338 – Supporting Suicidal Clients

REBT for Pain Management and Exercise – Counselling Skills Feedback

In Episode 338 of the Counselling Tutor Podcast, your hosts Rory Lees-Oakes and Ken Kelly take us through this week’s three topics:

Firstly, in ‘Ethical, Sustainable Practice’, we explore the essential and sensitive topic of supporting suicidal clients – discussing how therapists can respond ethically and effectively, including risk assessment and safety planning.

Then in ‘Practice Matters’, Rory speaks with Ruth Hill about her lecture on REBT for pain management and exercise – blending cognitive therapy with physical wellbeing to support client recovery.

And lastly, in ‘Student Services’, Rory and Ken discuss the importance of receiving and using counselling skills feedback – helping you get the most from peer observations and strengthen your skills in training.

Supporting Suicidal Clients [starts at 03:29 mins]

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In this section, Rory and Ken discuss the sensitive but important issue of supporting suicidal clients, and how to respond appropriately in therapy.

Key points discussed include:

Suicidal ideation can range from passing thoughts to detailed planning. All expressions should be taken seriously.
Risk factors include mental health diagnoses (e.g. depression, bipolar disorder), substance abuse, previous attempts, bereavement, and neurodivergence (particularly autism).
Warning signs may present as hopelessness, withdrawal, giving away possessions, or even sudden mood improvements.
Therapists should feel confident in:
- Asking direct, nonjudgmental questions
- Assessing risk through clarity on plans and means
- Creating collaborative safety plans with clients
Intervention may include providing helpline details, referring to a GP, or involving other services – guided by your therapeutic contract.
Documentation, supervision, and appropriate CPD are all essential to ensure ethical and competent practice.

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REBT for Pain Management and Exercise [starts at 42:15 mins]

In this week’s ‘Practice Matters’, Rory speaks with Ruth Hill about her lecture on REBT (Rational Emotive Behaviour Therapy), and how it can be used to support pain management and exercise.

The key points of this conversation include:

REBT explores irrational beliefs and helps clients reframe unhelpful thoughts (e.g. “I can’t cope with this pain” becomes “I don’t want this pain, but I can cope with it”).
Beliefs around pain often increase suffering and decrease motivation.
Therapists can help clients notice and challenge cognitive distortions like catastrophising, black-and-white thinking, and mind-reading.
Avoidance and guarding behaviour can worsen pain and increase deconditioning. Exercise can be reintroduced gently and collaboratively.
Therapists should explore client history around movement – school PE experiences, family values, or previous injuries can shape limiting beliefs.
Exercise doesn’t have to mean running a marathon – it could mean stretching, walking, or visualising movement to reconnect mind and body.

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Counselling Skills Feedback [starts at 01:05:57 mins]

In this section, Rory and Ken explore how to receive and use feedback on counselling skills, a vital part of developing as a student practitioner.

Key points include:

In triad skills sessions, the “client” should give feedback first, followed by the observer.
Keep feedback constructive – use statements like “I wonder what might have happened if…” instead of criticism.
Use observation forms to stay focused – reflect on specific skills such as silence, open questions, or paraphrasing.
Sandwich suggestions between two pieces of positive feedback.
Not all feedback is right – look for consistent patterns before making major changes.
Recording practice sessions can help spot what worked well and what could be improved.
Feedback isn’t just about ticking boxes – it’s about deepening empathy, timing, and connection in the therapeutic relationship.
Students are encouraged to build confidence gradually – skill use becomes more intuitive with practice.

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