suicide

Counseling Clients Through Crisis, Danger and Harm

Posted on by Mark Moran

In counseling, especially Trauma Informed Care counseling, counselors will not always discuss issues of the past.  Trauma from the past can scar emotionally and create many present issues, but many crisis situations exist also in the present.  Counselors or social workers or pastoral caregivers may discover clients that are in distress due to day to day threats and dangers.  This creates a difficult situation for counselors to discern legal and ethical obligations to protect someone from harm versus situations that while potential dangerous are not imminent and require the empathetic and therapeutic relationship to resolve.  New counselors have especially deeper concerns in this murky waters, while more seasoned counselors have a better understanding when and how to report, hospitalize or walk with a person in crisis that is facing danger or harm.  In this blog article, we will review various situations and how to deal with them, as well as important concepts in the therapeutic relationship that can help respect the autonomy and dignity of the person while also protecting the person.

Understanding how to help clients in potential or imminent danger and crisis. Please also review AIHCP’s Healthcare Certifications

Please also review AIHCP’s multiple certification programs in mental and behavioral health, including programs in Crisis Intervention, Grief Counseling, Christian Counseling and Trauma Informed Care.

The Importance of the Therapeutic Relationship in Resolving Crisis

Cochran points out that wrong decisions in counseling can have drastic consequences in helping those in crisis.  This means that following ethical and legal protocols are key, but assessing imminent danger and potential danger is a key skill.  Furthermore, even if as a counselor, one prescribes and writes down a plan for one to follow, there is never guarantee a client will listen. Many refuse to listen, or if feel coerced into doing something, fail to completely fulfill it because they do not believe in the course of action (2021, p. 222).  This is where not only discernment and assessment come into play but also understanding the dynamic role of the therapeutic relationship and how it can help a client in potential danger or even in some cases, imminent danger, a way to properly find safety without violating the person’s autonomy.  It is far more purposeful to help a person not only escape crisis and danger but understand how to progress and continue to heal and find better ways to to avoid it in the future.

Within the therapeutic relationship, Cochran emphasizes instilling within the client self responsibility that preserves dignity and integrity of the client with less restrictive interventions (2021, p. 222).  Why?  Simply because this allows the person to own the situation, understand the danger, be proactive in finding safety and share in the decision making process for finding that safety or care.  If this means convincing someone who is suicidal to admit oneself to a psych unit at a hospital, or help a person report an abuser, it is also best to guide and help the client make decisions with the counselor so the client can be fully on board.  When clients doubt, or question, or feel forced, they many times abandon the course of action and this is why the therapeutic relationship is so critical in helping clients escape danger.  Of course, unfortunately, there are cases where the client refuses to listen to reason, or refuses to report a crime, or puts oneself in harms way.  This is when a counselor reluctantly must obey legal obligations as a licensed counselor to protect a client.  Obviously these situations involve imminent danger, criminal activity, and a client unwilling to work with the counselor in a plan of action.  In addition to trying to utilize the counseling relationship to foster the best plans, it is also critical for the counselor to employ unconditional positive regard for the client and not just merely hear the situation, but to accept the person and the feelings behind it.  While one may be expressing self harm, or threat of being hurt by others, or hurting others, the counselor needs to employ empathy to help the person not only choose the best option but to also help the person heal.  Instead of judging, the counselor needs to hear the pain to better help the person correct the story (Cochran, 2021, p. 223).

Cochran points out that these situations of imminent threat to a client are some of the most difficult ones for counselors (2021, p. 249).   When dealing with suicidal clients, or domestic abuse victims, leave any counselors, much less new counselors feel a strong stress level when dealing with life and death.  Cochran points out that one of the biggest fears is never being 100 percent sure.  If a client completes a non-self harm agreement, a counselor can be left with a nervous feeling if the client will keep his or her word and not harm oneself.  In addition, Cochran points out that many times, counselors can be preoccupied with liability.  Rightfully so, liability is a key concern, and when necessary, legal actions need taken, but to focus solely on liability at the expense of the over-all situation and maintaining focus on the client, then larger errors can occur in the handling of a situation (2021, p. 252).  In addition to rookie jitters, lack of self confidence or experience, many new counselors sometimes also fear coordination with other counselors and professionals.  They may fear this may broach confidentiality but in many agencies, clients are seen by numerous other professionals and the seal of confidentiality is within the staff.  In addition, many times,  the discussions of imminent danger can be discussed with family, or other professionals due to legal laws (2021, p. 253-254).   If within the therapeutic relationship, family or other professional’s opinions can be inserted into the session without taking control away from the client.  These situations since they are so life altering sometimes need other minds and ideas and experiences to help provide the best outcome for the client.  When the client is working with the team and following a plan, instead of fighting against it and being forced into something, then these are the best situations.  Unfortunately sometimes, not all situations are ideal nor the existence of a therapeutic relationship’s existence.

