What Should a Counselor Do for a Suicidal Client?

No one, not even mental health professionals, can ever predict with 100 percent accuracy whether a person will attempt suicide. However, certain screening questions can help counselors discern if a client is actively considering suicide. Once it has been established that a client is contemplating suicide, counselors can take action, working with clients to find alternatives ways of coping and getting through the suicide crisis.

At Risk

• Certain individuals are at higher risk for trying and successfully completing suicide. Men are four times more likely than woman to die from suicide. The presence of a mental disorder or substance abuse also increases the risk that a client will try suicide. People older than 65, as a group, have the highest number of attempted suicides, and clients with prior suicide attempts or a family history of suicide are also at increased risk.

Screening For Safety

• A good suicide screening should include questions that clarify whether a patient has a plan and the means to carry out the plan. The more detailed the plan, especially if the client has access to weapon or other means, the more seriously the counselor should take the threat of suicide. In addition, counselors should interview clients about their support systems and look for signs of isolation. Some suicidal clients will talk about saying goodbye to loved ones, will give away possessions or otherwise get their affairs in order and will talk about these activities in counseling. However, the signs can be much more subtle. A recent loss, such as a breakup of a relationship or a death of a loved one, might also instill a feeling of hopelessness that could lead to suicidal thoughts. With the presence of any of the above signs, counselors should work with clients to create a plan for safety. This can include a detailed list of friends, relatives or community support groups for the client to call, as well as information about reaching local emergency services or suicide hotlines, such as the National Suicide Prevention Hotline, 1-800-273-TALK (8255). A team approach to working through a suicide crisis can also increase the client's safety. Whenever in doubt, counselors should work together with psychiatrists and other medical professionals to help stabilize clients.

Instilling Hope

• Suicide is about lost hope, and the counselor's job is to help client's regain hope. Once clients are out of crisis and are no longer actively suicidal, counselors can work with clients to regain meaning in their lives. A study published in the Journal of the American Medical Association showed that cognitive therapy, a type of talk therapy in which counselors help clients identify and reframe negative and counterproductive thinking, reduced repeated suicide attempts by 50 percent. By using these techniques and working with a team and the client to set specific goals, counselors can help clients find better solutions and renew optimism.