Before I write this post, I would like to make it clear that I don’t feel that there is a right or wrong answer to the question, merely an important topic to reflect on as a Counsellor (or human) when this issue will undoubtedly have a frequent presence in our line of work. Let’s take a look at Suicide in Counselling.
Autonomy is one of the six principles in the BACP Ethical Framework for the Counselling Professions (which you can read here.) It is also of the utmost importance in the Person-Centred approach to Counselling. With a focus on non-directivity, empathy and acceptance, how do we manage all these principles when we are sat with someone who is seriously considering suicide as an option?
Autonomy is defined by the BACP as “respect for the client’s right to be self-governing.” However, do we take this on board wholeheartedly when it comes to issues as serious as suicide? Do we commit to this principle even in these extreme circumstances?
It could be argued, that as with any Ethical Dilemma, the BACP recommends weighing up the whole Ethical Framework and making the best decision with consideration of all the principles and values that it sets out. For example, how do balance up Autonomy with Beneficence (a commitment to promoting the client’s wellbeing) and Non-maleficence (a commitment to avoiding harm to the client)?
One other important issue to consider is that research consistently shows that the majority of people regret suicide after they have attempted it and only a minority commit suicide after failed attempts in the past.
I think this is important to hold in mind as a Therapist because although we may have clients who are seriously considering suicide and we want to be able to hear and accept this as best as possible, I think that it is also helpful to know that the majority of people would regret this decision further down the line.
I do not think that this means we should change the way we work, instantly stop the client or even let them know about this fact, but it does give us a wider perspective of how suicidal ideation works for many people.
One thing that is important to know (as Clients and Counsellors) is that suicidal ideation or thoughts are extremely common in most people.
It can be extremely scary for anyone to admit that they are having thoughts of this nature because they can often believe that is unnatural or that the Counsellor will instantly break confidentiality and they will be put into a hospital.
The truth is that suicidal ideation does not necessarily equate to suicidal tendencies or action. More often than not, they are thoughts that come from a place of hopelessness, having had enough of a situation or want a break from the suffering that they are experiencing. It is often a sign of the only way that they can think of to switch off the torment in their head.
This is completely natural and deserves the acceptance and empathy that we would offer to any other topic so that the client can explore this to whatever depth they need.
Hearing the Cry
This is why Counselling is such a sacred place for people who are suffering and having suicidal thoughts. To be able to have a space where this can be talked about openly, without judgement and to be fully heard and understood, without infringement, is often all that most clients need.
I would say that the majority of my clients have expressed thoughts around suicide (often with no intention) and only a very small percentage have actually followed through with this act.
My experience is that just being able to admit, out loud, to another person, that you have had thoughts of this nature goes a long way to ease this burden and relieve some of the suffering that you are experiencing. Yes, there can still be a lot of work to do after this, but it is a vital step for any client and counselling relationship.
How to Deal with Suicide in Counselling
How you personally deal with suicide in Counselling will often be down to your own personal approach (if you are in private practice) and your organisation’s policy if you are employed.
Being employed and having an organisational policy to follow can often relieve some of the pressure, as your steps are usually clearly outlined, as well as an idea of where the line is around breaking Confidentiality.
If we do decide to break confidentiality in a counselling relationship, it is very important to inform the client that you plan to do this, why you are choosing to do it and also the steps that you will be taking. This is also why going through the contract (which will include confidentiality) at the start of the work is of vital importance. This allows the client to know the boundaries before the work starts and hopefully, will understand why you may need to break confidentiality if the situation arises.
Working with suicide can also often have an impact on the Counsellor. Early on in our experience as a Counsellor, we may be caught off guard or panic when the topic first comes up with clients. We may hear something like suicidal thoughts (without intention) and worry that we need to do something or panic and stop hearing clearly what the client is saying to us.
As with most things, this tends to ease with experience, but it is never without some form of impact on the Counsellor. This is why Supervision and support are of vital support to any Counsellor. To be able to talk through the impact of our work and also gain clarity on our feelings, thoughts and actions can be of huge benefit to our clients and ourselves.
If we are working within an organisation, and decide to break confidentiality, our first port of call will often be our line manager or Supervisor to discuss the issues and decide next steps (again, this is of vital importance to inform the client if we decide to share this with anyone other than our Supervisor.) This can often help form a plan of action, gain clarity on the situation and also have support for the Counsellor (and client) during the work.
In private practice, the lines are a little more blurry and where the issue of autonomy is even more prevalent. There is no law around reporting suicide (although is different for under 18s). This means that in private practice, the buck stops with you. It is important to be as clear as possible about your boundaries in regards to breaking confidentiality and making these clear to the client before you start your work. Again, this is where the importance of a (good) Supervisor comes in. Because in private practice, this will be your main source of professional support and confidant, as you are working alone.
What should be clear here is that as well as support for the client, self-care for the Counsellor is also of vital importance. Working as a Counsellor clearly has its impacts on us and suicide can be one of the hardest areas to work with.
As mentioned above, whatever setting you work in, it is important to be clear, confident (as possible) and aware of your personal beliefs and approach to dealing with suicide in Counselling. This can be a topic for reflection in Supervision, personal counselling and where training and CPD workshops can be of vital importance. Hopefully, the topic should also have been covered in your training and is a great forum to discuss and reflect on your relationship to suicide, both professionally and personally.
This ensures that when this subject is inevitably presented to us as Counsellors, we are in the best place possible to receive this and hold an empathic space for our clients.
This article was inspired by my experience of the Grassroots organisation in Brighton. A wonderful organisation and team that offer training and campaigns around Suicide prevention. It is also in support of World Suicide Prevention Day – 10th September