Suicide What a Coach Needs to KnowJul 14th, 2014 | By Jeff Williams | Category: Featured Content, Wellness Coaching, [None]
You are a coach, and you have a dilemma. A client asked you to help him to clarify his life purpose and to make a plan to pursue it, which you are happy to do because that’s what you are trained to do. However, in your most recent session he told you that he’s had thoughts of not wanting to live. The disclosure occurs in the context of your client processing a challenging season of life with you. He is in transition, and as usual, a lot of things are uncertain, painful and confusing. But now he’s brought up something that you don’t feel qualified to evaluate. What do you do?
As a coach and professional clinical counselor, a situation like this is pretty easy for me to handle because I’ve been trained to conduct what we call, ‘Lethality Assessments’. These assessments determine the level of risk that a person is to himself or others. When clients tell me that they’ve begun to feel like they don’t want to live, I’ve learned to ask some simple questions to assess what they are thinking. This is an important tool to have in your toolkit if you ever come across a similar situation.
Important Facts about Suicide
First, it’s important to know a few things about suicide:
1. Asking a person if they have had thoughts about taking their life doesn’t increase the chances that they will do it. If they are in pain, it’s likely that it already crossed their mind long before you asked the question. Asking them may actually play a role in potentially saving a life.
2. Untreated depression is the number one reason that people die by suicide. Your client in transition may be living in a perfect storm for developing symptoms of depression. Be alert.
3. The vast majority of people (estimates range between 90%-95%) give signs (including telling someone that they are suicidal) of what they are thinking before they do it. If a person brings the issue up in conversation, they may well be asking for help.
4. Substance use or abuse combined with a ready-at-hand means of taking one’s own life is the most lethal combination. Perhaps a client has shared that they hunt as a hobby and that they have struggled with substance use in the past. You have background information that could come into play during a conversation about their level of risk.
5. Hopelessness is the overarching emotional experience of those who die by suicide. Their situation may not seem hopeless to you; but if it feels hopeless to them that is the reality they are reacting to. Make sure you understand their perspective. If you’ve been using good skills to ask and listen, you already have a good idea of what life looks and feels like to your client.
6. You may well be in over your head to do more than to ask some additional questions about what your client is thinking. But don’t do nothing because you can’t do everything. There is a reason that your client has told you this, and now you are responsible to do something with it. A referral to another professional may be indicated (don’t be too quick to end your coaching relationship; sometimes coaching and counseling can be done at the same time), but you aren’t going to know what type of referral to make or help to call for unless you ask a few more questions.
A Simple Lethality Assessment
Here is a series of questions that will help you to understand exactly what your client is thinking. These are in sequence from low risk to high risk.
“I heard you say that you don’t feel like living any longer. Have you been feeling so bad that you’ve had some thoughts about ending your life?”
If client says yes, move to the next question. If they say no, then clarify if they said that to indicate how much pain, frustration, hopelessness (or other feelings they are having) and that saying they don’t want to live is a way of saying that they are exhausted by feeling so badly but they are not actively thinking about how to end their life. Ask them to promise to tell you or someone else if that changes.
“What are some specific ways that you have thought about doing that?”
If your client replies with some type of means to end their life (e.g., gun, rope, pills, driving their car off the road to make it look like an accident), ask if they have the means available or if they are planning to procure the means. Either way, ask the next question.
“Have you thought of a plan; a time and place to do this?”
If they have a plan, go to the next question
“What is your plan?”
If you get to this point, your client may be reluctant to tell you. You are asking them to disclose a secret plan that may be providing hope for relief from pain in their life. (A sudden bounce in the step of someone who has been really down can be a sign that they have settled on a plan to end their life). They may have a lot of mixed feelings about living vs. dying, and they may be embarrassed or scared to tell you. Reassure them that you are making no judgments about whether or not they are a good Christian, a bad or weak person (if they’ve indicated such things in their judgment about themselves), but that you truly and deeply care about them and their pain. Reassure them that you will be with them through it to support them, get them help, etc. Suicide prevention is largely about buying time for a client to think and feel differently. The adage that suicide is a permanent solution to a temporary problem applies.
If your client answered yes to question four you have enough information and enough reason to seek more expert help. But while you are having a conversation in which they are trusting you with sensitive information, try to learn as much as you can. Ask them when they think the best time is to execute their plan. Know that a matter of fact, non-judgmental (“I’m not panicked and I’m not scared about what you are telling me”) approach is most likely to elicit open sharing from your client, as well as providing relief to them that they are no longer carrying a dangerous secret by themselves.
At this point, saving their life and buying time for them to feel differently is your number one priority. Go with your gut. Stay with them if you are together in person. Insist on being with them until a friend or family member comes to pick them up, drive them to a mental health center or emergency room, ask them for their keys, make an emergency call to police to provide transport to a hospital (extreme cases), etc. It’s hard to cover all of the possible scenarios and actions that might be in order, but the point is that you trust your intuition about what to do. Remember, you are taking action to save a life and the situation is as serious as coming up on the scene of an accident and being able to do CPR.
What the Answers Mean
If the person answers “yes” to either question number four or five, it is absolutely necessary for you to consult with someone trained and competent to further assess and/or treat your client. However, if you have any level of this type of conversation with a client, be safe and check in with a professional. Consultation is an important step to check one’s judgment as a professional counselor, but it is also a protection against liability.
No matter how well trained and experienced they are, mental health professionals consult in such matters. We also exercise two ethical responsibilities: the duty to warn and the duty to protect in such instances. These duties protect us as counselors by allowing us to breach confidentiality when it comes to making attempts to provide safety and to protect lives. I suggest that coaches act according to these ethics as well if or when faced with situations in which the client or others are in danger.
How to Refer
The U.S. Air Force has a Wingman Program which outlines the responsibility of airmen when they discover that a colleague is at risk. They are instructed to remain alongside their colleague as a loyal and present wingman until a handoff is made to a person professionally competent to further assess and treat a person at risk.
You might be having all sorts of anxious feelings about now. “I don’t want to deal with situations like this” or “I’m not trained to handle this”. Let me assure you that I’m not trying to increase the scope of your practice as a coach to take on issues that are best dealt with by clinically trained persons! I simply want to give you a repertoire of questions you can ask to get your client to share more specific information if they confide they are not feeling like they want to live. Asking is something you have been trained to do very well, and following up on red-flag disclosures will relieve your anxiety because you won’t have pending questions (e.g., ‘I wonder what they meant by that’). It may also provide a lot of relief to them by providing the opportunity to talk about it and to get more help.
Don’t do nothing because you can’t do everything! Do what you can.
Jeff Williams is a Master Coach Trainer, and a Supervising Professional Clinical Counselor who once suffered a bout of depression accompanied by thoughts of not wanting to live. Reach him at Grace & Truth Counseling and Coaching through the website, http://graceandtruthrelationship.com. For more about clinical depression, see his blog entry dated, February 4, 2010, “Perfect Storms: Why Everyone is Vulnerable to Clinical Depression, and What to Do about It”, at http://graceandtruthcounseling.blogspot.com