Situations of Crisis that Can be Potentially or Imminent in Threat or Harm

Most situations of crisis that pose potential to imminent levels of harm include suicidal ideation, domestic violence and sexual abuse.  It is always best to utilize a therapeutic relationship in fostering the best play of action as opposed to arbitrary decisions, albeit sometimes when clients refuse to accept themselves, drastic decisions that may not fix the problem long term, but at least protect the client short term must be applied.

Helping those in distress can be difficult when trying to weight and balance legal duties as a counselor and also the autonomy of a client. The therapeutic relationship attempts to honor both

In all situations, it is best to help clients make the plan and be part of it.  Cochran points out that it may be tempting to take over and make it your plan for the client’s safety, but a counselor wants a client to have personal investment and ownership of a plan (2021, p. 225).   In planning, Cochran also calls for these situations to specifics in each plans that looks at all pitfalls or “what ifs” to help a client navigate the dangers of the crisis.  In addition, when a clients hint or speculate about things that may seem harmful, it is the duty of the counselor to error on the side of caution to broach the subject when necessary and even more so, say the words of “suicide”, or “abuse” if necessary to bring to the light the situation.  If a counselor feels a dangerous situation was implied, it should be saved for the end of the session to counter, but within the next few minutes to redirect to what was said to have a clear understanding of the danger the client is facing (2021, p. 226).

The Situation of Suicidal Threats

Suicide is nothing to ignore.  Many times, individuals dismiss these threats as attention seeking, or merely a state of momentary sadness.  While sometimes they may be benign statements, counselors, nor anyone should ever under estimate a possible suicidal threat.  Instead each needs to be taken seriously and with compassion and without judgement.  Each statement needs confronted and completely understood to see if it is merely a statement, or a wish that has potential or imminent harm intended.  Suicide assessment charts are common place in any counseling office.  These guides help counselors assess and discern situations but also help counselors better work with those who feel this way.

Counselors when broaching the subject of suicide, need to identify a plan of the person.  This plan entails why, when and how a person would kill oneself.  By discussing the details of each plan, counselors and trauma informed care specialists can better ascertain if the risk is minimal and requires therapeutic counseling or if it does pose a true and valid threat.  If it is a legitimate threat or desire, counselors need to determine the lethality of the plan.  The how of one wishes to kill oneself can be very revealing.  If one merely hopes to crash into a tree, or punch oneself, as opposed to shooting oneself, overdosing, or leaving a car running in a garage, then plans that involve less likely hood of death can be categorized as a lower risk level.   However, if more lethal methods are described, then the plan needs to be taken far more seriously.  Compounding the seriousness and lethality of the threat, counselors need to address if the means to carry out a plan is possible.  If a client owns a gun, or has a script that he or she could overdose on, then the level of imminent threat becomes a reality.

Counselors, however, can look for other clues to see the mindset of a client.  Clients may casually state I would like to kill myself, but it may hurt my family too much (Cochran, 2021, 229), or may state what would my baby do at home?  These types of clues are good ways to open the mind of the client to the counselor to better assess and determine.  In addition to preventative factors, counselors should look for future orientation (Cochran, 2021, p. 229).  If a client speaks of chores, events, or work schedules in the next coming weeks, then it is a good sign of no imminent threat, but if clients dismiss schedules, or events, or show no care these things, then a more imminent harm conclusion is warranted.   Another closely related clue to imminent threat is switch or sudden change in emotion about life.  If a client suddenly cares nothing about family, hobbies, or sports, or whatever interest that anchored to his or her reality, then this is a sign of danger that a counselor should take seriously (Cochran, 2021, p. 229).  In addition, a counselor should question the client on previous attempts of suicide.  Those with previous attempts pose a more serious threat to themselves.  Also, a counselor should discuss drug and alcohol abuse and the role it plays on inhibitions in regards to a person questioning life and whether to take it or not.

Through therapeutic counseling, the relationship in these conversations needs to end with some type of non-self harm contract.  The contract should include a time table of security, as well as persons to call if one feels sad or depressed or intrusive thoughts of harming oneself appear.  With this contract is safety planning, where the counselor attempts to receive from the client a promise of no self harm at least between sessions, as well as a call list of individuals that can help, as well as a promise to avoid substances that can limit inhibitions to prevent suicide (Cochran, 2021, p. 231).  One of the most important aspects of a plan is also removing any means that may exist.  If a person has access to a gun, then their is a promise to remove it, and if necessary facilitated through a family member.  If prescription medications are available, then the scripts are removed from the home or access of the person.

Some plans may not be able to be completed merely between the word of a counselor and client.  Some plans may need temporary hospitalization, or family intervention.  It is best that these plans are accepted by the client.  Hospitalization is important for individuals who cannot promise their own safety or commit to a plan.  It is good during this plan to discuss how the process will occur and the potential costs.  It may be helpful to to guide a client to the best facility to meet his or her needs.  It is also best to include family in this decision but also to not be afraid to ask for professional peer advice.   If a client is a threat to him or herself and refuses these measures, then unfortunately, the short term safety of the patient outweighs the therapeutic alliance (Cochran, 2021, p. 237).  It is always the best to have a client on board.  Good counseling and good relationships foster the trust for a client to follow the suggestion of a counselor he or she perceives as genuine and trustworthy.  Unfortunately, many in mental health may only see a client once or twice or in an emergency situation and may be forced making the tough but right decision on the spot.  It is however important to at least try to work with the client and empathetically guide them instead of stripping the person of all autonomy without conversation and empathy and respect.

