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How to Counsel a Suicidal Client

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How to Counsel a Suicidal Client

No counselor or therapist wants to hear that a client they have been treating has taken their own life. Unfortunately, this is a reality that providers face all too often. As of 2020, suicide was the 12th leading cause of death in the US, with over 45,000 people taking their own lives.

As a provider, it is important to be aware of the warning signs that your client may be at risk for suicide so that you can take appropriate action.

What Risk Factors for Suicide Can Be Identified Early in the Client/Patient Relationship?

Although anyone can experience thoughts of suicide at any time, certain risk factors can make someone more vulnerable. According to the American Foundation for Suicide Prevention, some risk factors include a previous suicide attempt, a family history of suicide; a history of substance abuse; a debilitating mental health condition; feelings of hopelessness, isolation, and worthlessness; and exposure to trauma or violence. While not everyone who experiences these risk factors will attempt or complete suicide, it is important to be aware of them so that you can provide support and resources to those who may be at risk.

How Can Clinicians Assess Whether a Client Is Suicidal and At Risk for Harming Themselves?

Although scales to measure the risk for suicide exist, none of them have been proven to be completely accurate. However, they can still provide valuable information to clinicians to help paint a picture of whether a client may be at risk. The two most commonly used scales are the Columbia-Suicide Severity Rating Scale (C-SSRS) and the Suicide Behaviors Questionnaire-Revised (SBQ-R).

The C-SSRS is a series of questions about thoughts, feelings, and behaviors related to suicide. It can be used with adults and children aged 6 and up. The SBQ-R is a self-report measure that assesses an individual’s thoughts, feelings, and behaviors related to suicide over the past 7 days. It can be used with adults aged 18 and up. Both measures can be used to identify those at immediate risk for suicide so that appropriate interventions can be implemented.

Additionally, clinicians should ask the client directly about their thoughts of suicide and their plans for harming themselves or others. This is often called the “danger assessment.” Asking direct questions about suicide will not put the idea into a client’s head or make them more likely to attempt suicide. In fact, it may relieve the client to know that someone is willing to talk about their thoughts and feelings openly and without judgment.

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What Are Some Warning Signs That a Client May Be At Risk for Suicide?

Several warning signs may indicate that a client is at risk for suicide. According to the National Institute of Mental Health, some of these warning signs include:

  • Talking about wanting to die or hurt oneself;
  • Expressing feelings of hopelessness, being a burden to others, or having no reason to live;
  • Exhibiting sudden mood changes;
  • Increasing alcohol or drug abuse;
  • Withdrawing from friends, family, and activities that were once enjoyed;
  • Abnormal eating or sleeping habits;
  • Giving away prized possessions;
  • And exhibiting risky or self-destructive behavior.

If you notice any of these warning signs in your client, it is important to take them seriously and assess the level of risk so that you can provide appropriate support and resources.

How Do You Create a Safe Space for Clients Who Are Suicidal and Encourage Them to Seek Help?

When someone is in the throes of suicidal ideation, they are consumed by the belief that death is the only way to escape their pain. As a clinician, it is your job to help them see that there are other options, and that help is available. But how do you create a safe space for clients who are suicidal and encourage them to seek help?

Many suicide prevention experts agree that establishing trust and rapport with the client is the first step. This can be done by actively listening, showing empathy, and conveying a genuine belief that the client has value and worth.

Once trust has been established, the next step is to explore why the client is considering suicide. It is important to avoid judging or shaming the client but rather to provide a non-judgmental sounding board for their thoughts and feelings.

Once you understand why the client is considering suicide, you can then begin to talk about other options and resources that may be available.  It is important to stress that help is available and that the client is not alone. If you feel that one of your clients is at risk, you can utilize telehealth capabilities to bridge the gap between in-person sessions. Software like TheraNest will allow you to take detailed notes on patients, launch virtual sessions using the patient portal, and chat with clients so that you can keep a close eye on them and encourage them to seek help if they are experiencing a mental health emergency.

Your Clients Are at Risk. Are You Prepared?

In addition to being aware of the warning signs of suicide, it is also important to have systems in place so that you can quickly reference client information when needed. This is where TheraNest comes in. With our electronic health records system, you can easily store and organize client information so that it is readily available when you need it.

For example, let’s say you have a client displaying some concerning behaviors lately. With TheraNest, you can easily pull up their file and review past notes to see if anything else may be causing these behaviors. Additionally, our templates allow you to quickly document each session to keep track of any changes in your client’s condition over time.

If you are ever in doubt about whether a client is suicidal, it is always better to err on the side of caution and reach out to their support system or emergency services. You can also encourage your clients to text or call 988 to reach the Suicide & Crisis Lifeline.  with TheraNest by your side, you can feel confident that you have all the information you need to make informed decisions about your clients’ care.


No one wants to think about their clients harming themselves, but unfortunately, it is something that providers must be prepared for. By being aware of the warning signs of suicide and having systems in place to quickly reference client information, you can be better prepared to identify clients at risk and provide them with the resources they need.

Try a free trial of TheraNest today to see how our electronic health records system can help you better serve your clients.



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