Ther: So why aren’t you dead? (thinking, “I hope this gets her attention”)
Pt: What? (stops crying and looks at the therapist for the first time)
Ther: You heard me. If you just wanted to be dead, you’d be dead. (Thinking, “she uses the word ‘what?’ to buy time”)
Pt: I just don’t have the nerve.
Ther: What do you mean by that?
Pt: I mean I’m afraid of the pain, and of the… of dying.
Ther: OK, now I understand you better. You want to die, but not all that much… at least, the pain and the dying seem worse than living at the moment, but not by very much, huh?
Pt: That’s right. (some relief in the voice)
Ther: Why did you only tell me part of it?
Pt: Well, that’s the part I wanted you to know about. I mean, about how bad I feel.
Ther: You wanted me to take your unhappiness seriously… not think it isn’t as bad as it really is?
Pt: That’s it.
Ther: I guess you must expect that people won’t take your unhappiness seriously.
Pt: Nobody does, I think. They just tell me that things will get better, and shit like that.
Ther: So if you had trusted me to listen better, what might you have said?
Pt: I guess…. I coulda said that I’m so unhappy that I want to die, but I’m still too afraid of death and pain, and that… I’m afraid you won’t believe how bad I feel, because… nobody else does.
Ther: Now do you think I would believe you?
Pt: (pause, some surprise in voice) Yeah, matter of fact, I think I do.
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