Enlisting the Person in Therapy as a Tool for Predicting Self-Harm

Clients who suffer from depression and substance use issues are more likely to harm themselves than individuals with other psychological problems. After in-patient treatment, clinicians often rely on their own observations to measure a client’s state and determine the likelihood that the client will self-harm again. But a new study suggests that enlisting the client’s own opinion of their risk for self-harm may be a more accurate predictor of future behaviors. “Clinicians routinely talk with patients about their behavior and collaborate with them to determine appropriate courses of action,” said Jillian Peterson of the University of California, Irvine, and lead author of the study. “This context could easily accommodate a discussion of patients’ perceptions of their own risk of self-harm.” She added, “With a lifetime of experience, individuals may be in a better position than are external evaluators to predict their own behavior.” This process of self-reception involves predicting behavior not emotional reactions to situations. Research has shown that self-perception as a method of predicting is more accurate than tests and independent observations from family members, clinicians and peers.

Peterson and her team examined 147 clients who were discharged from psychiatric facilities. “We focused on psychiatric inpatients because they are at greater risk of self-harm and suicide than are outpatients, particularly during the period after hospital discharge,” said Peterson. The participants were interviewed by phone eight weeks after discharge and in person 15 weeks after discharge, both times by the same interviewer. They found that the participants who had tried to harm themselves before admittance were 75% more likely to try again, and this was accurately predicted through the self-reports. “Generally, the results suggest that patients are an important source of information about risk, perhaps because they have built the most comprehensive experience base for predicting their behavior across a range of familiar contexts,” said Peterson. “Patients are made partners through this process and are treated as experts in their own lives, which may help build a collaborative relationship with their treatment provider.”

Peterson, Jillian, Jennifer Skeem, and Sarah Manchak. “If You Want to Know, Consider Asking: How Likely Is It That Patients Will Hurt Themselves in the Future?”Psychological Assessment 23.3 (2011): 626-34. Print.

© Copyright 2011 by By John Smith, therapist in Bellingham, Washington. All Rights Reserved. Permission to publish granted to GoodTherapy.org.

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Charla


    September 27th, 2011 at 3:35 PM

    Do you think that this kind of self reporting is going to be accurate?
    I rarely think of present and past drug addicts as the most homest people on eart. Sorry
    But then again I guess that they know better than anyone else the state of mind that they are in.
    But if they are really out to hurt themselves I am sure that being honest with the therapist is going to be the last thing on their minds/.

  • rochelle chavez

    rochelle chavez

    September 27th, 2011 at 4:09 PM

    Nobody knows themselves better than…er themselves. It sounds cliched but it is very true. Psychiatrists, therapist, psychologists you name it, can be great at predicting someones risk for self harm. But at the end of the day, no matter how many fancy tests and tools these proffesionals utilize they won’t know you better than you know yourself. It just isn’t possible with current technology (just wait a few years!)

    This along with other things is why a patient needs to be consulted with and allowed to be heard out. As therapists I think all of the technology available can blind us from the obvious stuff, so heres what I want you do think about if you are reluctant to weigh a patients opinion more heavily, “How would you feel if I patient commits suicide, right after you approved for release despite them saying that they weren’t ready?”

  • Brandon


    September 27th, 2011 at 11:41 PM

    having a patient say it out may work but is self-harm not instinctively driven? if it is so,then how can even the patient himself predict when he could try to self harm again??

  • eden


    September 28th, 2011 at 4:10 AM

    If not the client then who? And what a great way for the patient and therapist to establish a rapport by talking about the things that are really on the patient’s mind. That is, if you can get them to open up about those feelings.

  • KP


    September 28th, 2011 at 4:14 AM

    Yeah,the best one to evaluate would be the patient himself. A doctor may be able to diagnose a problem but nobody can identify what is happening inside a patient’s mind, except the patient himself.If they can get the patient to realize the fact that helping oneself is the best way forward then this procedure can be a very good tool.

  • Katie Chastain

    Katie Chastain

    September 28th, 2011 at 12:55 PM

    Most patients who are in these kinds of facilities are not going to be in much of the spirit to help themselves, especially at the beginning. So to say that this is a way to start therapy could be a wrong mood. But I can see that as the patient begins to make progress and move forward then certainly it is a great idea to seek involvement from him or her on how he is feeling and help him be that predictor that you are looking for. I am in agreement that he is going to know better than anyone else the state of mind that he is in and whether or not he is thinking of doing harm to himself. But I have to think that this is tricky ground to tread and would have to be handles very carefully.

  • Wendy


    September 29th, 2011 at 5:10 AM

    Interesting to read about using the client to come out with it! Although it may seem like going against logic,I think it is preach because not only will it give an alert but will also enable the client to question himself and observe why such feelings of self hurt occurred to him.

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