Domestic Violence and Sexual Abuse

A client who discloses sexual abuse or domestic violence poses a real ethical issue for some counselors.  A counselor is ordered to report crimes of physical or sexual abuse.  How it is reported is another thing.  When joined together with the client in reporting physical abuse or sexual assault, a victim can retain autonomy and healing.  A victim may have a difficult time reporting in confidence this horrific trauma and may have conflicting feelings for the perpetrator, or remain in intense fear, or have shame about the story becoming public.  It is imperative to reflect these concerns with empathy and non-judgement but also reflect the imminent danger and legal responsibilities of the situation.  In previous blogs, we have discussed the importance of safety, security and trust in trauma informed care and this is especially important here.

Those facing potential harm need the ear of a good counselor to help guide them and protect them with an appropriate plan for the given situation. Please also review AIHCP’s Healthcare Certifications

Situations that do not denote reporting that lack physical violence or sexual assault can be more tricky.  There is definitely potential for harm and it may be imminent but has yet occurred.  In cases of emotional and verbal abuse, a very careful plan must be construed that utilizes the strengths of the therapeutic relationship.  Cochran points out that many relationships in crisis that carry emotional and verbal dysfunction may be unhappy but not necessarily imminent to harm (2021, p. 248).   It is important for counselors to understand the underlying causes for the dysfunction, approach ways to reduce triggers by both parties,  as well as ways to help them manage emotions.  Counselors should also seek to understand the past history of violence, if any physical violence occurred in the past to help ascertain the situation and its lethality.  Counselors may also suggest avoidance of high risk activities that lower inhibitions.  The use of drugs and drinking can correlate with violence.  Finally, whether, verbal or physical, anger in the home can be detrimental to children.  Special considerations need to be discussed regarding what children hear and what they feel regarding the uneasy tension (Cochran, 2021, p. 249).

If a situation does not warrant reporting yet has potential or imminent possible harm scenarios, a plan needs developed that guarantees the safety of the client.   Discussions on how to remove oneself from the situation, de-escalate, who to call, or where to possibly stay should all be highlighted.   Counselors are there in the therapeutic relationship to discuss the possible hardships and issues that surround all decisions (Cochran, 2021, p. 249).

In some cases, the counselor may speaking with the offender.  This may occur in solo sessions or couple counseling-The offender who admits to verbal or emotional abuse or to past incidents.  In this therapeutic setting, the counselor is to display unconditional positive regard despite any disgust or disapproval.  The point is this client or person has come for help.  They may at first make excuses but through empathy and good counseling skills, a person can start to see what he or she is doing is wrong in the situation.  This involves patience and no judgement to help facilitate the change necessary internally for the person to seek reform instead of being told to do something.  The counselor can help these individuals identify their own triggers, as well as circumstances, or situations that affect them.  The counselor can also identify if the client had been abused in the past and how to help the person heal and not pass on the same abuse.  Plans can involve identifying triggers, avoiding substances, and seeking the necessary help that may be beyond individual counseling sessions (Cochran, 2021, p. 243).

Conclusion

Counseling is not always about past trauma or issues that do not pertain to present potential or imminent harm.  Counselors need to understand their legal obligations when presented to report crimes or potential harm to a client or others, but they can also employ the therapeutic relationship which understands the pain of the individual and the distress of the entirety of the situation.  Sometimes this involves helping the person come to the conclusion that direct help beyond counseling is required, other times it may involve a plan for non imminent or criminal threats to a person’s safety.  The counselor in the therapeutic relationship manages the crisis with empathy but also respects the dignity and autonomy of the individual in coming to logical conclusions and safety plans that protect the individual and others.  When a client works with a plan instead of being coerced, then healing is more possible.  Unfortunately, some clients who are victims of crimes, or are a harm to themselves that refuse to work with a counselor, must be hospitalized, or the situation reported despite the pain it causes.  These are difficult times for counselors, especially new counselors.  Hence, it is important to employ a health therapeutic relationship when applicable, assess situations, consult with other professional peers and make the best decision for the welfare of the client.  It is not an immediate assessment but one that is made with many considerations, facts, and complications considered for the best outcome that respects the law but also safety of a client.

Please also review AIHCP’s healthcare certification programs in trauma informed care, crisis intervention and grief counseling

Always remember though

“The American Psychological Association (APA) offers ethical guidance through its “Ethical Principles of Psychologists and Code of Conduct.” Under these principles, therapists can disclose information without client consent if deemed necessary to protect the client or others from harm. This authorization for disclosure also extends to situations where the client has given permission, or when required by law, such as when providing professional services, seeking consultation from other professionals, or obtaining payment for services.” (Deibel, 2024).

