Important Considerations When Talking about Suicide in Counselling

In this article, I would like to share about a number of important considerations when talking about issues related to suicide in counselling. This includes common misconceptions, demographics and warning signs, and questions to ask when assessing for suicide.

To begin with, there are at least four common misconceptions about suicide. The first misconception is the idea that talking about thoughts of suicide may cause a person to attempt suicide. The second misconception is that there is a tendency by counsellors and others to discount suicide threats, by blaming people for attempting to get attention. A third misconception is that the therapist cannot intervene with a client who has already decided to commit suicide. The fourth misconception is that the person who commits suicide really wants to die. None of these ideas are generally very accurate conceptions about suicide.

The demographics of suicide and risks are typically based on identifiers such as age, gender, ethnicity, childhood loss, recent losses, alcoholism or other substance misuse, depressive illness, declining physical health, downward economic mobility, urban living, marital disruption, previous suicide attempts, and history of attempts or contemplation in families. I think it can be a slippery slope to assume we have certainty about knowing risks based on demographics, because studies and surveys can't always accurately account for variations in how people self-report.

There are however some well accepted warning signs, with features and manifestations that seem to suggest a pattern. These warning signs may include changes in a person appearing increasingly quiet, withdrawn, or having fewer friends. Signs could also include changes in behavior or increased sense of failure or pressure in their usual roles. There may also be recent family changes or losses and feelings of despair or hopelessness. By most standards, communicating about suicidal thoughts or feelings is a sign, as well as the presence of a plan to take action toward harming oneself or taking one's own life. In addition, there may be negative or fearful attitudes toward counselling therapy, mental health, or crisis services that create barriers.

In assessing for suicide there are some important questions to consider asking. In my own counselling practice, I may ask clients if there are times that they feel like life is not worth living? If so, do they want to hurt themselves or die? If they want to hurt themselves or die, are these vague and general thoughts or do they think about specific ways to harm themselves or die? What are the specific ways they have thought about? Have they taken any steps toward planning or acting on it?

Finally, I want to acknowledge that these can be difficult questions for counsellors to ask and difficult conversations for clients to have with counsellors. There might be a tendency to hold back direct questioning that could come across as insensitive or forceful with clients. This could be related to the specific details about how clients have imagined ending their life or the plan they’ve created. In my assessment, I would want to listen to the client’s details of their plan, the lethality and reversibility of their actions, the intentionality and possibility of being rescued, and the proximity of others who are supportive. Most importantly, I value connecting deeply with people who are feeling hopeless and thinking about hurting themselves or wanting to end their life. It's essential to express genuine care and concern, acknowledging that a person's life is meaningful, even if they don't feel that way.