Podcast Summary: Private Practice Startup Podcast

Episode 138: 5 Top Things You Need to Know in Assessing Suicide Risk in Private Practice

Hosts: Dr. Kate Campbell & Katie Lemieux
Guest: Noreen Van Der Heven, LCSW
Release Date: June 1, 2019

Episode Overview

This episode takes a deep dive into assessing suicide risk within the unique context of private practice. Hosts Dr. Kate Campbell and Katie Lemieux welcome Noreen Van Der Heven, an expert in suicide prevention, to equip therapists with practical strategies and essential knowledge for handling suicide risk, especially when working solo. The discussion covers myths, effective assessment questions, paperwork, consultation, resources, and clinician self-care.

Key Discussion Points & Insights

1. How Noreen Became a Suicide Risk Assessment Expert

• Background: Noreen fell into this specialty by accepting a supervisor role for a children's mobile crisis response team, leading her to in-depth work and ongoing learning in suicidology.
• Continuous Education: Attending conferences such as those by the American Association of Suicidology (“It’s like going home to a family. Every year I just learn more and more.” – Noreen, 03:24).

2. The Emotional Impact: Clinicians' Experiences with Client Suicide

• Hard Truths: Katie shares personal stories of clients lost to suicide, reflecting on the trauma and difficulty of these experiences, even when all protocols were followed.
• Isolation in Private Practice: Unlike agencies with team support, private practitioners often feel alone in crisis situations.
• Quote: “It was traumatic for me.” – Katie Lemieux (04:36)

3. The Importance of Thorough Paperwork and Direct Questions

• Paperwork Standards: Intake forms must explicitly address suicidality, not just with general “harm” questions.
• Directness is Key: Avoid vague language; directly ask about suicidal thoughts.
• Quote: “You have to be direct. You can’t say, ‘Do you want to hurt yourself?’... harming yourself and killing yourself are two different things.” – Noreen Van Der Heven (06:54)
• Myth Busting: Asking about suicide won’t plant the idea.
• Quote: “Don’t think that they haven’t thought about it already.” – Noreen Van Der Heven (08:20)

4. Language Matters: Compassionate, Precise Communication

• “Died by Suicide” vs. “Committed Suicide”: Language shapes stigma; clinicians are encouraged to adopt nonjudgmental terms.
• Quote: “Saying ‘committed suicide’ sounds like you did something wrong. It’s not wrong. It’s sad and it’s tragic.” – Noreen Van Der Heven (10:00)

5. Concrete Steps for Private Practitioners

a. Intake and Session Practices

• Assess on a 1-to-5 Scale: More helpful and accurate than a 1-to-10 scale for gauging suicidality.
  • Quote: “If you say 1 to 10, it gives such a range and it really isn’t as clear... One meaning no thoughts... five meaning you are going to end your life today.” – Noreen Van Der Heven (11:27)
• Clarify the Client's "Number": Ask, “What does a three mean to you?” since ratings are subjective.

b. Check Paperwork Responses

• Red flags: If clients skip questions about suicide, follow up immediately.
  • Quote: “If it’s blank, I know to go back... Most people don’t forget to answer.” – Katie Lemieux (13:29)

c. Crisis Referral and Resource Readiness

• Know Your Local Numbers: Post and have contacts for local crisis teams and 911 at hand and in your paperwork.
• Post in Office: Make resources visible to clients and families.

d. Consultation and Professional Support Systems

• Build a Consultation Network: Don’t depend solely on in-office colleagues; have multiple professionals to consult for crises and legal guidance.
• Liability Insurance: Notify them of potential issues early to preserve coverage.
  • Quote: “If you do not let your liability insurance know and you act without them knowing... they could not represent you...” – Katie Lemieux (19:22)

e. Prepare for the Unexpected

• Prevalence: At least 1 in 7 therapists will lose a client to suicide in their career (20:48).
• Ongoing Education: Training in suicide prevention should be pursued even if not required by your state.

6. Safety Plans vs. Safety Contracts

• Safety Plans: Collaborative, listing triggers, coping mechanisms, contacts, and crisis steps (not a legal contract).
• Contracts are Ineffective: Not binding and may be coercive.
• Quote: “A safety plan is collaborative... you’re finding out from them what helps them when they’re in distress.” – Noreen Van Der Heven (21:45)

7. Making Suicide Assessment Routine

• Normalize Discussion: Introduce suicide and abuse questions as a standard, not punitive, part of intake and ongoing care.
• Genuine Affect Matters: Clients sense when therapists are uncomfortable; directness and empathy are critical.

8. Training & Resources

• Recommended Reading:
  • Helping the Suicidal Person by Susan Rose Blauner and Susan F. Friedenthal (28:18).
  • Relational Suicide Assessment by Dr. Gralnick and colleagues (32:08).
• Annual Conferences: American Association of Suicidology is highly recommended for its diverse, intensive content (29:00).
• Learning from Survivors: Personal accounts at conferences are deeply instructive.

Memorable Quotes

• Myth-Busting on Asking Direct Questions:
  “People are so afraid to ask their clients, ‘Do you feel like you want to kill yourself?’... There’s this myth that if you ask someone about suicide, you’re going to put it in their head.”
  – Noreen Van Der Heven (07:00)

• On Language:
  “If you say you committed suicide, it sounds like you did something wrong. And it’s—It’s not wrong. It’s sad and it’s tragic…”
  – Noreen Van Der Heven (10:00)

• On Consultation:
  “Have some other resources of therapists you trust that you can always call to consult with... and always know you can call the National Suicide Prevention Lifeline to ask any questions.”
  – Noreen Van Der Heven (15:29)

• On Comfort and Affect:
  “If you don’t feel comfortable asking, they’re going to pick up on that and they won’t feel comfortable sharing.”
  – Noreen Van Der Heven (26:46)

Practical Takeaways (Five Top Things You Need to Know)

1. Ask Direct, Clear Questions about Suicide

   • Don’t use euphemisms (“hurt yourself” vs. “kill yourself”)
   • Make it routine in paperwork and verbally

2. Use a 1-to-5 Scale for Assessment

   • Clarify what each number means to the client

3. Know Your Emergency Resources

   • Have contacts for local crisis teams and 911 visible
   • Inform clients and families

4. Build a Strong Consultation & Support System

   • Find trusted colleagues for consultation
   • Keep liability insurance and legal contacts informed

5. Develop Collaborative Safety Plans, Not Contracts

   • Focus on individualized triggers and coping strategies
   • Make a plan together, set brief review intervals (typically not more than a week)

Actionable Resources

• Downloadable Tools:
  • Noreen offers her "Five Things You Need to Know" checklist and a safety plan template at noreenvanderhoeven.com (33:44)
• Recommended Books:
  • Helping the Suicidal Person by Susan F. Friedenthal (28:18)
  • Relational Suicide Assessment by Dr. Gralnick et al. (32:08)
• Professional Associations:
  • American Association of Suicidology (suicidology.org)

Final Takeaway from the Guest

“This is a critical topic to address with every single client because you just never know. Get the education and feel comfortable asking the questions.”
— Noreen Van Der Heven (30:58)

Further Learning

• American Association of Suicidology: Conferences, training, publications (suicidology.org)
• Local Mental Health and Suicide Prevention Teams: Know your area’s crisis response resources
• Regular Training: Pursue ongoing CEU and specialized training in suicide assessment and prevention

This summary is designed to provide vital, practical highlights of the episode for mental health professionals seeking to strengthen suicide risk assessment in private practice settings.