Trauma Informed Care Specialists, those in crisis counseling, and any licensed mental and behavioral health professional, as well as healthcare professional can face these situations and must have a clear understanding what to do but also have the skills necessary to facilitate health client interaction that leads to joint conclusions when possible.

Please also review AIHCP’s multiple healthcare certifications and see which ones best meet your academic and professional goals.

Resource

Cochran, J & Cochran, N. (2021). “The Heart of Counseling: Practical Counseling Skills Through Therapeutic Relationships” 3rd Ed. Routledge

Additional AIHCP Blogs

Suicide Assessment. Click here

Suicide Lethality.  Click here

When Trauma Emerges in Counseling.  Click here

Additional Resources

Health Information Privacy. US Department of Health and Human Services.  Access here

Barsky, A. (2023). “Duty to Protect and the “Red Flag” Option”. Psychology Today.  Access here

“Guidelines for working with clients when there is a risk of serious harm to others” APS. Click here

Diebel, A. (2024). “What is a Therapist’s ‘Duty to Warn’ and Why is it so Important?” Grow Therapy. Click here

 

Crisis Assessment and Lethality Video

Posted on by Mark Moran

Identifying suicidal ideation and lethality is critical in crisis intervention and counseling.  It is also essential to report and find these individuals the needed help.  Crisis Counselors sometimes deal with individuals on the scene who are suicidal or deal with individuals in short term care facilities that may express it.  Counselors in general also need to be aware of clients who may be expressing lethal intentions. This video reviews the keys to assessing lethatlity

Please also review AIHCP’s Crisis Intervention Program by clicking here

The program is online and independent study and open to qualified professionals seeking a four year certification in crisis counseling.

Suicide and Crisis of Lethality

Posted on by Mark Moran

Crisis Intervention specialists deal with an array of issues.  Usually issues of self harm, harm of others and suicide are a very common theme.  In crisis, logical thinking and hope are erased and the person can sometimes do things out of character that are very lethal in nature.  Understanding suicide, suicide assessment, prevention and intervention are key components of helping individuals in crisis not make a permanent and fateful decision.

Suicide is rarely a conscious choice but one with emotional and mental implications that remove one from a state logical thinking

It is critical for crisis counselors, grief counselors, pastoral care givers and ministry, licensed mental health professionals, as well as those in healthcare to have a strong training and educational background in suicide and crises of lethality.  AIHCP offers certifications in Grief Counseling but also in Crisis Intervention to help train members in those fields with the additional knowledge and abilities to handle crisis of lethality.

Suicide

While in the past, AIHCP has offered blogs, as well as video content on the nature of suicide, this particular blog will focus on the crisis element of it.  It will identify suicidal signs, assessments, but also focus on intervention in particular.

James points out that a person in suicidal crisis is engaged in an expressive act of homicide where emotional state looks to reduce psychological pain (2017, p. 203).  According to statistics, James point out that 600, 000 to 100, 000 suicides are attempted each year in the United States and 30, 000 to 60, 000 die each year in those attempts, with 19, 000 permanently injured (2017, p. 204).  While different groups within the US  have different rates of suicide as compared to others, the leading group is older white males.

Theories surrounding suicide share many common features but also have different emphasis on certain reasons why one attempts to kill oneself.  Freud’s psychodynamic theories saw suicide as a reaction of some inner conflict with external stressors (James, 2017, p. 206).  Erickson saw reasons for suicide correlated with developmental issues that prevented the person from advancing and reaching certain goals in life.  Individuals who become stagnant and unable to develop sometimes choose suicide as an option to escape (James, 2017, p. 206).   Escapist theory views suicide as the only way out of a bad situation during fight or flight.  Within this theory, individuals feel they fell short, blame themselves, focus on narrow deficits only, and only see a view of perfectionism that if not met can only end in suicide due to the hopelessness perceived (James, 2017, p. 206).   Hopelessness remains a common theme in all situations where the person feels they have no power over the situation.

Another important theory was developed by Edwin Shneidman, the founder of suicidology.   In understanding suicide he measured one’s psycheache or pain in the mind, one’s perturbation or the degree of the pain, and the press or stress due to external factors (James, 2017, p. 206),   With the combination of these things, Shneidman saw how psycheache frustrates  or blocks psychological needs leading to hopelessness and suicide and reaching the state of critical mass to activate suicide.

