How I help suicidal clients

I don’t want to go on with life.

Nobody would miss me if I stepped in front of a train.

Life isn’t worth living any more.

I wish I were dead.

My family would be better off without me.

When a phrase like the ones above comes up in the therapy room, it is a critical moment between therapist and client. If the therapist is panicked or overwhelmed to hear of the client’s suicidal thoughts, or immediately wants to break confidentiality to prevent the client acting on them, the therapy room may no longer feel safe to the client.

This is my approach to suicidality.

Listen

Above all, I listen. I want to hear whatever my clients want to tell me. I’m not afraid to go to dark places with them, and I’m not panicked by hearing their suicidal thoughts. I take suicidality seriously, but I’m not scared or overwhelmed by it. I appreciate, though, that it may feel scary and overwhelming to my clients when they are experiencing it, so I want to hear what it’s like for them.

Understand what clients mean

A phrase like “I don’t want to go on with life,” can mean I want to kill myself or I’m fed up with the way things are and could do with a break. I try to understand exactly what a client means. Do they want to be dead or do they just want life to stop for a while? If they want to be dead, are they considering acting on that desire?

Think together about keeping the client safe

It can be comforting for a suicidal client to have a plan in place to keep them safe when their suicidal thoughts are strong. So, if the client wants to, we will think together about a safety plan. That might include people the client can call when they are at their lowest, and removing from their home the means to kill themselves, for example.

Respect the client’s autonomy

Throughout, I never take a client’s autonomy away from them. I believe that if a person wants to end their life, that is probably a reasonable response to their circumstances, and it is their right. So I don’t pressure clients into any preventative course of action they don’t want to take. Not only do I not consider it my place, I know that for many suicidal people the thought they could end their life is a comfort. It would be a betrayal of our therapeutic relationship if I tried to take that option away from them.

Maintain confidentiality

A key part of respecting my clients’ autonomy is that I don’t break confidentiality over suicidality. Some therapists inform a client’s GP or next of kin when they are suicidal. I might explore with the client whether they want to tell anyone themselves, but if they don’t want to, I respect that. 

In summary, my approach is to provide a safe space where my clients can talk about feeling suicidal without fear of judgement or of having their autonomy taken away. 

If that sounds like something you could benefit from, please do get in touch or book an initial consultation.