Helping Clients Who Harm Themselves

Description of the Tests and Assessments

The first assessment is the evaluation of a client’s suicide history. If the client has already attempted to cease their life, there is a higher chance that it will repeat again than in cases when there is no suicide history. It is important to understand what attempt was the first and the closest to death. These will provide the pivotal information for ascertaining the circumstances under which the client inflicts self harm. It is also vital to ascertain the client’s reaction to the attempt, which will inform the therapist of protective factors.

The second test is the evaluation of acute risk factors that may drive the client to make a suicide attempt. These include “health problems, current affective state, sleep disturbance, current life stressors, access to weapons, recent use of illicit substances, and recent preparations and/or rehearsal” (Houston, 2017, p. 70.). Naturally, the presence of one factor is not indicative of suicide ideation. Yet, the combination of them may signal the higher chance that the client may attempt suicide.

The third assessment is overview of protective factors which prevent self-harm. Houston (2017) points to “marriage, children, participation in treatment, resiliency, treatment compliance, no reported intent, no presence of characterological deficits, no previous mental health treatment, cultural aspects” as indications of a client’s willingness to live (p. 70). Combined with risk factors and history of suicide attempts, protective factors allow the therapist to predict one’s suicide predisposition.

Testing and Assessment in Intervention Planning

The first way suicide assessment is used in intervention planning is by considering a client’s current emotional and physical state. Berrouiguet et al. (2018) write that statistically, “most suicide reattempts occur within the first month of discharge”, making it “critical for emergency and mental health care service follow-up” (p. 1). If the client has a history of suicide attempts, intervention planning should be focused on the first weeks after the hospital. Subsequently, text messages are sent to discharged patients, the goal of which is to establish contact with them and dissuade them from self-harm.

If there is no history of suicide, intervention planning is focused on helping clients overcome mental crisis. Clinicians analyze the client’s risk factors and use the results of this assessment to develop problem solving plans (Houston, 2017). The reason why clients decide to commit suicide is that they see it as a solution to their crisis of problem. Therefore, the therapist’s goal is to convince the patient that their crisis can be resolved in a different manner. This is where the assessment of risk factors becomes important, as they provide the valuable information where intervention efforts should be concentrated.

Changes to the Tests and Assessments of Self Harm

The American Psychiatric Association believes that clinical practice has underscored the need for the adoption of new approaches in assessment of clients. Specifically, “in the following alternative DSM-5 model, personality disorders are characterized by impairments in personality functioning and pathological personality traits” (American Psychiatric Association, 2013, p. 761). Therefore, any assessment of self harm should be viewed within the context of a larger personality disorder.

In total, five alternative criteria are suggested that would inform the therapist of the state of their client. First, the level of personality functioning indicates how consistent patients are in their identity and self-direction (American Psychiatric Association, 2013, p. 762). Second, the assessment of pathological personality traits will allow the clinician to ascertain the mental damage. The third and the fourth criteria are pervasiveness and stability, which indicate the extent of self-harming behavior across different spheres of life. An especially important notion is that “impairments in functioning and personality traits are also relatively stable”, which implies that damage is relatively equal in all spheres of a person’s life (American Psychiatric Association, 2013, p. 763). Finally, alternative explanations for personality pathology are presented as the fifth criterion. In essence, it allows to explain self-harm as an expression of other problems, such as non-mental medical conditions and sociocultural environment.


Reporting abuse is done by letting law enforcement people know that the perpetration has happened or is about to transpire. However, as Cohen and Swerdlik (2017) argue, there is a problem of men and women underreporting abuse. In such cases, the information may become available as a result of confessions during counselling sessions or anonymous surveys. Similarly, the abuse done to oneself can also be reported by friends and family members. In some cases, self-harm may inflict damage on other people, which should also be avoided.

When patients there is a threat to the client’s family members or friends, the therapist can warn them of the danger. According to Cohen and Swerdlik (2017), clinicians have a duty to warn endangered people when the assessment indicates that a client may inflict harm. Subsequently, victims’ rights override personal privacy, thus enabling the counsellor to disclose important information to them. Although the goal is prevention of self-harm, protection of other people is just as important.


American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders: DSM-5. American Psychiatric Association.

Berrouiguet, S., Larsen, M. E., Mesmeur, C., Gravey, M., Billot, R., Walter, M., & Lenca, P. (2018). Toward mHealth brief contact interventions in suicide prevention: case series from the suicide intervention assisted by messages (SIAM) randomized controlled trial. JMIR mHealth and uHealth, 6(1), 1-9.

Cohen, R. J., & Swerdlik, M. E. (2017). Psychological testing and assessment. McGraw-Hill Education.

Houston, M. N. (2017). Treating suicidal clients & self-harm behaviors: Assessments, worksheets & guides for interventions and long-term care. PESI, Incorporated.

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