Seven Things a Therapist Needs to Know When Working with a Suicidal Client

1.  Move painful to present.  It can be scary as a therapist when we have a client talking about suicide.  Our mind might skip ahead to the worse-case scenario; death.  Instead, staying present in the pain can alleviate some of the intensity in a client feeling they have safety and permission to talk about it.

2.  Remember, curiosity doesn’t kill this cat.  Remaining curious and open to a client sharing their experience can help you identify the risks and your next steps rather than escalating things.  Adrenaline might be flowing but as an empathetic listener, you can identify the snippets of their suicide story that elevate risk and come up with a plan.

3.  Avoid band-aids for bullet holes. Your own fear or inexperience may drive your desire to place your client in a hospital level of care but slow down! Many clients are reluctant to share their suicide story due to fear that you will hospitalize them so opening up takes work and trust. Identify when hospitalization is necessary versus the hotline, safety planning, or other life-saving resources.

4. Support safety planning out of a sinkhole.  Engaging your client in safety planning can support awareness of wellness, warning signs, and triggers for decline while supporting practice of positive coping skills.  It can also help you have some peace of mind by knowing how they can support themselves between sessions by utilizing other resources that could prevent burnout for you in this challenging work.

5.  Accept chronic thoughts as comfort objects. You might not find comfort in the nonchalant disclosure of a client with chronic suicidal thoughts but they do!  Alleviate the awkwardness by focusing on relationships, coping skills practice, and ongoing follow up of their suicidal thoughts to ensure nothing critical changes.

6. Know this isn’t one and done.  You have the tools and the training to understand the complex relationship between dozens of risk factors. Tracking mental health, increased symptoms, and/or new or growing stressors that would put your client at greater risk for suicide can help you determine next steps.

7.  Focus on quantity over quality.  Client protective factors are identified as things internal or external that keep them alive in the face of suicide. Helping your client to build a longer list of protective factors can support them in finding hope and support outside of your therapeutic sessions.

Suicide Assessment: Starting a Conversation

Are you thinking about suicide? Do you want to kill yourself? Several of the most respected trainings nationwide, including Applied Suicide Intervention Skills Training (ASIST) by LivingWorks and Collaborative Assessment and Management of Suicidality (CAMS) by Dr. David Jobes, are providing the skills to encourage professionals to start a conversation with a person at-risk of suicide. September is National Suicide Prevention Month! It’s time we talk about suicide, and not just in the month of September. 

Many health organizations are participating in the Zero Suicide Initiative and schools are developing protocols to support our youth as they pursue their education. Research continues to explore findings around trends in certain populations, such as our transgender individuals, Veterans, and those suffering from Anorexia, all possessing factors that may put them at a higher risk of suicide. How do we, as mental health or helping professionals, address the stigma to start a conversation to better understand suicide?

In support of professionals who are passionate about helping at-risk individuals, please allow me to introduce an interactive tool meant to engage a person at-risk in facilitating a conversation about their experience with the help of a trained professional. The Community Assessment and Coordination of Safety (CACS) is an interactive tool that supports mental health professionals and other community partners such as school staff, non-profits, caseworkers, and public safety to have the words and the tools to start a conversation on suicide. 

The Details

In using CACS, a helping professional can access standard suicide assessment questions including but not limited to risk factors, family history, and recent stressors. When a professional desires more information as to the purpose of a question or how to ask a clinical question within the risk assessment, CACS provides helpful hints, such as suggested questions you can ask to explore a particular component in more detail for the most accurate results. The assessment then uses an algorithm to determine a risk level and populates a list of resources throughout Colorado in order to identify appropriate referrals that could best help the person at risk.

In addition to using an algorithm, CACS provides an electronic, user-friendly platform to assess and explore a person’s experience, all while allowing the flow of supportive conversation with a person they can trust. CACS can take into account various information entered into the app to calculate a level of risk based on an algorithm that factors in current research trends on suicide.  Individuals found to be at high risk would be directed to resources such as hospitals, inpatient programs, or Crisis Walk-in Centers. Individuals found at moderate or low risk could explore current resources for mental health, substance use, community support, and wraparound services with filtering options of location, service, and age group served. 

Lastly, CACS allows the helping professional to complete a wellness safety plan with the person at risk, empowering them to identify facets of their life that they can track and address with positive coping skills or engagement within their communities. Research is pointing us to the power of communities, therefore it could be valuable to explore how communities can support or enhance our interactions in pursuit of personal wellness. 

Resources

Let us begin a conversation and demonstrate our willingness to speak of the challenges in order to support those that need it most. You can learn more about the Community Assessment and Coordination of Safety (CACS) at www.cacs-co.com.

If you are interested in a suicide assessment training, check out ASIST by LivingWorks at livingworks.net or CAMS Integrated Training at CAMS-Care.com.

If you are feeling suicidal and need immediate support, please call 9-1-1 or go to your nearest emergency room. Trained professionals are available 24/7 at the National Suicide Prevention Hotline by calling 1-800-273-TALK.