Therapists face a number of fears and anxieties when working with clients. However, one fear stands out as particularly common: the fear of a client attempting or completing suicide. This fear stems from the seriousness of suicide and the tremendous responsibility therapists feel for their clients’ wellbeing. Below we will explore why suicide is such a prevalent fear, how therapists manage this fear, and steps therapists can take to reduce suicide risk among their clients.
Why is suicide such a common fear among therapists?
There are several reasons why the fear of client suicide is so widespread among therapists:
- Suicide is a leading cause of death – Suicide claims over 800,000 lives globally each year. It is the 10th leading cause of death in the US. With such high suicide rates, many therapists have or will work with suicidal clients at some point in their careers.
- Therapists often work with high-risk populations – Therapists frequently work with populations at increased risk for suicide, including those with mental health issues like depression and schizophrenia, trauma survivors, and individuals in crisis situations.
- Suicide can occur suddenly and unpredictably – Suicidal ideation can escalate quickly, and warning signs are not always apparent. Therapists may fear they will fail to identify imminent risk in time to intervene.
- Therapists feel responsible for protecting clients – Therapists often develop close connections with clients and feel duty-bound to ensure their safety and wellbeing. A client’s suicide may feel like a personal failure.
- Risk of malpractice suits or license discipline – Following a client’s suicide, some therapists face lawsuits or licensing board complaints accusing them of negligence. Even unfounded complaints take a heavy emotional toll.
In short, the possibility of client suicide evokes therapists’ deepest fears of failing those they have sworn to protect. However, there are many ways therapists can effectively manage this fear while providing high-quality care to clients.
How do therapists manage the fear of client suicide?
Therapists utilize various strategies to manage fears about client suicide, including:
- Seeking support – Consultation groups, peer supervision, and personal therapy help therapists process feelings about suicidal clients in a judgement-free space.
- Engaging in self-care – Maintaining work-life balance, healthy habits, mindfulness practices, and activities like exercise and hobbies preserve therapists’ emotional reserves.
- Setting clear professional boundaries – Keeping appropriate therapeutic boundaries helps therapists avoid excessive feelings of responsibility for client actions.
- Pursuing additional training – Advanced education in suicide assessment, intervention, and postvention equips therapists with enhanced skills and knowledge.
- Focusing on the meaningful aspects of their work – Reflecting on lives saved, suffering alleviated, and hope provided can help therapists regain perspective.
- Utilizing evidence-based tools – Following established protocols for suicide risk screening and safety planning ensures therapists take reasonable precautions.
- Consulting colleagues – Discussing challenging cases with other professionals provides reassurance therapists are following best practices.
While client suicide remains an occupational hazard, therapists can implement strategies like these to manage fears in a healthy, productive way.
What steps can therapists take to reduce suicide risk?
Therapists play a critical role in suicide prevention. Some important steps therapists can take to reduce suicide risk among clients include:
- Systematically assess for suicide risk factors, warning signs, and protective factors during intake and ongoing treatment.
- Directly ask clients about thoughts of suicide and prior attempts.
- Determine level of imminent risk and implement safety precautions like securing lethal means or arranging for hospitalization if risk is elevated.
- Develop a safety plan collaboratively identifying coping strategies and sources of support clients can utilize during a suicidal crisis.
- Build hope by identifying clients’ reasons for living and strengthening problem-solving and emotion regulation skills.
- Recognize and respond to subtle signs of risk like emotional withdrawal, giving away possessions, or saying goodbye.
- Monitor suicidal clients closely after acute risk and following hospital discharge.
- Consider the role of medications in reducing suicidal thoughts when appropriate.
- Involve family members, first responders, or others who can enhance safety.
- Follow ethical and legal mandates for suicide risk management such as breaking confidentiality if necessary.
Therapists should also strive to reduce societal suicide risk through advocacy for prevention programs, lethal means restriction, and expanded mental health access. With compassion, commitment and clinical skill, therapists can significantly impact suicide rates one life at a time.
Fear of failing to prevent suicide
Many therapists report an underlying fear they will fail to prevent a client’s suicide. This fear stems from the devastating emotional impact of client suicide as well as potential professional fallout. Warning signs can be missed, risk assessments can prove faulty, and safety plans may fail despite best efforts. To manage this fear, therapists can commit to ongoing training, consultation, and reflective practice focused on suicide prevention. However, ultimately therapists must recognize that client suicides, while tragic, are not always preventable.
Fear of litigation
Therapists also commonly fear legal consequences following a client suicide, even though suits are relatively rare. In truth, as long as reasonable suicide precautions are taken, therapists are not legally liable for a client’s death by suicide. However, litigation is emotionally and financially draining even when therapists are exonerated. Maintaining careful documentation, consulting colleagues, and carrying malpractice insurance can help therapists feel more secure.
Fear of emotional trauma
Client suicide can be intensely emotionally traumatic for therapists. The grief, shock, guilt, and self-doubt can lead to burnout and PTSD symptoms. Following a client loss, therapists must make self-care a priority and seek personal and professional support. Therapists may also fear their own emotions could cloud judgement with other suicidal clients. Peer consultation helps prevent this by offering an outside perspective.
Fear of damage to professional reputation
Therapists may worry a client suicide could harm their professional reputation even when no negligence occurred. Many keep client suicides private to avoid perceived judgment. In reality, most colleagues understand that statistically, over a long career, even skilled therapists may lose clients to suicide. Still, promoting competence and compassion around suicidality helps therapists feel confident in their skills.
How can therapists overcome excessive fear of client suicide?
While maintaining a healthy respect for the risks is appropriate, excessive, immobilizing fear of suicide is counterproductive. Strategies to overcome excessive fear include:
- Education – Learn warning signs, risk factors, assessment tools, and intervention protocols.
- Experience – Anxiety tends to decrease as a therapist works with more suicidal clients without incident.
- Perspective – Understand that clients are responsible for their choices and that suicide risk can only be mitigated, not eliminated.
- Self-awareness – Notice excessive fear signals like avoidance or overprotectiveness and process the feelings fueling them.
- Healthy boundaries – Do not over-identify with clients or become enmeshed in their emotions.
- Self-care – Nurture emotional reserves through relaxation practices and life balance.
- Consultation – Draw on the experience of fellow professionals who have also navigated this fear.
While the competent therapist takes every suicidal thought seriously, excessive anxiety can become a self-fulfilling prophecy. By cultivating experience and perspective, therapists can overcome paralyzing fears that impair their judgment and engagement. They can move forward with compassionate determination to make a difference in clients’ lives.
Table: Common Fears of Therapists Regarding Client Suicide
| Fear | Description |
|---|---|
| Failing to prevent suicide | Worrying they will miss warning signs or that safety plans will fail, resulting in a client’s death |
| Litigation | Fear of being sued for negligence, even if proper precautions were taken |
| Emotional trauma | Grief, guilt, and self-doubt following loss of a client to suicide |
| Reputational damage | Concerns a client suicide will harm their professional reputation |
Conclusion
In conclusion, the fear of client suicide is very prevalent among therapists due to its devastating potential impact and the responsibility therapists feel toward their clients’ wellbeing. However, through education, self-care, professional support, adherence to best practices, and perspective, therapists can move beyond paralyzing anxiety to provide effective suicide prevention. While the fear may never completely disappear, therapists have an incredible capacity to instill hope and intervene positively in their clients’ lives even in the face of suicidal risk. With compassion for themselves and their clients, therapists can overcome excessive fears to make suicide prevention a meaningful part of their life’s work.