Durkeim in the 19th Century proposed the sociological theory which looks at a person’s connections to society and how social norms and society based on a person’s integration with those norms plays a large role.  Egoistical suicide refers to one’s lack integration with any group.  Anomic suicide refers to when economic and financial systems of society break down all around the person.  Altruistic suicide refers when a person commits suicide for cultural reasons or the perceived better good according to the society.  Fatalistic suicide refers to if a person is an intolerable or unescapable situation such a concentration camp (James, 2017, p. 207).  According to Van Orden interpersonal states are also key in the mind of those contemplating suicide.  Suicidal individuals may acquire capability by decreasing innate fear of pain and death gradually.  In their personal views, they perceive themselves as burdensome to others as well as failing to belong to anyone or find attachment to anything (James, 2017. p. 207).   Existentialism and meaning also play an important role in suicide theory.  Ideas on death, existential isolation, meaning and meaningless in making sense of the world and the freedom of existentialist thought to make choices all play a role in the construction of existentialist thought.    When challenges to existence and death are overwhelmed and an existentialist anchor is lost, then many individuals can fall into hopelessness without any reason to exist (James, 2017, p. 208).

Another interesting theory follows a basic suicide trajectory model based on various risk factors that correlate with suicide.  This includes, biological, substance abuse history, genetic predispositions, gender, self esteem, psychological maladies, cognitive thinking and environmental stressors (James, 2017, p. 207).    Psychology also points to imbalances within the brain, neurochemical reactions that do not allow a person to better respond to a situation (James, 2017, 208).

From these theories and multiple other ones, one has a better understanding that suicide is rarely a free choice but is committed in a state of emotional turmoil without true cognitive reasoning.  This is why so many religious views on suicide as a choice or sin have been replaced with a better recognition that most if not all are victims of it.

Characteristics of Suicidal Individuals

For the most part, those thinking of suicide exist in an acute state of crisis or a chronic state of depression that leads to certain characteristics that manifest emotionally, socially, mentally and physically.

Many suicidal individuals suffer from depression or hopelessness. Please also review AIHCP’s Crisis Intervention Certification

Situationally, individuals face an endurable pain they cannot overcome.  A stressor frustrates the psychological need (James, 2017, p. 209).  Hence situations involving trauma, death, loss, finances, relationship or anything that creates a perceived unbearable loss appears.  Motivation wise, individuals look to seek a solution and that solution entails to remove the stressor via cessation of consciousness.  Accompanied with this are the affective emotions of hopelessness and helplessness.  Cognitively, individuals see solutions in a very narrow scope with out any alternatives to think their way out of the situation.  Relationally, an individual wishes to communicate intent and find mutual justification in it and acknowledgement of that right to do so.  Serially, characteristics reveal a long history of trying everything else but no other option remains (James, 2017,p. 209).

Within these characteristics of the suicidal mind, it important to dismiss certain myths that distort.  First, one needs to dismiss fears of discussing suicide as if it will cause it.  In fact, discussing suicide and being very upfront is key.  Second, one needs to dismiss the notion that those who say they will commit suicide rarely carry through with it.  In fact, many who say they are contemplating are very high risk of attempting it.  To the individual suicide is perceived as a very rational act.  Third, individuals who commit suicide are insane.  Most who commit or attempt suicide are only acutely affected with emotional issues.  Fourth, suicide is only impulsive.  In fact, most suicides are planned and plotted outside acute crisis.  Fifth, suicide is painless.  Many suicides can be very gruesome and some go awry and very wrong.  Sixth, suicidal thoughts are rare.  In fact, they are more common than one may think with 8.3 million have some type of suicidal ideation (James, 2017. p. 212).

Suicide Assessment is Key

Assessment is critical in saving a life.  While some crisis specialists deal with suicidal individuals in an acute and heated moment, many suicides are well planned and plotted.  Counselors need to be aware of the possibility and assess the lethality

James points out that there are a variety of verbal clues, statements and written letters.  As well as behavioral clues such as self harm or isolation.  Also situational clues that involve death of another person, financial woes, loss job, or divorce should be acknowledged.  In addition, syndromatic clues such as depression, hopelessness and unhappiness with life can play key indicators in possible suicidal.  This is why it is so important to also ask someone in assessment (2017, p. 212).

Another tool to utilize is PATHWARM.  This  is an acronym from the American Association of Suicidology.  It utilizes the letter within the acronym to better identify various warning signs.  Within the acronym is: Ideation, Substance Abuse, Purposefulness, Anxiety, Trapped, Hopelessness, Withdraw, Anger, Recklessness and Mood.

There are many, many assessment keys, questions, or triages one can utilize.  We will briefly go over a select few.

First, the basic clinical interview is essential in determining suicidal ideation.  Within it is a long laundry list of observations and questions.  Here are a few: Does the person exhibit suicidal intent or tendencies?  Does the person have a family history of suicide?  Does the person have past suicide attempts? Does the person have a specific plan?  Has the person experienced a death recently? Does the person have a history of drugs and substance abuse? Does the person display radical changes in mood and behavior?  Does the person display hopelessness?  Has the person experienced past trauma?  Has the person discontinued medication?  Does the person exhibit extreme emotions?  Has the person faced financial troubles or loss of job?  Does the person feel threatened?  Does the person see everything as all or nothing?  Does the person feel as if he or she does not belong? Does the person struggle with identity and self esteem?  Does the person have access to firearms?  Has the person explored suicide through online search or literature?  Has the person not seen a medical professional within the last 3 to 6 months? (James, 2017, p. 215).

