This World Suicide Prevention Day we consider how working with someone who has suicidal feelings can be hard. Here are some things that I have found useful in my experience as an honorary psychodynamic counselor working with university students …
Keep it in mind
Take any mention of suicidal thoughts or feelings seriously. And if a client talks about ‘wanting to disappear’ or ‘not exist’, think about suicide and consider whether this person might be considering hurting themselves to take their own life.
Listen to what is not said
I strongly believe that listening to what is not said, like the feelings you have in your body in response to someone, or how you feel when someone is talking about something, are very important. So if you suddenly feel very worried for a client and feel that they might be at risk, even if they haven’t said anything – then don’t ignore it.
I have found it useful to be direct. If I am worried enough about a client, and consider them to be at risk, I will directly ask if they have had suicidal thoughts or feelings. I will ask if they have a plan of action to kill themselves. And I will ask on a scale of 1 to 10, where 10 is very definitely wanting to die and take their own life, where they currently sit. These are quite practical questions in a counselling world and can feel jarring when you are used to being less directive, but I do think they are necessary and helpful.
Refer on to a GP
It is always good practice to ask if someone has made an appointment to talk their GP about suicidal thoughts and feelings. This helps to join up care, and can mean that a client has a chance to explore other avenues for support like taking anti-depressants.
Keeping themselves safe
You will not be with a client that is feeling suicidal 24/7. It’s just not possible. So it can be important to ask a client what they would do to keep themselves safe if they felt like taking their own life. Check out that they know where their local A&E is, how to get there, and if they know about areas of support like the Samaritans telephone line, 116 123.
Think about immediate risk
If you consider someone to be at high risk then it is important to consider how safe they will be once they leave the counselling room. Do they have plans for that evening? You could ask how safe they feel once leaving the counselling session. If they do not feel safe, would they like to go to A&E? Could you book their transport? Can someone go with them?
Explore the meaning
Someone can have a suicidal fantasy but not actually want to take their own life. It can be useful to explore the meaning behind this fantasy, what feelings are attached to it? Are there feelings of sadness, anger or a desire for revenge? What is it about?
Ask the question
If a client has mentioned feeling suicidal previously but appears to have moved on, it can be useful to check in again to see how they are feeling now. Something like ‘you mentioned previously that you were a five out of 10 on a scale of wanting to kill yourself, how are you feeling now?’ It can again feel direct and jarring to be so upfront, but it can be useful.
Think about clients that you’re not worried about
My first year tutor in my counselling training, former Director of Counselling at Westminster University Ann Heyno, said to me to worry about clients who you are not worried about. So in other words, some clients will keep you up at night feeling anxious. But sometimes those who don’t enter your mind are those most at risk.