I had a client who came into my office who was stating that she felt suicidal because she’d had a sexual relationship with her former therapist. The evaluation and management of a suicidal client is frightening to say the least. As I approached the suicide assessment, I kept in mind three things: 1) I need to consult with a colleague for another opinion. 2) I make sure I document, document, document everything. 3) I evaluate the client’s risk for actually killing herself. The risk factors for suicide are:
1. A client with a mental diagnosis, especially depression and substance abuse, or Borderline Personality Disorder that increases risk.
2. People over 45 years old are higher risk.
3. Gender – men will use more lethal means such as a gun, women will try more often such as using pills.
4. People who have never married, who are divorced, widowed, recently separated are highest risk.
5. Recent loss of a loved one increases risk.
6. Have there been any previous suicide attempts?
7. Has there been a recent job loss?
8. Is there a history of suicide in the family?
9. Does the client have a history of violent outbursts or impulsive behavior?
"A.4.a. Avoiding Harm: Counselors act to avoid harming their clients.
A.5.a. Current Clients: Sexual or romantic counselor-client interactions or relationships with current clients, their romantic partners, or their family members are prohibited"
I told her that the former therapist needed to be reported to the state licensing board. I warned her that her confidentiality could be breached as a part of the reporting process. I also told her that she needed to engage a reputable attorney because there was a strong possibility that the former therapist might try to lie his way out of the accusation and blame her by saying she was making false claims.
She asked me what would happen to him and I told her that he could be the target of a lawsuit. He could have his license revoked or suspended as well as lose his insurance coverage and his job. In the State of California there is even criminal liability when a therapist initiates a sexual encounter with a client. My client finally understood that this ethical violation was the most egregious and damaging thing that a counselor could do to an unsuspecting client.