Suicide: Dynamics and Implications for Counseling

Abstract

'The authors discuss the dynamics of suicide, how to work with a potentially suicidal client in the counseling relationship, and legal and ethical implications for the counselor.

Suicidal and counter-suicidal thinking

“…Practitioners must ensure that they are knowledgeable about (a) aspects of client behaviour which indicate relatively greater levels of risk of suicide and (b) sound client management procedures for those deemed to be at risk. A paper by Fujimura, Weis, and Cochran (1985) presents a useful summary in relation to counselling practice. Finally, the value of consulting with a colleague for a second opinion should be appreciated.…”

‘I Don't Want to Live This Way, Doc. Please Take Me Off the Ventilator and Let Me Die.’

“…Despite multiple efforts to wean him off full‐time ventilation, he continued to require full ventilator support (this was before phrenic nerve pacers). The patient and his wife had explored and embraced the issue of termination of life support and quality of life via literature from the Hemlock Society before the injury [4]. After having made the request to terminate ventilator support on the acute medicine service with no sympathetic ear, the patient renewed his request (with his wife's support) upon admission to the rehabilitation center.…”

The Mental Status Examination: Its Use by Professional Counselors

“…Similarly, anger or irritability can be the result of drug or alcohol intoxication, manic or depressive states, head injury, stroke, dementia, or neurologic disorders. Although suicidal indicators are always critically important, particular attention should be paid to suicidal information when the mood is in the depressed range and anger is at a level that may lead to risk for aggression to self and others (Fujimura, Weis, & Cochran, 1985;Shneidman, 1985). When such circumstances are present the counselor may ask, "Have you been depressed to the point that you thought life was not worth living anymore?"…”