good relationships.

Despite all of our differences, pretty much every person on the planet has one goal in common- to be happy. However, we probably all have very different ways that we believe we will achieve that goal. Some may think happiness is having a good job, being rich, living in a paradise, the ability to travel, having a lot of cats… sorry maybe that’s just me! In fact, according to psychiatrist and researcher Robert Waldinger in his Ted Talk What makes a good life, 80 percent of millennials surveyed said that a major life goal for them was to get rich, and 50 percent said a major goal was to become famous. Sounds great, but not only are those goals not practical, they do not necessarily bring you happiness. Celebrities have just as many or more problems than the rest of us, and a 2010 Princeton study shows that money only makes you happy up to a certain point (about $75,000/year) and any income above that makes no significant difference in emotional wellbeing.

So you are probably wondering, what does lead to happiness? I recommend watching the Robert Waldinger Ted Talk, but I will summarize it here. His talk is about the results of the Harvard Study of Adult Development- a 75-year qualitative and quantitative study of 724 men: some from Harvard, and others disadvantaged boys from inner city Boston. Waldinger formed three compelling conclusions from this plethora of data: social connection is good for your physical and mental health, the quality of your close relationships is paramount, and good relationships protect your brain functioning from aging. Healthiness leads to happiness and vice versa, and results in a longer life.

These conclusions tell us that our goals in life should be centered upon forming strong relationships of all kinds- friends, family, and romantic. This is the secret to happiness. According to Waldinger, loneliness is a killer and conflictual relationships are detrimental to health. We should seek out social connections, resolve conflicts with family, and nurture our close relationships. Perhaps if we focused on these things, life would be more satisfying.

Of course that is easier said than done. Humans are wired for connection but we are also doomed to misunderstand each other due to the confines of language and confusions of different cultures and upbringings. Therapy can certainly help this process, and marriage and family therapists such as myself are specifically trained to help people with relationships. I am biased because of my degree, but I truly believe in the work we do for couples, families and individuals. My masters program was a transformational process for me as a person and a therapist, and I hope to help others change their lives by passing along my knowledge and using my clinical skills to improve relationships. As Waldinger said, “The good life is built with good relationships”.

Tips for Managing Anxiety, From an Anxious Therapist

Anxiety has become an accepted part of many people’s normal lives in our fast-paced, technology-driven society. Even as a therapist, I came to accept that I would feel the effects of my constant worrying every day and tried my best to ignore them- lost sleep, feelings of insecurity, hypervigilance, even anger. I caught myself labeling me as “an anxious person”.


However once I learned about the physical effects of anxiety on the body, I realized that I needed to prioritize de-stressing techniques in my life. Cortisol, the “fight or flight” hormone, increases when we are anxious. It helps us to be more alert and focused for a short time, but the problem arises when a person has chronic heightened levels of cortisol. Unfortunately then, the benefits are not the same and cortisol can be detrimental to our health. It can cause weight gain, a weaker immune system, interrupt learning and memory storage, and much more.


Not only is anxiety detrimental to your health, it can also affect your relationships. Anxiety can transform you from the caring, kind person that you are into a snappy monster that is unhappy and drives away your loved ones. Constantly being worried puts you on edge, which can be contagious for those close to you. It prevents intimacy and vulnerability because we are trying so hard to control everything around us.


It is difficult to break oneself of anxious behavior, but so necessary for your physical and relational health. Here are some simple tips to help you to relax and let go of worry.


  1. Say no more often. Many anxious people have a problem with taking on too much. We want to be able to do it all, but unfortunately not only is that not practical, it decreases the quality of what we do. Practice saying “no” to some things, like a dinner party on a Friday night when you have had a long week and need time to recuperate, or even to a new project at work when you know you need more time to do your best on the one on which you are already working.

  2. Write it down. A huge part of anxiety is obsessive, circular thoughts about what you have to do today, planning for the worst, and attempting to structure your life to a T in order to contain unease. It can help immensely to be able to write things down to “get them out” of your head. If you’re having trouble sleeping due to ruminating thoughts, write them down in a journal. Make a list of what you have to do today, and prioritize what is most important. Acceptance of the fact that you will not get everything done is essential.

  3. Adult coloring books. It sounds silly, right? However, recent studies have been done showing that coloring is very similar to meditation- it helps us relax and be in the moment. It is a patterned, repetitive act that actually decreases heart rate and lengthens brainwaves. Give it a try!

  4. Dedicate time to a hobby. Many people with anxiety need an outlet for their nervous energy. One of mine is knitting. Similar to the coloring book idea, doing something creative with your hands like knitting, needlepoint, or crochet can help you be in the moment and feel soothed. Other helpful hobbies can be running, yoga or other exercise of your choice, puzzles, building models, or reading.

  5. Practice yoga breathing. Everyone says it- take deep breaths as a coping skill. Many people shake their head and think this won’t work for them, but there is a reason that all self-help books and websites tout this practice. Deep breathing provides space for you to calm your emotions before reacting. Try taking a deep belly breath in for three counts, and exhaling for three counts. Repeat several times. If it doesn’t “work” the first few times, keep trying! Practice makes perfect.

  6. Recognize your triggers. All of these coping skills can help you manage distressed feelings, however we must look at the root of the problem. What drives your anxiety? Yes, you are busy and have a lot on your plate, perhaps financial worries, a high-pressure job, children, etc. Look more deeply though- how did you grow up? What were the messages in your childhood about how to be “good enough”? What are your catastrophic fears? Answering these questions is where the real work lies.


I know how anxiety can put a damper on happiness and permeate life and relationships. I believe that everyone deserves happiness and lightness. It can be hard work and may require the help of a therapist.

I hope these tips can be of help to you and your loved ones. For extra support in the form of individual or family counseling, please contact me.