Suicide: Re-Thinking Assessment, Treatment and Prevention

By Ofer Zur, Ph.D.

Client suicides may be the most severe crisis in a therapist’s career. It is estimated that approximately 25 % of psychologists have had a client commit suicide, 11% of pre-doctoral trainees have lost a client to suicide, and an additional 29% have had a client attempt suicide. The old and the young seem particularly vulnerable. The incidence of suicide among adolescents has tripled since 1955. Despite these disturbing statistics, surveys of psychology graduate programs consistently find that the assessment and treatment of suicide is barely covered.

Suicide pills

In addition to the severe emotional and professional effects on therapists whose clients commit suicide, there are legal ramifications which every therapist needs to be aware of. Not only are most therapists under-prepared for treating suicidal clients, there may not be another condition so clouded with the therapist’s (and society’s) values. It’s not surprising that under such conditions, myths about the suicidal person have proliferated. These values and misconceptions prevent effective treatment and can cause therapists who aren’t well versed in the issues surrounding suicide to sometimes accidentally push a client further into suicidal thinking and action.

David Jobes’ approach, featured in this new course, epitomizes the latest thinking in assessing and treating suicidal clients. His Collaborative Assessment and Management of Suicidality (CAMS) stresses joining with the client in a compassionate investigation not just of the suicide risk but into the client’s thinking and feelings that are triggering such an existential crisis. The work of David Webb is also featured in this course. The first person to attempt suicide and go on to earn a Ph.D. in Suicidology, Webb goes even further, reminding clinicians that their job is not to dissuade clients from killing themselves but to de-pathologize suicidality and try to understand how their clients’ are feeling and thinking. Approaches such as Jobes’ and Webb’s remind clinicians that what is crucial is the ability to connect with and understand each individual client, rather than merely see him/her as a “suicidal client” to be fixed.

Did you know…
  • The primary value of no-suicide contracts is to temporarily allay therapists’ fears. They are generally highly ineffective in deterring suicides and thus they offer virtually no protection against subsequent lawsuits and sanctions. No-suicide and safety contracts should be used only when the therapist has established a meaningful connection with the client.
  • There are no assessment tools which reliably predict which clients will commit suicide.
  • However, there are risk factors such as previous attempts, plans and means of killing oneself, negative life transitions, narcissism, impulsivity, and co-morbid disorders. (Depression by itself is not a reliable predictor.)
  • Clients who express a wish to die are not necessarily suicidal, nor is that wish necessarily pathological.
  • The suicidal state is usually transient and treatable.
  • Respectful, open communication with suicidal clients is more important than empathy and certainly more important and effective than trying to dissuade them from killing themselves.

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