World Suicide Prevention Day: Working with Suicidal Ideation in the Therapy Room

Written by Kelsey Someliana-Lauer, Therapy Practice Solutions Virtual Assistant

As a therapist, how do you feel about working with suicidal ideation in the therapy room? 

Suicidal ideation is when someone has persistent thoughts about ending their own life. These thoughts can take many shapes and sizes. For some, it might be as subtle as wishing they weren't around or feeling like a burden to others. Others might have more intense and detailed thoughts, like thinking about how they would do it or when. Suicidal ideation is a serious issue that calls for understanding and professional help to make sure the person stays safe and finds a path toward healing.

While we all have our own feelings and comfort level with suicidal ideation, one thing remains the same: clients who seek mental health counseling very frequently experience occasional or even chronic thoughts of wanting to die. In fact, 12.3 million people in the United States report seriously considering suicide some point in the last year.

So, how can you work with suicidal ideation in the therapy space? The pros at Therapy Practice Solutions are here to help! Check out three ways to work with clients who are experiencing suicidal thoughts today.

Creating a Safe and Non-Judgmental Space:

Suicidal ideation can be terrifying to talk about with others - especially when talking to a therapist, who could potentially report your thoughts to the authorities (we’ll talk more about this later). Consider the following ways to make the environment safe:

1. Establish a trusting and empathetic therapeutic relationship where the client feels safe discussing their thoughts and emotions without fear of judgment.
2. Encourage open and honest communication, reassuring the client that their feelings are valid and that you are there to support them.
   
   
3. Use active listening and reflective responses to demonstrate understanding and empathy, fostering a sense of connection.

Assessing Risk and Developing Safety Plans:

One of our ethical responsibilities as a therapist is to assess for danger and make sure clients are empowered to reach out for crisis support if/when needed. Consider the following ways to assess risk and establish safety:

        1. Conduct a thorough risk assessment to gauge the severity of the suicidal ideation, including the             presence of a specific plan and access to lethal means.

        2. Collaboratively develop a safety plan with the client, identifying strategies to cope with suicidal             thoughts and actions to take in a crisis situation.

        3. Ensure that the client has a support network and knows how to reach out to crisis hotlines or                     emergency services when needed.

Exploring Underlying Issues and Building Coping Skills:

Suicidal ideation usually doesn’t come about without associated concerns like depression, anxiety, or trauma. Consider the following ways to help end suicidal thoughts for good:

        1. Work with the client to explore the underlying causes of their suicidal ideation, which may include         past trauma, emotional pain, or untreated mental health conditions.

        2. Employ evidence-based therapeutic modalities, such as Cognitive-Behavioral Therapy (CBT),                 Dialectical Behavior Therapy (DBT), or Mindfulness-Based Cognitive Therapy (MBCT), to build                 coping skills and emotional regulation.

        3. Collaboratively set therapeutic goals and explore alternative ways to cope with distress, helping             the client develop a toolbox of strategies to manage their emotions and thoughts more effectively.

Responsibility to Report:

As a gentle reminder, regardless of our nervousness around suicidal ideation, it is our ethical responsibility to make decisions that are best for the client. Consider the following questions when deciding if it's time to report:

        1. What is the likelihood this person will harm themselves? (Use the SIMPLE STEPS assessment if         you’re unsure.)

        2. Would calling the authorities be more harmful than helpful for this person? (Consider the                     presence of police is not safe for everyone, and involuntary holds in hospitals can contribute to                 trauma rather than help solve it.)

        3. Am I hesitating to report to preserve the therapeutic relationship? (Please keep in mind that it             is 100% better to lose a client because of their anger than to lose a client because of their actions.)

We hope this post helped you learn three ways to work with suicidal ideation in your practice. At Therapy Practice Solutions, we know how important it is for you to use your time and energy in ensuring high quality care for your clients. If you’d like to offload tasks to make time for providing great care to your clients, reach out to us today. The pros at Therapy Practice Solutions would love to help you help others. We look forward to hearing from you!