Sharpening Our Skills: Expanding Our Clinical Toolbox for Suicidality
#MentalHealthProfessionals #TherapistTools #ClinicianResources #PsychologyTools #TherapySkills #Suicide #ProfessionalDevelopment
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Heads up: This one’s mainly for those in my audience who provide psychotherapy services (i.e. therapists, social workers, psychologists, nurse practitioners, and other mental health professionals). If you’re reading as a client or just curious, the ideas can still be interesting, but they aren’t a substitute for personal mental health care. |
“There’s no point in living anymore.”
“Everyone would be better off if I weren’t around.”
“The pain is just too much. I can’t handle it.”
These are some of the thoughts that may be repeating in the minds of the people we see in our practices. For some clients, suicidal thoughts may come and go during periods of distress. For others, those thoughts can become persistent, consuming, and increasingly difficult to challenge. When desperate thoughts go round and round for long enough, a client may begin to believe them. Add the sense of isolation that can come from not talking about what is happening internally, and it can become incredibly difficult for the client to see a way out of the emotional turmoil. As clinicians, working with suicidality can bring its own set of emotions and concerns. We may feel the weight of responsibility. We may question whether we are asking the right questions, using the right interventions, or recognizing the level of risk accurately. We may also worry about liability, hospitalization, or what could happen if a client's risk escalates. This is why continuing education matters.
Suicidality Requires More Than One Tool
There is no single intervention that will work for every client experiencing suicidal thoughts or behaviors. Effective clinical care requires us to consider the individual sitting in front of us, their history, their current circumstances, their level of risk, their support system, and the factors contributing to their distress. Sometimes a higher level of care is necessary. At other times, a client may be appropriate for outpatient treatment with thoughtful assessment, safety planning, ongoing monitoring, and evidence-informed interventions. The goal is not to avoid hospitalization at all costs. The goal is to develop the clinical judgment and skills necessary to determine what level of care is appropriate while continuing to help clients move toward safety, hope, connection, and a life they can experience as worth living. That takes training.
Sharpening Our Knowledge and Skills
This year has been about raising our frequency through intentionally sharpening our knowledge, strengthening our skills, and making choices that serve the life we are building. As clinicians, that same intention belongs in our professional lives. Working with suicidal clients is not an area where we want to rely solely on what we learned years ago. Research continues to evolve. Assessment practices continue to develop. Evidence-based interventions continue to expand. And each client brings a unique combination of experiences, protective factors, vulnerabilities, relationships, and internal parts that require us to remain curious and present. Sometimes raising our professional frequency simply means recognizing where we could use a little more knowledge. Maybe we need to become more comfortable assessing suicide risk. Maybe we want to strengthen our safety-planning skills. Maybe we want to learn how another therapeutic approach conceptualizes suicidal thoughts and behaviors. Or perhaps we have worked with suicidal clients for years but recognize that there are still areas where we could use additional tools. There is nothing wrong with that. In fact, recognizing where we can grow is part of being a thoughtful clinician.
Learning From Experts Across the Field
A part of the tool kit to help sharpen our skills is PESI's (affiliate link) Clinician’s Suicide Prevention Course: Treatment Strategies to Inspire Hope and Save Lives. One of the things that makes this suicide prevention training collection valuable is the opportunity to learn from clinicians and researchers who approach suicidality from different perspectives. The collection includes experts such as Thomas Joiner, director of the Joiner Research Lab; Kathleen Chard, co-developer of Cognitive Processing Therapy; and Kelly Posner, director of the Columbia Lighthouse Project and developer of the Columbia Protocol. The trainings also explore approaches including Dialectical Behavior Therapy, Internal Family Systems, Cognitive Processing Therapy, crisis response planning, suicide prevention screening, and interventions specifically focused on veterans, youth, teens, and survivors of suicide loss. That variety matters because our clients are not one-size-fits-all. The more perspectives we have in our clinical toolbox, the more opportunities we have to meet clients where they are.
Managing Suicidality With High-Crisis DBT Clients
For clinicians working with clients who experience significant emotional dysregulation, DBT can offer important strategies for addressing life-threatening behaviors. The training on (affiliate link) Managing Suicidality with High-Crisis DBT Clients focuses on practical techniques grounded in DBT principles. Participants explore the biosocial model and its relationship to emotional dysregulation, suicidal urges, and suicidal behaviors. The training also examines how DBT coaching can support more effective communication while helping clinicians avoid reinforcing unskillful behaviors. One particularly useful area is the development of a quick and effective coaching structure, along with strategies for establishing a safety plan with clients who are new to DBT. For clinicians using DBT, these skills can become another layer of support when working with clients experiencing intense emotional arousal and life-threatening coping behaviors.
