Why Therapists Should Stop Asking about Suicide on Intake Paperwork
To my esteemed therapist colleagues, I invite you to join me in reevaluating the way we approach suicide on intake paperwork.
Creating a safe and supportive environment is paramount in our practice, and it's time for us to reconsider the inclusion of questions about suicide on these forms.
We're always looking for ways to make our clients feel comfortable and understood, right from the very beginning. That's why it's time for us to reconsider asking explicit questions about suicide on intake paperwork. Questions like, "Have you ever had thoughts of suicide?" or "Have you made any suicide attempts in the past?" are commonly included. Let's explore the reasons why, the challenges we face, and some alternative approaches that will better serve our clients' well-being.
Therapeutic Intentions behind Including Lethality Questions on Intake Paperwork
We often include questions about suicide on intake paperwork because we genuinely care about our clients' mental health. It's all about getting a comprehensive assessment to provide the best possible treatment. Here's why we include these questions:
1. Thorough Assessment
By asking about suicide, we want to give clients a chance to express any concerns they have about their safety or the safety of others. This information helps us plan the right treatments and interventions to support them effectively.
2. Identifying Immediate Risks
Asking about suicidality on intake paperwork helps us quickly identify clients who may be at immediate risk. This way, we can offer timely support and put safety measures in place even before our first face-to-face session.
3. Establishing Safety Measures
Including lethality questions shows our clients that we take their safety seriously. It creates a foundation of trust and safety right from the start, so they feel supported and understood.
4. Opening Dialogue
Asking about suicide encourages clients to talk about their thoughts and emotions. This helps us build open and honest communication, which is crucial for effective treatment.
5. Legal and Ethical Considerations
In some places, it's our professional responsibility to assess and address the risk of suicide and harm to others. By asking these questions on intake paperwork, we show that we're committed to providing a standard of care that prioritizes safety and well-being.
The Challenges of Inquiring about Lethality on Intake Paperwork
Now, let's talk about the challenges we face when we ask about suicide on intake paperwork. It's important to understand these challenges so that we can find better ways to assess safety and well-being:
1. Incomplete and Outdated Information
Intake paperwork is often completed before our first session, leaving a gap in time. This is perhaps the biggest challenge to asking about suicide on intake paperwork. We might be holding onto crucial safety information before actually seeing our client. By the time we see the client, the information may be outdated, and their risk factors could have changed. Relying solely on this paperwork might lead to an inaccurate assessment, potentially compromising safety.
2. Lack of Context and Non-Verbal Cues
Paperwork can't capture the full context or non-verbal cues that help us understand our clients' emotional state. Their feelings may have shifted by the time we meet them in person, making it difficult to accurately assess their risk based solely on intake paperwork.
3. Stigmatization and Anxiety
Asking direct questions about suicide on paperwork can contribute to stigmatization and anxiety. It may make clients uncomfortable, leading them to hold back their thoughts and concerns. This inhibits open communication and can hinder the therapeutic process.
4. Limited Opportunity for Exploration and Support
Asking about suicide on intake paperwork limits our ability to fully explore and support clients. In-person assessments allow us to delve deeper, actively listen, ask targeted questions, and observe non-verbal cues. This helps us assess their emotional well-being more effectively and tailor our treatment approach.
5. Ethical Considerations and Confidentiality
When a client indicates a high risk of harm on intake paperwork with a time gap before the intake session, we are confronted with a critical ethical dilemma. It presents the possibility of failing to act despite evidence of potentially imminent risk or feeling compelled to break confidentiality before meeting the client in person. Striking a delicate balance between urgency and maintaining trust in the therapeutic relationship becomes paramount. As therapists, we hold an ethical obligation to prioritize the safety and well-being of our clients. When a client expresses risk on intake paperwork, it raises concerns about their immediate safety. While inquiring about suicidality on intake paperwork aims to gather essential information and facilitate appropriate interventions, relying solely on this information can pose challenges. Consider a scenario where a client completes the intake paperwork and indicates a high risk of self-harm. Asking about suicidality on intake paperwork without immediate follow-up runs the risk of overlooking the urgency of the situation. If the client were to act on their expressed risk, and we did not take immediate action based on the provided information, severe consequences could ensue.
Alternative Approaches for Assessing Safety: A Shift in Questioning
Now, let's explore alternative approaches that facilitate effective safety assessment while fostering trust and open communication:
1. Introducing a General Safety Concern Question
Instead of directly inquiring about suicide on intake paperwork, we can pose a broader question regarding safety concerns. For instance, we can ask clients, "Do you have any concerns about your safety or the safety of others?" This question creates a comfortable and non-stigmatizing space for clients to express their thoughts and emotions regarding safety, enabling a more comprehensive exploration of their concerns and providing valuable insights into their well-being.
2. Follow-Up and In-Person Assessment
If a client responds "yes" to the safety concern question, it prompts us to conduct a detailed in-person assessment. During the session, we can delve deeper into their specific concerns, examining the context, severity, and immediacy of the issues raised. This approach allows us to actively listen, observe non-verbal cues, and ask targeted questions, facilitating a more accurate assessment of their emotional well-being and safety.
3. Strengthening the Therapeutic Alliance
Engaging in face-to-face conversations about intake paperwork disclosures and safety concerns enhances the therapeutic alliance. By actively listening and addressing their concerns, we demonstrate support and understanding. This approach fosters trust, establishing a solid foundation for effective therapy and overall well-being.
4. Addressing Multiple Safety Risks
The general safety concern question also allows us to address risks beyond suicide. It opens the door for clients to discuss concerns related to harm to themselves or others. If such concerns are raised, we can engage in direct discussions and fulfill our ethical and legal obligations, such as reporting cases that pose a risk to the client or others involved. This ensures safety while maintaining confidentiality within the therapeutic relationship.
Remember, regardless of the client's response to the intake question, in-person follow-up remains crucial. It enables a comprehensive understanding of their safety, empowering us to tailor interventions, provide appropriate support, and develop effective safety plans.
Conclusion
As therapists, our top priority is creating a safe and supportive space for our clients to heal and grow. By reevaluating the inclusion of questions about suicide on intake paperwork, we can better align our practices with this goal. Shifting our approach to assessing safety by asking a broader question and following up in person leads to a more thorough and compassionate assessment. It promotes a stronger therapeutic alliance and ensures that our clients feel heard, understood, and appropriately supported right from the start.
Let's embark on this journey together, always keeping our clients' well-being and dignity in mind. Together, we can create a more inclusive and empathetic therapeutic environment that fosters healing and growth.
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