Suicide assessment mistakes

Yesterday’s post was about suicide. Counselors sometimes fail to adequately evaluate suicidal ideation, plan, or intent in their counselees. Some years ago, I ran across a research study looking at the most common mistakes made by 215 masters level counselors when dealing with suicidal clients. I’ve lost the bibliographic data for the article and couldn’t find it easily in Psychlit…

Here are some of the mistakes (in no particular order):

• Superficial reassurance (“you have so much to live for”
• Avoidance of strong emotions (not allowing client to express strong despair–usually with first bullet point)
• Professionalism (cold and distant, possibly seen as uncaring in assessment)
• Inadequate assessment (failure to explore fully because of nervousness or fear of asking)
• Failure to identify precipitating causes (most suicides have both current and historical precipitating events. Counselors may identify historic event (e.g., divorce 4 years ago) but miss the current precipitant.)
• Passivity; failure to be empathic (25% took this stance)
• Insufficient directness. No contract to not harm, no next steps
• Overbearing advice. Counselee needs to be involved in the planning for safety
• Stereotyping response (“She’s just a borderline!”)
• Defensiveness (usually about whether hospitalization is necessary)

Every counselor worries about how they will perform when addressing the serious problem of suicide risk assessment. We do well to review (a) our natural inclinations when stressed (e.g., do we tighten up, become over-controlling, too professional?), (b) our standard of practice when confronted with despairing or suicidal clients, and (c) our assessment procedures with all clients. While there is no way to prevent the suicides of highly motivated people, we can increase our capacity to respond well to those the Lord sends our way.