SIMPLE STEPS is another acronym that can utilized in assessment during interview. Again it emphasizes the importance of asking the question are you thinking of killing oneself?  Within the acronym are the following points.  Suicidal? Ideation? Method? Pain? Loss? Earlier attempts? Substance abuse? Troubleshooting for alternatives? Emotions? Parental history? Stressors? (James, 2017, p. 216-17).  This triage captures the basic essence again of all assessment in that it asks the difficult question and looks to identify potential lethality and danger of a plan.  Not all cases may present an immediate acute threat while others may require immediate intervention and reference to medical professionals or notification of authorities and family.

Suicide Intervention

In intervention, whether in acute setting or discussing possible plans of a person to commit suicide, professionals need to not judge the person, or demean the person’s perceived tragic nature of life.  Instead, crisis professionals are encouraged to gain an understanding, form a bond and offer alternative options.

The Three “I”s are essential to know if looking to defuse suicidal situations.  The person feels the situation is inescapable, intolerable and interminable (James, 2017,p. 218).  Hence it is important to help the person feel secure, less painful, and offer hope with solid solutions.   When a person is facing crisis, they may feel there is no other way out and may need alternatives presented and applied to the situation.  In addition, the crisis counselor may try to help the person reframe the situation with attributes of CBT to see the situation from a different light.  The crisis counselor must also help the individual face the pain and discover that is not forever.  Helping focus on not so much the lethality but the perturbation of the person can help the person see more clearly, utilize problem solving abilities, and offer alternatives to the current issue.  Addressing stressors and helping the person see hope is the biggest key.  At this core, Crisis Management looks to help the person plan a response to suicidal issues (James, 2017, p. 222).

Those in suicidal ideation need alternatives and options. They need to know the there is escape and an end to the pain that involves not ceasing consciousness

In counseling, professionals should help clients reframe.  This involves not only a new line of thinking but also validating emotions and discussing future suicidal behaviors and how to counter them.  It is important to help the person learn real problem solving skills for issues but also address teaching individuals how to cope with pain and emotions in better ways.  In addition, counselors can help clients find better social connections to prevent isolation as well as play an important role in life coaching with positive thoughts, plans and goals.  Importantly as well, a counselor should obtain from the person a no harm commitment through a suicide “Do not Harm Contract” or “Stay Alive” contract which the individual signs.  It is important to let the person know he or she is not alone and can reach out or call when certain triggers may appear that seem unbearable (James, 2017, p. 227)>  In some cases, calls to the authorities may be needed, or a person may need observed for a period of time before the crisis has subsided.

Conclusion

Suicide is not simply a call for help but a true crisis situation that demands attention.  Through warning signs, assessment and proper intervention, crisis counselors can save lives.  It is also important to note that suicide is not something rationally chosen but one that is mentally and emotionally chosen when in a illogical state of mind.  Hence negative social stigmas need removed and professionals as well as society need to see these individuals who attempt or complete suicide as victims.  This is why it is so important to be educated on the subject and listening and observing with empathy for those who shows signs of suicidal ideation.

Please also review AIHCP’s Crisis Intervention Program and see if it meets your academic and professional goals.  The program is online and independent study and open to qualified professionals seeking a four year certification.  Counselors, first responders, clergy and other mental health professionals can play a key role crisis intervention and saving lives from suicide.

 

Resources

James, R & Gilliland, B. (2017). “Crisis Intervention Strategies”. (8th). Cengage

Additional Resources

Clay, R. (2022). “How to assess and intervene with patients at risk of suicide”. APA. Access here

Are you thinking about suicide? How to stay safe and find treatment. Mayo Clinic.  Access here

Ryan, E. & Oquendo, M. (2020). “Suicide Risk Assessment and Prevention: Challenges and Opportunities”. Psychiatry Online. Access here

Suicide and suicidal thoughts. Mayo Clinic.  Access here

Suicide Prevention Tools for Public Health Professionals. CDC.  Access here

988 Life Line  Access here

 

 

 

 

 

Crisis and Suicide Assessment

Posted on by Dominick Flarey

Suicide is vital in any counseling whether clinical or pastoral.  Pastoral counselors should refer patients or members of the community to a professional counselor if he or she feels the person is experiencing depression and suicidal ideation.   In most cases, suicide assessment will consider a person to be low risk or high risk.  As opposed to low risk, high risk individuals have a far worst depression and a more lethal plan.

Suicide assessment is key in assigning low or high risk individuals. Please also review AIHCP’s Crisis Intervention program

 

When anyone feels depressed, especially over time, it can become overwhelming.  This is why when helping depressed and grieving individuals to probe and ask questions about suicide.  It is critical to ask if one wishes to hurt or harm oneself when interviewing the patient.  It is important to see if those types of thoughts or ideas are entering the person’s mind.  If someone who is experiencing depression states they feel hopeless, then this is definitely a warning sign.  Not all hopeless individuals commit suicide, but anyone who has ever attempted or committed suicide definitely felt hopeless.