Understanding Why People Die by Suicide
Another training in the collection, (affiliate link) Why People Die by Suicide, explores Thomas Joiner's theory of suicidal behavior. Joiner's work identifies three important factors associated with suicide risk: perceived burdensomeness, thwarted belongingness, and the acquired capability for suicide. Understanding the experiences underneath suicidal behavior can help clinicians move beyond simply asking whether a client is suicidal and toward developing a deeper understanding of what the client may be experiencing. The training explores suicide risk assessment, treatment and prevention approaches, and the experience of those who have lost someone to suicide. For clinicians, this kind of conceptual understanding can help us listen differently. Sometimes the most important information is not simply what the client says they want to do. It is the story surrounding why life has begun to feel unbearable.
When Suicide Changes the Lives of Those Left Behind
Suicide does not only affect the person who dies. Those left behind may experience grief, guilt, shame, trauma, anger, confusion, questions about what they could have done differently, and even a crisis of faith or meaning. The (affiliate link) Losing a Loved One to Suicide: Interventions to Move Survivors Beyond the Ruins focuses on helping clinicians support survivors as they navigate the profound disruption that can follow suicide loss. The training explores trauma, guilt and shame, existential crisis, meaning-making, somatic resourcing, Parts work, Polyvagal Theory, DBT exercises, resilience, and Post-Traumatic Growth. This is an important reminder that our work with suicide prevention does not end when a crisis passes. There are also people who need support in making sense of what happened and finding a sustainable way to move forward.
Considering Culture and Historically Marginalized Communities
Suicide prevention also requires us to examine the ways culture, stigma, systemic barriers, and provider bias can influence access to care. The (affiliate link) Suicide in Historically Marginalized Communities explores the stigma surrounding mental health and suicide in the Black community, with particular attention to Black men and the historical challenges that can affect access to mental health care. The training also examines how clinician bias can influence therapist-client interactions. As clinicians, cultural humility requires more than knowing that disparities exist. It requires us to remain curious about our own assumptions and how those assumptions may show up in the therapeutic relationship. Sometimes raising our frequency means looking inward at the parts of ourselves that still have room to learn.
What Do We Do When Suicidal Thoughts Won't Go Away?
Some clients may experience suicidal thoughts that persist even when they do not currently intend to act on them. The (affiliate link) What To Do with Suicidal Thoughts That Just Won't Go Away focuses on safety planning, coping with emotional pain and distress, building hope, and finding meaning in suffering. This is an important distinction. Helping someone survive a suicidal crisis is essential, but our work does not stop at keeping someone alive. We also want to help clients develop ways to tolerate emotional pain, reconnect with sources of meaning, identify reasons for living, and build lives that contain more moments of safety and possibility. Hope may not always arrive as a giant revelation. Sometimes it begins as something very small that gives a client enough space to stay.
The Columbia Protocol and Suicide Risk Screening
Assessment is another essential part of suicide prevention. The Columbia Protocol, also known as the C-SSRS, provides a structured approach to identifying suicidal ideation and behavior. Training in suicide screening can help clinicians and organizations develop more consistent approaches to recognizing risk and determining appropriate next steps. The training explores universal screening, reducing stigma, addressing fears surrounding suicide assessment, and using the C-SSRS as part of a broader suicide prevention approach. Having a reliable framework can be especially helpful when the fear of asking about suicide becomes a barrier to asking the question at all. Sometimes we worry that asking about suicide will introduce the idea. Instead, asking directly can create an opportunity for a client to finally say what they have been carrying alone.
Lessons From Treating Suicidal Veterans
Veterans and active-duty military populations may present with unique experiences and risk factors that require thoughtful, individualized care. The (affiliate link) Lessons from Treating Suicidal Veterans: The Latest Interventions focuses on the Crisis Response Plan and patient-centered narrative assessment. Rather than relying only on a checklist, narrative assessment allows clinicians to understand the individual's experience of suicidal risk in context. The Crisis Response Plan then provides a framework for identifying personalized strategies that the client can implement during periods of increased risk. There is something powerful about helping clients identify what they can actually do when distress begins to rise. The plan becomes more than a document. It becomes a roadmap.
Cognitive Processing Therapy and Suicidality
Trauma and suicidality can intersect in complicated ways, particularly when clients become stuck in painful beliefs about themselves, others, or the world. The (affiliate link) Cognitive Processing Therapy (CPT) for Suicidality: Overcoming Stuck Points and Creating Mental Flexibility, presented by CPT co-developer Kathleen Chard, explores how cognitive processing can be used with clients experiencing suicidality in the context of PTSD. The training examines common myths surrounding suicidality and PTSD and introduces cognitive processing techniques for addressing stuck points. For clinicians already using CPT, this can provide another way to understand the thoughts and beliefs that may keep clients trapped in painful cycles.
