If you or someone you know is thinking about suicide, please call the National Suicide Prevention Lifeline at 1-800-273-8255 for free, confidential, 24/7 support.
Many adults who experience suicidal thoughts do not access mental health services, and those who do begin treatment often do not finish it. In fact, the American Psychological Association has found that nearly twenty percent of mental health clients will end therapy before treatment is completed. So what can be done to ensure an individual experiencing suicide ideation receives the therapy they need?
A person may discontinue therapy for any number of reasons. Some become overwhelmed by experiences of stigma. Others fear being hospitalized for sharing their thoughts of suicide with their therapist. Even just committing to a treatment plan with a mental health professional can be daunting. But all of these fears can be overcome by finding a therapist who is an expert in the treatment of suicidality — a therapist who will respond to varying risk levels and symptoms with the appropriate interventions, who is experienced in treating suicidality and who the client can trust.
Seeking Treatment for Suicidality
Any person experiencing thoughts related to suicide needs immediate help. But what happens after the emergency is over? Or when a person is in need of non-emergency treatment?
Only a qualified mental health professional can assess an individual in distress and determine his or her level of risk, as well as assist in identifying the relationships between suicidal thoughts, feelings, and behaviors. A professional treatment plan may involve therapy and/or prescription medication, such as an antidepressant, to address suicidal thoughts and the underlying issues.
A therapist or mental health practice will likely specialize in a certain type of therapy. Two of the treatment models that have been found to be most successful for the treatment of individuals who present with suicide ideation, according to the American Foundation for Suicide Prevention, are:
- Dialectical Behavior Therapy (DBT) — therapy designed to treat emotion regulation difficulties and suicidal behavior; it includes a skill-building component that addresses distress tolerance and the development of healthy emotion management strategies.
- Cognitive Behavioral Therapy (CBT) — a treatment model focused on teaching the client an array of coping strategies, such as how to overcome and change self-defeating thoughts; this type of therapy has been found to be extremely effective for treating anxiety and depression, both of which are commonly experienced with suicidal thoughts.
It is important to note that what works for one individual may not work for another. For that reason, it is a good idea to discover as much as possible about a therapist before determining if his or her treatment plan is right for you or your loved one.
Choosing a Therapist with the Right Experience
Like any professional, therapists have areas of experience and training. It is a common myth that all therapists are equipped to address all issues clients face. The reality is that training programs equip therapists with generalist competencies but often are unable to train therapists in specialized issues. In fact, many therapists have a large amount of experience with the most common mental health issues in the country, such as depression and anxiety, but lack the necessary experience with issues like trauma, grief and especially suicidality. That is why it is important for individuals to verify that a prospective therapist has the knowledge and skillset to help with his or her specific issue.
A therapist with strong training and experience in suicidality displays effective engagement skills, understands the extremely painful and isolating existence of living with suicidality, knows how risk and protective factors interact with current experiences to lead someone to think about suicide, and matches the most effective interventions to the individual need of the person.
It is also important that a therapist knows how to create a context that fosters trust for their clients. However, a competent therapist understands that trust is difficult to expect when someone is experiencing suicidal thoughts because there are so many unknowns.
There are a number of ways to determine a prospective therapist’s experience with suicidality. The easiest way is to ask. No client should be afraid to ask questions, “shop around” for a mental health professional or seek a second opinion.
Some people may feel awkward questioning a licensed therapist about their qualifications, but a skilled mental health professional understands the limits of his or her own expertise and may even be able to refer a client to a colleague with more experience. Therefore, it is always appropriate to ask a potential therapist if they have education, training and experience working with individuals facing relevant issues, especially when that issue is suicide ideation or suicidality.
Questions to Ask A Potential Therapist
It is often helpful to ask for a brief phone consultation prior to setting up an appointment. This can be an efficient way to establish if a therapist has the skills to help. This is not always a possibility, as mental health system structures differ; however, always ask.
When asking a therapist about his or her experience, it is a good idea to arrive prepared with a list. The goal is to ask specific questions that will help assess whether the therapist is a good fit for your needs. Here are four questions the mental health professionals at St. Louis Center for Family Development recommend:
1. “How much formal education did you receive in suicide risk assessment in your graduate training program?”
One of the first things a therapist will do when beginning treatment with an individual having thoughts about self-harm is assess his or her suicide risk. For this reason, it is important to verify the therapist has had training in suicide risk assessment. Unfortunately, this type of training is not a requirement in most graduate-level therapy programs, and according to a report from a task force with the American Association of Suicidology, a majority of therapists report having received very little, if any, training in the area.
While there is no correct or incorrect answer to this question, there are certain training programs that are beneficial for a therapist to have participated in. A few of these include:
- Applied Suicide Intervention Training (ASIST)
- Collaborative Assessment and Management of Suicidality (CAMS)
- Counseling on Access to Lethal Means (CALM)
A therapist may also have attended specific courses on suicide risk assessment within their graduate training program. Or they may have taken part in professional development programs on suicide risk assessment strategies. Both of these are signs that the therapist in question has received this all-important training.
2. “Do you use any evidence-based assessments or suicide risk assessment measures?”
If a therapist has received the appropriate training, this question should be a simple one. Evidence-based therapy refers to treatment models designed and based on the most recent peer-reviewed scientific evidence available, rather than models that lack evidence of their effectiveness.
An array of suicide risk assessment measures is used in mental health practices today, but a few to listen for are:
- The Columbia Suicide Severity Rating Scale (C-SSRS)
- Beck Scale for Suicidal Ideation (BSSI)
- High-Risk Construct Scale
- Modified SAD PERSONS Scale
However, measures alone should never be the only method of assessment. The key question to ask is how these measures are incorporated into a holistic suicide risk formulation.
3. “How frequently do you work with individuals at risk for suicide?”
There is a big difference between having “experience” with individuals experiencing suicidal thoughts and having “expertise.” It is up to each individual to decide how many past clients or years of experience will help him or her feel confident in the therapist’s abilities. Furthermore, if concerns over the therapist’s professional experience are expressed, it is likely he or she can refer the client to a colleague or peer who specializes in suicide prevention or intervention.
4. “What is your common approach to the use of emergency rooms or hospitalizations for individuals expressing suicidal thoughts or urges?”
This is a difficult question to answer, but a therapist with expertise in treating suicidality will say that he or she takes all risks of suicide seriously and utilizes a comprehensive framework to match the type of intervention with the appropriate risk level. These types of interventions may include safety planning, support and monitoring by a loved one, follow-up appointments, scheduled check-ins or, in necessary cases, hospitalization. In other words, the answer to this question should be that the therapist is willing to consider a range of interventions based on the level of risk and severity of symptoms.
Treatment for Suicidality at STLCFD
All the therapists at St. Louis Center for Family Development are highly trained and supervised in the most effective tools for the assessment and treatment of suicidality. Several of the treatments we use are Dialectical Behavior Therapy and Cognitive Behavioral Therapy for suicidality and corresponding depression and anxiety. Additionally, as we know the strong link between trauma exposure and the future development of suicidality, STLCFD’s trauma-informed lens fosters an environment respective of the impact of those experiences on people’s lives.
Please note that this website is not an emergency hotline. If you or someone you know is experiencing suicidal thoughts, please call the National Suicide Prevention Lifeline at 1-800-273-8255.