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Ethical Issues Relevant to the Assessment of Suicide Risk
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another thought about acceptance and setting ethical boundaries. You may not have
thought that acceptance also involves expectations. Think about it, you not only
accept the client for what he or she is, but you accept them for what they are
capable of being.
As in the preceding example in track ten of the custody judge,
his lack of acceptance of the low social economic family leads him to expect that
they would not make good parents. This expectation based on acceptance assumes
great significance in setting boundaries. Your expectation of the client's potential
influences your attitude and behavior, and may have a bearing on the outcome of
your therapy sessions.
♦ Base Expectations on Reality
It cannot be too strongly emphasized, however,
that your expectations must be based on reality. These expectations are to be
arrived at, as much as possible, without the influence of your biases or stereotypes
brought about by your lack of acceptance of a client's actions or situation.
my mind, there is no area of counseling where this acceptance leading to expectations
is more controversial than in the "duty-to-warn" an identifiable other of a threat made by your client. In short, what you expect your client to do determines whether
you should set a boundary on your client's behavior by warning the intended victim.
Secondly, and of equal importance, is your "duty-to-protect" the client from self-harm.
♦ 5 Boundaries Regarding Suicide
look at expectations as they related to the complication of a suicidal client. I'll be giving you a five point evaluation of boundaries you set regarding foreseeability,
and appropriate diagnosis of risk behavior for suicide.
The first boundary you
set regarding suicide is to ask the question: Was I aware, or should I have been
aware, of my client's risk for suicide?
The second boundary's question is: Was
I thorough in my assessment of my client's suicide risk?
Thirdly, did I make reasonable
efforts to collect sufficient and necessary data to assess the risk?
my assessment data lead to a misdiagnosis?
Fifth, do I feel I mismanaged the case,
being unavailable or unresponsive to my client's situation? Hindsight is always
20/20. For a client at risk for suicide, the action you took regarding the preceding
five boundaries was based upon your expectation as to what you felt the client
key is, by accepting your client and not judging, you set expectations based on
reality...and the setting of boundaries regarding the duty-to-warn and the duty-to-protect
are key illustrations of the expectation boundary setting.
Peer-Reviewed Journal Article References:
Berzofsky, M. (2010). Review of Turning points in dynamic psychotherapy: Initial assessment, boundaries, money, disruptions and suicidal cases and The damaged core: Origins, dynamics, manifestations and treatment [Review of the books Turning points in dynamic psychotherapy: Initial assessment, boundaries, money, disruptions and suicidal cases, & The damaged core: Origins, dynamics, manifestations and treatment, by S. Akhtar & S. Akhtar]. Psychoanalytic Psychology, 27(4), 539–540.
James, K., & Stewart, D. (2018). Blurred boundaries—A qualitative study of how acts of self-harm and attempted suicide are defined by mental health practitioners. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 39(4), 247–254.
Wilson, C. M., & Christensen, B. K. (2012). Ethical issues relevant to the assessment of suicide risk in nonclinical research settings. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 33(1), 54–59.
By accepting your client and not judging, you set expectations based
on what? To select and enter your answer go to .