Client suicide is one of the greatest fears of all counselors. Suicide prevention is a difficult and commonly avoided area of counseling. Client confidentiality is of utmost importance, but when a client indicates that he or she may be suicidal, counselors have a duty to report this to family members and authorities. Contrary to common belief, there are several effective suicide treatments for adolescents and adults. Using these techniques, first counselors must help clients out of the actively suicidal state, and then they must help the client develop the skills needed to create and uphold lives worth living (Meyers, 2017).
Clients may be asked to sign a No-Suicide contract or a Commitment to Treatment contract. These can be helpful in certain instances, but if the counselor-client relationship is strained or new, clients can feel as though they are being made to sign the contract to shift moral blame away from the therapist in the event of a tragedy, although the contract is in no way legally binding. Suicide is the third leading cause of death among 15 to 24 year-olds (Canady, 2017). Seventy-one percent of psychotherapists report having at least one client who has attempted suicide, and twenty-eight percent of psychotherapists report having had at least one client die by suicide (Firestone, 2018). It is an unfortunately common event that most practitioners will experience in their careers.
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For most counselors, an ethical dilemma is apparent when they encounter a confounding situation in which they feel hindered in their decision making because there appears to be conflict between or inconsistency among the ethical standards, the situation is so compounded that the ethical codes offer unhelpful guidance, there appears to be a discrepancy between ethical and legal standards, or there appears to be a conflict between the moral principles that underlie most ethical codes. If the correct route to take in a counselling situation is unclear, the ACA’s ethical decision-making model may need to be employed (Forester-Miller & Davis, 2018). When making an ethical clinical decision it is essential to consider both personal bias (ACA, 2014, A.4.b) and level of professional competence (ACA, 2014, C.2.a)
A 30-year-old client named John decides to speak to a counselor because he has been feeling down. His thirtieth birthday was a month ago, and since then he has been overwhelmed with the feeling that he is not where he expected to be at this point in his life. He married young and has been divorced for five years. He is estranged from his parents and he does not have any siblings. He did not complete college and complains about his unrewarding and tiresome job. He lives alone and struggles to find a healthy balance for his life, saying that he usually only works, comes home, drinks, and watches TV before falling into a restless sleep,
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