We know that clients may initially refer to their suicidal thoughts indirectly or through the use of metaphor. Phrases such as ‘I want to get out of people’s way’ or ‘It would be better if I wasn’t around anymore’ can indicate such thinking but need clarification by the therapist to fully understand the client’s meaning.

One anxiety for many therapists (and others) is that in asking about suicide, they may put the thought into the client’s mind where it did not exist before. There is no research evidence to support this concern. Rather, direct questioning provides the client with an opportunity to talk about their suicidal thoughts, and to know that this is acceptable, whilst also giving the therapist the opportunity to explore the level of risk.

This resource is underpinned by the Good Practice in Action fact sheet Working with suicidal clients in the counselling professions GPiA 042.

Download your CPD certificate for Exploring suicidal risk with clients (PDF).

About the resource

You’ll join practitioner Andrew as he works with client, Jackson (also known as Jack). Jackson presents with suicidal ideation part way through their latest session. You’ll watch two examples demonstrating different approaches Andrew takes to pick up on Jackson’s reference to suicidal thoughts.

When viewing this resource, you are encouraged to reflect on your own practice and consider how you might incorporate risk assessment tools in a creative way as a foundation for discussion and meaningful exploration with clients around suicidal risk. The resource is approximately 1 hour and 10 minutes long.

Setting the scene

Jackson is in his early twenties and has been recommended for therapy by his GP. We join part way through the latest session.

Questions to consider

  • consider your own response to Jackson’s presentation. How might you feel in Andrew’s position?
  • what phrases or metaphors may have caused you concern, if any?

Demonstration of not asking a client about suicidal ideation

In the first video, Jackson has alluded to suicidal thoughts using metaphor. In this example, Andrew picks up from the reference to suicide but rather than asking about it directly, continues to use predominantly reflective and paraphrasing responses.

Questions to consider

  • observe Jackson’s response to this approach. Consider what’s explicit and implicit about Jackson’s response and engagement with the session.
  • by the end of the session, what do they both know about Jackson’s suicidal thoughts and feelings?
  • what might you have done differently?

Practitioner reflections – part one

Andrew reflects on how his approach of using reflective and paraphrasing responses to address Jackson’s metaphor for suicide impacted the session and the therapeutic relationship.

Demonstration of explicitly naming suicide and exploring risk through dialogue

In this example, Andrew explicitly asks Jackson about his metaphor and whether he means suicide when he uses that language.

Watch what happens in the relationship, connection and dialogue compared to the first example.

Questions to consider

  • observe Jackson’s response. By the end of the session, what do they both know about Jackson’s suicidal thoughts and feelings? How much more does Andrew know about Jackson’s level of risk?
  • how did Andrew work with Jackson to establish additional resources and support?

Practitioner reflections – part two

Andrew reflects on explicitly asking Jackson about suicide.

Questions to consider

  • as you listen to Andrew’s reflections, consider whether there is anything that you may do differently in your practice now?
  • can you think of any adaptations you would make to your risk assessment, or risk management process with clients?

For further support, view the Good Practice in Action fact sheet, Working with suicidal clients in the counselling professions GPiA 042.

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About the contributors

Dr Andrew Reeves is a Professor in Counselling Professions and Mental Health at the University of Chester, teaching on the professional doctorate in Counselling and Psychotherapy and Psychological Trauma, as well as supervising on the PhD programme.

He is a Senior Accredited BACP member as well as a Fellow of BACP and Senior Fellow of the AdvanceHE. He has worked in a professional helping role for 35 years, practicing for 31 years as a social worker and 29 years as a therapist.

Andrew has researched therapy with suicidal clients and people who self-injure and self-harm for over 25 years and has written extensively about this, including four authored texts and two co-edited texts, in addition to numerous academic and practitioner articles.

Jackson (Jack) is portrayed by actor Keanan Lloyd-Adams.

Disclaimer

This content is intended as informal learning (as opposed to training). Unlike formal training, content is non-course based and does not assess understanding. The resource can only be used for personal CPD purposes and are intended to inform good practice. All the scenarios shown are fictional. The content cannot be copied, replicated or used for any other purpose including but not limited to training.