If the seriousness of an assessment manifests, then one needs to determine if one is low risk or high risk.  Many individuals in pain or depressed may think occasionally of killing oneself, but do not have the intention, desire or capability to do so, but as thoughts of suicidal ideation become more frequent and loud, then an assessment is definitely needed.  Hence after assessing symptoms of depression and the thought or at least implicit idea of suicide within the patient’s mind, it is important to access whether this person is low or high risk.  High risk individuals will require more intense observation and measures, while low risk will require less intense intervention.

If one makes comments about harming oneself, the next question is to determine lethality of the plan.   Is the plan doable?  Are the means, times and places for the event possible? If someone dictates one would like to shoot oneself, then access if this person has access to firearms.  A person who points out that he owns a gun that is at home and currently loaded in his closet poses a severely high risk.  Hence the more detailed the plan the higher the risk level.  If a person has access to the weapon named in the thought and a time planned, then immediate intervention is required. Police should be called or the person should be submitted to a psych ward for observation.  If the person on the other hand does not have access or ability to commit immediately, one should be immediately referenced to professional counseling for depression.

Someone who is high risk has more detailed plans, numerous thoughts, deeper depression, more drinking and drug issues, and access to carry out the plans. High risk individuals are also individuals who have survived past attempts.  So it is important to ask these questions as well, but also including family history of suicide.   Unfortunately, many individuals due to mental health stigmas, keep their sadness and depression to themselves.  No-one is aware of the high risk involved with the loved one or friend.  Many times, friends and family miss the subtle comments about life and death or the anxiety and depression someone is enduring.  Awareness, questions and listening are key in helping depressed individuals find the help they need.  Assessments can later be employed to determine the risk level.

When one is in crisis, it is important to ask questions about self harm or hurting oneself and see if anyone is frequently thinking of it or planning it

 

If anyone manifests any level of suicidal ideation, it is important to convince the person to make a no-suicide contract in which the individual promises to call someone if the person feels low, hopeless, or ideation of killing oneself manifests.   This last outlet may be the helping hand one needs not to take it to the next step. In this type of contact, the person promises to call a loved one or yourself if ideation manifests.  Sometimes this last call for help is the difference between life and death.  It is also important to discuss the frequency of alcohol and drug use during this period of time and how it can play a role in poor decisions.

Individuals kill themselves not because they want to die but because they do not feel life is worth living.  Many of them are not in the proper state of mind due to depression, trauma or extreme pain.  These individuals need counseling and help so they do not fall victim to suicide itself.  With so many stigmas surrounding suicide, it is important to remember that someone who commits it or attempts is dealing with temporary mental illness.  One should not blame but try to help.  It is not a true sin in the classical sense that once was attributed to it but a true mental state of imbalance.

Pastoral caregivers can play a key role in helping members of the congregation work through suicidal thoughts.  They can be the first line of defense for those who have noone to talk to or discuss their feelings with.  They can mentor, guide and help individuals find hope when they are depressed.  Christian Counselors, pastoral counselors and those in ministry should all have crisis intervention training and suicide prevention training.  This will enable them to better help individuals suffering from these types of thoughts.

Please also review AIHCP’s Grief Counseling, Christian Counseling and Crisis Intervention Counseling Programs.  The programs all to some extent touch on suicide.  The Grief program discussing the role of depression and loss in suicide.  The Christian Counseling Program discusses the pastoral implications from a Christian perspective and the Crisis Intervention Program discusses suicide prevention, assessment and helping individuals who are in a state of acute crisis.  All the programs are online and independent study and open to qualified professionals who work in the counseling and ministry fields.  Please review and see if the program meets your academic and professional goals.

Again, if in any type of counseling, whether professional or pastoral, be sure to have a complete understanding and working suicide assessment list.  Also, if anyone is feeling worthless or hopeless, please call the National Suicide Hotline and seek help.  Simply dial 988. Hurting oneself is never the answer.

Additional Resources

988 Suicide & Crisis Lifeline.  Access here

“Suicide Assessment”.  Access here

“How to assess and intervene with patients at risk of suicide”. Clay, R. (2022).  APA.  Access here

“Adult Outpatient Brief Suicide Safety Assessment Guide”. National Institute of Mental Health. Access here

Grief Counseling Training Program Article on Depression with Suicidal Thoughts

Posted on by Dominick Flarey

In times of crisis suicidal thinking can overtake, but it can also gradually creep into the mind of the person via depression.  Understanding and identifying suicidal depression is important and can save a life.

Helping some through suicidal thoughts takes indepth training. Please also review AIHCP’s Grief Counseling Program

 

The article, “Understanding Suicidal Depression” from Healthline explores the characteristics of suicidal depression.  The article states,

“When someone has clinical depression with suicidal ideation as a symptom, Marshall says it means that they are experiencing suicidal thoughts as part of their overall health symptoms. “However, it’s important to remember the vast majority of people who are depressed do not go on to die by suicide,” she explains.”

