In this thought-provoking episode, I sit down with Dr. Selma Gaily-Luoma, a researcher and psychologist to explore the transformative role of agency in suicide prevention. Agency, defined as the sense of being able to influence your thoughts, behaviors, and circumstances, is a cornerstone of psychological resilience. We delve into how fostering a sense of agency can be a powerful antidote to feelings of entrapment and despair that often accompany suicidal crises.
What resonated deeply with me was Dr. Gaily-Luoma's insight into the paradox of suicide agency. This understanding that even keeping the option of suicide on the table can unexpectedly open doors for life-affirming decisions. It underscores the essential need for practitioners to respect the autonomy and agency of those in distress, not by imposing control, but by facilitating a supportive environment where those who are struggling feel heard and empowered to make choices toward recovery. This conversation challenges us all—researchers, practitioners, and perhaps even those who are in the midst of their own battles—to reframe our approaches, emphasizing respect, empowerment, and the creation of space for those we aim to support.
Dr. Gaily-Lioma Bio:
Dr. Gaily-Luoma is a postdoctoral researcher at the University of Jyväskylä and an entrepreneur in psychotherapy and education. She holds a doctorate in psychology and degrees in integrative individual, couple, and family psychotherapy.
Dr. Gaily-Luoma’s expertise spans mental health disorders, psychosocial treatments, recovery, and suicide prevention, with a focus on research, professional practice, and development. Specializing in suicidality and caring interaction, she conducts research, provides training, and offers supervision.
Dividing her time between university work and professional practice, she also serves as chairperson of the Finnish Association of Integrative Psychotherapy and as a member of the Finnish Psychological Association’s professional section for adult mental health and substance abuse work.
Key Discussion Points
Understanding Agency:
Dr. Gaily-Luoma unpacks the concept of agency as the combination of intentionality and power that moves people toward a goal. We discuss how agency is the opposite of feeling trapped. We explore how suicide is often a reaching for agency or a succumbing to a lack of power toward realising recovery-related intentions. When it comes to therapy, emphasizing the role of empowerment after deeply listening to the needs of autonomy and competence, even when suicide is on the menu, allows individuals to see choices and possibilities.Real-World Applications in Reframing Agency in Suicide Prevention:
Dr. Gaily-Luoma offers insights on creating environments that encourage therapists and support systems to reinterpret behaviors often labeled as resistant, defiant, or difficult. Instead, she suggests recognizing these actions as expressions of recovery-related agency—signals of an individual’s determination to communicate their needs and maintain dignity. By reframing behaviors such as withdrawal or retreat as intentional steps toward recovery, therapists can foster a collaborative dynamic. This approach allows individuals to feel seen and respected in their ongoing negotiation between a desire to live and the presence of suicidal thoughts. This reframing empowers individuals and promotes meaningful engagement in their healing journey.Dr. Gaily-Luoma’s research introduces client perspectives on the The Attempted Suicide Short Intervention Program, developed by Dr. Konrad Michel and Dr. Anja Gysin-Maillart.
Connection to Rory O'Connor's Work:
Drawing from When It Is Darkest: Why People Die by Suicide and What We Can Do to Prevent It, we explore how a lack of agency contributes to the feeling of entrapment, a key driver of suicidal despair. The conversation highlights actionable ways to support individuals in reclaiming their sense of choice and control.Integration with Dr. David Jobes’s CAMS Approach:
The paradox of agency in therapy: how respecting an individual’s agency, even when it includes a desire to die, can open pathways to hope and healing. Dr. Gaily-Luoma discusses how collaborative approaches like CAMS (Collaborative Assessment and Management of Suicidality) align with her research and practice, helping individuals rediscover a life worth living.
SHOW NOTES:
Dr. Selma Gaily-Luoma’s university profile and key publications: https://www.jyu.fi/en/people/selma-gaily-luoma
Dr. Selma Gaily-Luoma’s webpage: https://www.mielenterveydeksi.fi/etusivu-2-2-2/
The Attempted Suicide Short Intervention Program: https://assip.ch/
Dr. David Jobes and CAMS: Learn more about CAMS
A Self-Determination Theory Perspective on CAMS: Holmström, É. (2020). Self-determination theory and the collaborative assessment and management of suicidality. Mental Health Review Journal, 25(1), 75–83. https://doi.org/10.1108/MHRJ-09-2019-0029
Dr. Rory O’Connor’s book: When It Is Darkest: Why People Die by Suicide and What We Can Do to Prevent It
Gaily-Luoma, S., Valkonen, J., Holma, J., & Laitila, A. (2024). Suicide attempt survivors’ recovery-related agency in the relational context of services: A qualitative analysis. BMC Public Health, 24(1), 3068. https://doi.org/10.1186/s12889-024-20459-z
Gaily-Luoma, S. (2024) Co-constructing recovery in suicidal crises: Service users’ perspectives on healthcare and crisis services after a suicide attempt. JYU Dissertations. https://jyx.jyu.fi/handle/123456789/96823
Gaily-Luoma, S., Valkonen, J., Holma, J., & Laitila, A. (2023). Client-reported impact of the Attempted Suicide Short Intervention Program. Psychotherapy Research, 33(0), 1–14. https://doi.org/10.1080/10503307.2023.2259070
Gaily-Luoma, S., Valkonen, J., Holma, J., & Laitila, A. (2022). How do health care services help and hinder recovery after a suicide attempt? A qualitative analysis of Finnish service user perspectives. International Journal of Mental Health Systems, 16(1), 52. https://doi.org/10.1186/s13033-022-00563-6