bracketing is defined as “the intentional separating” or “setting aside” of personal values to “provide ethical . . . counseling to all clients” (Kocet & Herlihy, 2014, p. 182). Ethical bracketing requires that counseling practitioners honor their commitment to working in the best interests of their clients—even when doing so conflicts with their religious values or beliefs.
Staying Focused When Strong Emotions Rise Up
As a Catholic, Mateo had deep moral values and an especially strong belief that suicide was morally wrong. As a graduate student in counseling, Mateo was learning about the need to bracket his values and not impose them on his clients. In his second year of training, Mateo worked with two clients who talked a lot about suicide. Whenever the word suicide came up in counseling, Mateo felt himself flinch inside. He had an impulse to plead with these clients to focus on God’s love as a solution to their suicidal crises. Mateo began questioning whether he could contain his moral judgments about suicide; he also began questioning whether he could continue in his training to become a professional counselor.
Mateo decided to discuss the feelings he was having with his supervisor. Mateo’s supervisor listened and helped Mateo explore his feelings. Later they brainstormed and problem-solved different ways Mateo could become better at monitoring and bracketing his moral judgments. In the end, Mateo and his supervisor identified four self-statements Mateo could use to compartmentalize or bracket his moral reactions:
1 “I know the research and clinical guidelines say that I can more effectively prevent suicide if I accept my clients’ suicidal ideation and remain nonjudgmental” (Jobes, 2016).
2 “I know that people who are feeling suicidal are already feeling shame; therefore, if I shame them in any way, I could increase their misery or sense of powerlessness.”
3 “I want to prevent suicide for religious and professional reasons. My best chance at preventing suicide involves using evidence-based assessment and treatment strategies.”
4 “When I feel triggered and judgmental, I will refocus my efforts on using nondirective paraphrases, reflections of feeling, open questions, and other motivational interviewing skills” (W. R. Miller & Rollnick, 2013).
Kocet and Herlihy (2014) offered a five-step counselor values-based conflict model to aid students and clinicians in ethical bracketing. Using Mateo’s situation as an example, we walk you through the steps of the model.
1 Determine the nature of values-based conflict. Mateo’s conflict was both personal and professional. Mateo believed that suicide was a sin, but he also knew that suicide competencies required him to listen nonjudgmentally as his clients talked about suicide.
2 Explore core issues and potential barriers to providing an appropriate standard of care. When his clients talked about suicide, Mateo was emotionally activated and felt impulses to confront clients with statements like “God loves you” and “Suicide is immoral” and “If you kill yourself, you’ll end up in hell.” These moralizing thoughts interfered with Mateo’s ability to have empathy for his clients.
3 Seek assistance/remediation for providing an appropriate standard of care. Mateo recognized his personal/professional conflict. He chose to meet with a supervisor he trusted to discuss the issues.
4 Determine and evaluate possible courses of action. Mateo and his supervisor agreed that Mateo could not avoid working with suicidality in counseling. They worked together to provide Mateo with a good rationale for using evidence-based (rather than religious-based) strategies for working with his clients. In addition, they identified internal cues that Mateo could use to alert himself to shift to using nondirective motivational interviewing skills.
5 Ensure that proposed actions promote client welfare. Mateo and his supervisor agreed to collaboratively and continuously monitor Mateo’s values-based judgments and behaviors during counseling sessions.
As illustrated in Mateo’s situation, personal values and attitudes have a complex and interactive relationship with self-care and ethical behaviors. Ethical bracketing is an important process for helping you juggle your values, attitudes, reactions, self-care, and ethical responsibilities. We return to ethical issues and counselor competence in Chapter 2 and beyond. For now, we turn to our strengths-based model for understanding and working with people who are suicidal.
Seven Dimensions of Being Human: Where Does It Hurt, and How Can I Help You?
We began this chapter by describing the case of Alina. Most likely, what you remember about Alina is that she is displaying several frightening suicide risk factors and has openly shared her suicidal thoughts. However, Alina is not just a person who is suicidal—she is a unique individual with a delightful array of idiosyncratic quirks, problems, and strengths who also happens to have suicidal thoughts.
When clients or students begin talking about suicide, it is easy to overly focus on suicidality. Suicidality is such a huge issue that it overshadows nearly everything else and consumes your attention. Nevertheless, all clients—suicidal or not—are richly complex and have a fascinating mix of strengths and weaknesses that deserve attention. To help keep focused on the whole person—and not just on weaknesses or pathology—we use a seven-dimension model for understanding people with suicidal thoughts and impulses.
Suicide Treatment Models
In the book Brief Cognitive-Behavioral Therapy for Suicide Prevention, Bryan and Rudd (2018) described and assessed three distinct suicide intervention models. The risk factor model emphasizes correlates and predictors of suicidal ideation and behavior. Practitioners who follow the risk factor model aim their treatments toward reducing known risk factors and increasing protective factors. Unfortunately, a dizzying array of risk factors exist; some are relatively unchangeable; and in a large, 50-year, meta-analytic study, researchers concluded that risk factors, protective factors, and warning signs are largely inaccurate and not useful (Franklin et al., 2017). Consequently, treatments based on the risk factor model are not in favor.
The psychiatric model focuses on treating psychiatric illnesses to reduce or prevent suicidality. The presumption is that clients experiencing suicidality should be treated for the symptoms linked to their diagnosis. Clients with depression should be treated for depression, clients diagnosed with posttraumatic stress disorder should be treated for trauma, and so on. Bryan and Rudd (2018) noted that “accumulating evidence has failed to support the effectiveness of this conceptual framework” (p. 4).
The final model is the functional model. Bryan and Rudd (2018) wrote, “According to this model, suicidal thoughts and behaviors are conceptualized as the outcome of underlying psychopathological processes that specifically precipitate and maintain suicidal thoughts and behaviors over time” (p. 4). The functional model targets suicidal thoughts and behaviors within the context of the individual’s history and present circumstances. Bryan and Rudd emphasized that the superiority of the functional model is “well established” (pp. 5–6; they cited a meta-analysis showing that functional approaches are significantly superior to the psychiatric model for suicide risk reduction; Tarrier et al., 2008).
Our approach differs from the functional model in several ways. Given our wellness and strengths-based orientation, we studiously avoid presuming that suicidality is a psychopathological process. Instead, consistent with social constructionist philosophy, we believe that locating psychopathological processes within clients risks exacerbating and perpetuating psychopathology as an internalized