To read the entire article, please click here

It is important to never underestimate suicidal thoughts and to help individuals find the help and care they need if beyond one’s ability.  If someone is experiencing suicidal thoughts, it is important to delve deeper into how well thought a potential plan is and also the ability to carry out that plan. In addition it is important to make a pact that if someone feels they can no longer cope to call or let you know.

Please also review AIHCP’s Grief Counseling Training Program and see if it meets your academic and professional goals.  The program is online and independent study and open to qualified professional seeking a four year certification in Grief Counseling.

 

Grief Counseling Certification Article on Suicide Grief and Grieving

Posted on by Dominick Flarey

Making sense of suicide is difficult.  Loved ones who lose family to suicide suffer immensely in the days and months and years after.  Questions swirl around their minds.  What could one have done better, or why did one say this or that, or why was one not paying attention to the signs.

Processing the loss of a loved one to suicide is a very difficult process. Please also review AIHCP’s Grief Counseling Certification

 

Regret, guilt and intense grief can follow.  The very fact that suicide is a taboo subject can also intensify the grieving process.  Suicide grief hence has all the prerequisites and ingredients for a possible complication emotionally for the family.

The article, “Making sense of suicide grief” by Susan Quenelle looks deeper at suicide grief for family members trying to make sense out of the senselessness.  She states,

“September is National Suicide Prevention Month. This designation helps to serve as a reminder to all of us of the many people who struggle with emotional issues on an ongoing basis. But another related area of concern is those who are left behind after someone has committed suicide.”

Those left behind suffer the most and it is important to help them understand their grief.  To read the entire article, please click here

To learn more skills to help others through the process of losing a loved one to suicide, then please review AIHCP’s Grief Counseling Certification

 

Grief Counseling Training Article on Child Suicide

Posted on by Dominick Flarey

Losing a child is the greatest loss a parent can face.  How the child dies can make the loss even more unbearable.  The loss of a child through suicide is even a greater loss.  Many parents need emotional and professional support in dealing with such a loss.

The loss of a child through suicide may be one of the most painful losses. Please also review our Grief Counseling Training

The article, “How do you live after your child commits suicide & you never saw it coming? A grieving parent reflects” by Linda Collins explores this painful grief.  She  recounts from a book about such sad tales.

“Victoria was their only child. Three years after the incident occurred, Collins recounts her 17-year-old daughter’s suicide in this book, weaving in her daughter’s diary entries, personal memories and accounts from the people in her life.”

The article offers an excellent book for others to investigate and read.  If you would like to read the entire article, please click here

Please also review our Grief Counseling Training and see if it meets your academic and professional needs.

 

Christian Counseling Certification Article on Pastoral Care of Suicide

Posted on by Dominick Flarey

Suicide for the longest time was considered only to be a sin of despair.  It was a stigma and received more condemnation than care.  Today, individuals who attempt suicide are treated more like victims fortunately.  Family is also given the care and love they deserve from a pastoral perspective.

Suicide is not always a sin of despair but also sometimes a mental condition. Please review our Christian Counseling Certification

The article, “SUICIDE: MOVING BEYOND CONDEMNATION TO CARE” by Elizabeth Evans states,

“Numerous faith traditions have a history of criticising suicide as a sin – and one that leads to damnation.  But some faith leaders are now working not only to offer those facing despair help in addressing the root causes of suicide but to remove the stigma that keeps so many suffering families quiet after the death of a loved one.”

To read the entire article, please click here

Please also review AIHCP’s Christian Counseling Certification and see if it meets your academic and professional goals.

Grief Counseling Certification Article on Stigma Of Suicide

Posted on by Dominick Flarey

Suicide is a messy thing. It is filled with multiple emotions of loss and despair, but what modern science teaches is that is most of the time an illness.   Someone does not simply wish to end his or her life with a clear head.  It is because of this and many other factors that cloud judgement that many churches have removed the stigma of suicide itself.  Suicide while a horrible thing must not be shelved away but discussed in the open and understood a decision based upon mental illness.  If so, we as a society can move forward and deal with suicide survivors, as well as family survivors of a successful suicide of a loved one.

The choice of suicide is a result of a mental imbalance that leaves everyone in tears.
The choice of suicide is a result of a mental imbalance that leaves everyone in tears.

The article, “Opinion: Talk about suicide, end the stigma” by Natalie Sept looks closer at suicide and how it can no longer be seen simply as a rational choice but more so as a decision based in intense emotional instability.  It is time to stop treating it as a stigma and face it head on and recognize the surrounding demons of it.   The article states,

“When I received the news recently of his suicide, there was something in me that knew it would end this way. Jay struggled with addiction. Our family watched nervously as his jovial disposition became clouded with the pall of substance abuse that eventually pulled him into an irreversible decision.”

To read the entire article, please click here

To learn more about grief counseling and helping others with suicide, please review our Grief Counseling Certification.