In this series of posts, I will outline how to do a suicide assessment. This post will cover general tenants of suicide assessment.
Because we are seeing people who have trouble dealing with emotions, it follows that it may be likely we will see a client who is either actively or passively suicidal. It is important that as counselors we do not shy away from this topic, that we remain calm and address it directly- our client’s lives may depend on it.
First, let’s take away the fear. Discussing suicide with clients isn’t going to make it more likely that they will do it. We cannot talk our clients into suicide. Rather, there is much more risk in NOT discussing it. Any reference to self-harm must be taken very seriously; it’s important to err on the side of caution. It’s OK to feel both scared for the client and scared yourself, but don’t let that fear stop you from exploring the topic.
The process of suicide risk assessment is challenging and complex. It is more difficult with adolescents and children, mainly because the executive centers of their brains aren’t as well developed as in adults. Also, younger clients may be more apt to throw around phrases like “I want to kill him.” We can’t assume as clinicians that this is just talk; it must be explored.
Exploring suicidal ideation and assessing risk is ongoing and collaborative with the client. Each situation is different, and ultimately the clinician must make a judgement as to the severity of the ideation. Based on severity, the clinician must then decide if hospitalization or commitment are required. Although there are tools that can help (which will be discussed in a future post) ultimately this is a subjective clinical judgement.
It’s important to be clear and direct. Don’t be afraid to say “Are you going to kill yourself?” or, “Are you considering hurting yourself?” Clients are emotionally overwhelmed, so don’t add to their confusion by dancing around the subject.
Cultural context is also important for both counselor and client. Different cultures have different beliefs about suicide. If a client’s culture says that suicide is wrong, it doesn’t mean the client isn’t thinking about it. In fact, a conflict between a client’s suicidal thoughts and their culture could add another layer of conflict and complexity into an already intense situation. This conflict can actually intensify their struggle, and cause them not to want to share their suicidal thoughts. It can be helpful to focus on the client’s pain in order to help them open up and trust you.
In my next post, I will cover suicide risk factors.
Yours in the Joy of Knowledge,
Dr. Barbara LoFrisco
Source: Personal communication with Dr. Caroline Wilde, November 13, 2013
