So far in my counselling career, I've not had to cope with the suicide of a client. And I'm grateful. I can only imagine the impact on the clinician if a client takes their own life. It must provoke difficult, painful, complex feelings. I have, however, had many conversations with clients about suicidal thoughts. The conversations are never easy. I try to be interested but not intrusive, to permit but not push. I also try to manage my own maelstrom of feelings. As I said, it’s not easy.

Do I sometimes retreat from those conversations? Maybe. I might judge the time to be wrong, for both me and the client. But I wonder if I'm also influenced by the concept of risk management.

Many organisations have in place a policy to identify clients who are at risk of suicide, as well as a protocol if a client raises suicidal thoughts. Such policies and protocols can be useful. They might allow the clinician to offload, or at least share, some of the responsibility for a suicidal client. They might also offer a certain amount of containment for the therapist’s feelings.    

But the risk management of suicide can also disrupt the therapeutic process. As Andrew Reeves writes in his article Suicide risk, risk is intrinsic to our work. Indeed, it is intrinsic to our lives. The notion that risk must be managed, mitigated or avoided can therefore block the exploration of suicide and ultimately inhibit the relationship between client and clinician.

We need to talk about suicide – and not just with our clients, but with each other. Why is it so rarely discussed in the profession and on training courses? And surely our apparent reluctance to open up the debate is an indicator that we must.   

Healthcare professionals often find it difficult to talk, sometimes because they fear judgment or backlash. It's perhaps, therefore, no surprise that doctors have a higher risk of suicide than the general population. So, it’s good to read in this issue about the work of the charity Doctors in Distress in Help for the helpers, which offers group support for healthcare professionals across primary and secondary care.  

Whether we're talking about suicide or any other issue, the client must set the pace. Rebecca Fox reminds us in Working with trauma of the importance of offering a safe space for clients, particularly clients who have experienced trauma. Clients must feel they can tell us what they want, when they want.

Is talking enough? Andrew Keefe suggests that we might approach trauma from a different perspective in How boxing and running can aid trauma recovery. He wonders whether trauma recovery is possible, particularly for clients who were not able to fight or flee in response to the original, traumatic experience.

Some people like to run – or walk – outside, finding succour in nature. Gardening is also therapeutic for many. As Sue Stuart-Smith writes in Seeds and self-belief, gardening is like the good-enough mother. It allows us to experience both success and frustration, so nurturing both self-belief and resilience. I wonder if we fulfil a similar function for our clients?  

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