True Therapy — Expressing Gratitude for the Giver
Burdensomeness, suicide, and the path to healing
I am a therapist who works with adolescent clients, often with acute presentations such as suicidality. Notably, one of the most important factors contributing to suicidality is what we call perceived burdensomeness. That is, these young people believe that they are a burden to their families and their friends. They believe they have become stuck, against their will, in a role of taking — they believe that they have nothing to give. In fact, a common and tragic belief suicidal young people have is that suicide is their one opportunity to give. By removing themselves from the world, they believe that they are relieving their families and friends of the burden that it is to care for them.
When we understand this, we can see that these suicidal young people are in fact deeply committed to giving. How many of us are willing to even consider dying for the betterment of the people we love? They are considerate individuals and deeply attuned to the suffering of those around them. Often they are committed to alleviating that suffering, more so than they are committed to alleviating their own.
But I know, as a therapist, as a support to the parents of these young people, and as a personal friend of someone who died by suicide, that the tragic irony here is that suicide is not giving but taking. And being alive, being a beautiful presence and energy on this earth, no matter how troubled, is a form of giving to everyone who loves you.
Yet, when these young people present to my office, they find themselves, yet again, forced into a position of taking. Usually, they do not want to be in therapy; that was their parents’ choice. They have not chosen freely to enter into a relationship with me, and they are particularly sensitive to the lopsided nature of the relationship. This is another setting in which the assumption is that they need help, an assumption which, if allowed to continue, will only reinforce the perceived burdensomeness that exacerbates their thoughts of suicide. They often express this by being extraordinarily passive, refusing to give the therapist more to “help” them with — refusing to be a burden.
My aim as a therapist, then, is to subvert this therapeutic assumption. Rather than reinforce their sense of burdensomeness, my responsibility is to support these young people in reclaiming their right to give.
So where to start? The first step is to create the experience of giving, of being a giver, in our relationship. And as I have already mentioned, the young person in my office is already giving me something: their presence. My first task, then, is simply to find a way to appreciate that presence, to genuinely like them as a person. By appreciating their presence, I am accepting their gift, which helps challenge their belief that they are a burden — a taker — and reminds them that they have something to give.
But in order for this to work, I have to communicate this to them — that I have received their personhood and I value it. This may be tricky. It must be done effectively. Often, caregivers by family or by profession will attempt to communicate this idea — that they have “accepted the gift” of the young person’s presence — before it is actually true. They will express appreciation for the young person, without bothering to take the time to actually find and feel what they appreciate about them. But people, young and old, are perceptive. They will know if it isn’t genuine. Further, the young person is usually particularly skeptical of anyone liking them, given their perception of being a burden. This means that the communication of appreciation must be done repeatedly and creatively, and with great attunement to the capacity of the young person to believe and feel this appreciation.
Once the client feels valued, the true magic of healing begins. They are likely to become more active in the relationship, more freely giving of who they are, of their concerns, of their own values and their own goals. This creates space for freedom. They may then collaborate with me to create their own goals, in line with their own values, all the while experiencing and knowing and double checking that this is a reciprocal relationship. They are free and able to give to me, and in doing so, they become more willing to accept from me as well.
They may even discover that to accept my offer of help, however small, is another form of giving. Because they can see that their acceptance has a positive impact on me: the sense of joy and purpose and connection that I feel when I get to see that they have accepted something from me and that this has led to a positive change. And this may make them feel even better — because just as I feel good when my actions have a positive impact on them, they feel good when their actions have a positive impact on me. Giving, in this way, can be a virtuous cycle — when a gift is received with gratitude, both giver and receiver gain, and are incentivized to keep the positive feedback loop going.
This is not rocket science. Anyone who loves someone can support this shift of an acutely suffering person out of perceived burdensomeness and back to reclaiming their right to give. It is easy to see suffering and want to “help.” But, as I hope has been illustrated here, it is better to see suffering and to recognize to the sufferer that their very survival is an act of giving to you because you love them. That their presence is an act of giving to you. That their willingness to hear and be impacted and change as a result of your relationship is an act of giving to you. Helping without care can negate another’s right to give. To help as a contributist is to reaffirm another’s right to give by recognizing what they are already giving.