Other posts in this series: Part 1 | Part 2 | Part 3

To close this series on training interns, I want to address the issue of suicidal counselees.  (Obviously there are other crises an intern may encounter but I'll focus on counselees who pose a danger to themselves.) It's inevitable during the year that an intern will have a suicidal counselee. Learning how to assess and manage the risk of such a situation is a critical aspect of training.

Probably the most important thing I stress is, "Be willing to ask your counselees whether they have thought about suicide." This is particularly critical in counselees with depression, severe anxiety, or fluctuating moods. It is a myth that asking someone about suicidal thoughts can give that person the idea. But the opposite is true—not asking someone initially or not following up on a passing comment that indicates risk is a problem. Invariably, counselees who have had suicidal thoughts are thankful that their counselor has raised the issue. Doing so is an act of loving care.

No doubt raising such issues can be anxiety producing for new counselors. It often raises issues of competency and experience—Can I handle this? A "don't ask, don't tell" policy may promote a comfortable ignorance but it's not an option in counseling. Thomas Kuhn has said, "The answers you get depend on the questions you ask." Asking the right questions may thrust a counselor into uncharted and uncomfortable territory, but someone's life may depend on exploring such territory.

Asking about suicide is hard because it is so personal. Exploring the details of someone's specific plans to harm himself is not an easy or comfortable conversation, for either the counselor or counselee. Believers who are struggling this way often feel a lot of guilt and shame. Such a discussion also may evoke the counselor's own experiences with the trauma of suicide (in self, family, or others). Finally, as the author Shawn Christopher Shea says, "If we do our job well, we may have to pay a not-so-insignificant price in time." Asking the hard questions commits the counselor to the time-consuming task of carefully addressing the answers given. But it's a necessary task, a practical counseling application of the second great commandment.

How we ask questions is important also. "You haven't thought about suicide have you?" is not a helpful inquiry! Such a question communicates, "Surely you haven't had a foolish thought like that, and if you did, I don't really want to hear about it." I try to stress the importance of progression in the line of questions an intern might ask a counselee. For example, a series of questions might look like this:

• "I'm really struck by how discouraged and hopeless you are right now. Do you ever wish you were dead?" (If they deny it, I might press the issue, "Really, never?")
• "Have you had thoughts of trying to make that happen by doing it yourself? Have you had thoughts of killing yourself? When? How often?"
• "Have you thought of some ways you might do it?" If they are vague or deny it, I'll ask about specific methods—"Have you thought about taking an overdose?  Have you thought about shooting yourself? Etc." I also want to assess whether they have the means for their chosen method available (e.g., gun, pills, rope, etc.).
• "Have you ‘practiced'?" (In other words, has the person done a "dry run"—e.g., tying a rope to the rafters, putting a loaded gun in the mouth, etc.)
• I would also assess "risk-mitigators"—what reason(s) do they have for living, for not proceeding with suicide.

It's clear from this progression of questions that a person can experience a wide range of suicidal thinking, and our job as counselors is to assess the level of risk and address it accordingly. Space does not permit a fuller discussion of this topic, but let me recommend two helpful resources:

• Jeffrey S. Black, Suicide: Understanding and Intervening. (Phillipsburg, NJ: P & R, 2003.)
• Shawn Christopher Shea, The Practical Art of Suicide Assessment: A Guide for Mental Health Professionals and Substance Abuse Counselors. (Hoboken, NJ: John Wiley & Sons, 2002.) This is an exceptionally well-written and practical book that I am going to require for incoming interns. I recommend it for all counselors.

One last point: we are ultimately dependent on the Spirit in this process of suicide assessment. None of us possess the power to keep someone from harming himself. God calls us to faithfully and wisely wade into these deep waters, and this should drive us to our knees in prayer. Certainly we should develop our assessment skills. Certainly we must seek the input of seasoned counselors in a crisis situation. But certainly we must cry out for God's intervention in sustaining someone's life.