Working With Youth and Teens
Suicide prevention also requires us to consider developmental differences. The (affiliate link) New Insights and Strategies: Crisis Safety Planning with Youth and Teens focuses on assessment, risk management, healthy relationships, and self-regulation in younger clients. Working with youth often means considering the larger system around the client as well. Parents, caregivers, schools, peers, and other support systems may all play important roles in safety and treatment. The clinician's ability to assess risk while also building connection and helping young clients develop regulation skills can make an important difference.
Looking at Suicidality Through an IFS Lens
As someone who appreciates the Internal Family Systems model, I was particularly interested in (affiliate link) Embracing Suicidal Parts: Using Internal Family Systems (IFS) to Heal Traumatic Wounds. IFS offers a different way of understanding suicidal thoughts and behaviors by exploring the parts of a person's internal system that may be carrying overwhelming pain or using extreme strategies to protect the individual. Instead of viewing these parts as bad or broken, clinicians can approach them with curiosity and compassion. This does not mean minimizing risk or romanticizing suicidal behavior. Safety remains essential. It means recognizing that there may be important information underneath the behavior. What is this part trying to protect the person from? What pain has become too much to carry? What does this part believe would happen if it stopped doing what it is doing? When we can become curious about the internal experience without judgment, we may create more room for connection, Self-leadership, and new possibilities.
A Clinical Toolbox Is Meant to Be Used
One of the biggest takeaways for me is that continuing education is not simply about collecting certificates. It is about expanding our capacity. Every training we complete adds another perspective to the clinical toolbox. Every new intervention gives us another possibility to consider. Every opportunity to learn helps us become a little more prepared for the moments when a client says something that requires us to slow down, listen carefully, assess thoughtfully, and respond intentionally. We do not have to know everything.
But we do want to remain willing to learn. Working with suicidality can feel heavy. It can activate our own fears and uncertainty as clinicians. Having reliable frameworks, evidence-informed interventions, and practical skills can help us feel more grounded in our role. And when we feel more grounded, we may be better able to offer that same steadiness to our clients.
Raising Our Professional Frequency
This year, we have been talking about raising our frequency through sharpening our knowledge, strengthening our skills, and making choices that support the life we are building. That applies to our professional lives too. Sometimes raising our frequency looks like taking another training. Sometimes it looks like revisiting an assessment tool we have not used in a while. Sometimes it means learning a modality outside of our usual approach.
And sometimes it simply means admitting, “I could use another tool in my toolbox.” There is strength in that awareness. Our clients deserve clinicians who continue to grow, remain curious, and recognize that there is always more to learn. Because when someone is sitting across from us wondering whether life is worth continuing, we want to have more than good intentions. We want to have skills. We want to have a plan. And we want to have the clinical confidence to stay present with them while helping them find their next step toward safety, connection, and hope. The (affiliate link) Clinician’s Suicide Prevention Course: Treatment Strategies to Inspire Hope and Save Lives can help us well on our way to this aim.
A friendly reminder here, to help us keep creating free educational content, the EnvisionCo Blog participates in affiliate partnerships. If you choose to purchase a course through our links, we may earn a small commission at no extra cost to you. If this article resonated with you, we’d love to hear your thoughts in the comments, or have you share it with a friend or colleague who might need this resource today. Small conversations about mental wellness can make a meaningful difference. And please remember that wherever you are on this wellness journey, do not worry about getting it perfect; just get it going. Until next time. Happy reading!
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Raising our frequency is also about creating the stability that allows us to keep growing, learning, and showing up fully. As clinicians, we know that when stress begins to pile up, our capacity can become stretched, and financial stress can quietly add another layer to that load. Just as we encourage clients to develop tools that support safety, regulation, and greater stability, we can consider where we might need additional tools in our own lives. For some, consolidating high-interest debt into one predictable payment may be one way to reduce financial overwhelm and create more breathing room. If a financial reset feels appropriate for you, a SoFi Personal Loan is one option to explore that may help streamline debt and potentially lower your interest rate. If you apply through my affiliate link and are approved, SoFi will give both of us a $300 bonus as a thank you. Continuing to sharpen our professional skills is important, but so is making sure we have the personal resources and stability to use those skills well. Sometimes raising our frequency simply means creating a little more room to breathe, regroup, and keep moving forward. |
“Hope is being able to see that there is light despite all of the darkness.” ~Desmond Tutu
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