Responding to a Client Talking About Self-Harm or Suicide: A Step-by-Step Guide for Massage Therapists working with Adults

As massage therapists, we often create a safe and nurturing environment where clients feel comfortable opening up about deeply personal matters. Occasionally, this may include conversations about self-harm or suicide. While these moments can feel heavy and unexpected, knowing how to respond with compassion—while staying within our professional scope—can make a meaningful difference. This guide offers practical steps for navigating such conversations and connecting clients with the help they need.

Step 1: Stay Calm and Listen Actively

• Maintain a composed and empathetic demeanor - be present.

• Provide a safe space for the client to express themselves without judgment.

• Listen without interrupting and avoid trying to "fix" them/their feelings immediately.
  

Step 2: Assess the Level of Risk

• If the client expresses passive thoughts (e.g., “Sometimes I feel like I don’t want to be here”), continue a supportive conversation within the boundaries of your scope of practice.

• If they mention active suicidal intent (e.g., “I’ve been planning to end my life”), take immediate action.

• Use open-ended questions to gauge their risk:

  • "Have you had thoughts of hurting yourself?"

  • "Do you currently have a plan to end your life, or have you attempted self-harm or suicide before?"

  • "Do you have a support system you can talk to?"
    

Step 3: Set Boundaries and Recognize Your Role

• Acknowledge their pain but clarify that, as a massage therapist, you are not a mental health professional.

• Offer compassion while guiding them toward professional help.

• Use reassuring statements like:

  • "I hear that you're struggling, and I care about your well-being."

  • "I want to support you in getting the help you deserve."

  • "I can’t provide mental health care, but I can help you find someone who can."

    
    

Step 4: Encourage Professional Help

• Suggest they talk to a therapist, counselor, or crisis hotline.

• Provide crisis resource information:

  • National Suicide Prevention Lifeline (U.S.): 988

  • Crisis Text Line: Text HOME to 741741

• If they resist professional help, gently encourage them by saying:

  • "Would you be open to talking to someone trained to help with this?"

  • "There are people who can help—would you like me to help you find a resource?"

    
    

Step 5: Handle Emergency Situations

• If the client is in immediate danger and has a clear suicide plan, do not leave them alone.

• Ask if they have a trusted person to contact.

• If necessary, call 911 or a crisis response team while keeping them engaged in conversation.

• If they leave the session suddenly and you’re concerned about their safety, you may consider notifying authorities (911) or a family member (if you have their emergency contact).

  
  

Step 6: Document the Interaction

• Write a factual, non-judgmental note about the conversation in your client records.

• Include:

  • Date and time of the conversation.

  • What the client shared.

  • Your response and any resources provided.

  • Any steps taken (e.g., offering referrals, calling emergency services).

    
    

Step 7: Practice Self-Care

• Dealing with conversations about self-harm or suicide can be emotionally taxing.

• Seek supervision, talk to a trusted mentor, or debrief with a professional if needed.

• Set emotional boundaries and recognize when you need support.

Disclaimer & Liability Statement: The information provided in this article is for educational purposes only and is not intended as medical, psychological, or crisis intervention advice. Massage therapists are not licensed mental health professionals, and any conversations about self-harm or suicide with clients should be handled within the boundaries of professional scope of practice.

If you or someone you know is feeling hopeless, helpless, or thinking about self-harm or suicide, please seek immediate help from a qualified mental health professional or call a suicide prevention hotline:

• U.S. Suicide & Crisis Lifeline: Dial 988 or text HOME to 741741

• Find International Hotlines: https://findahelpline.com

By using the information in this article, you acknowledge that neither the author nor the publishing organization is responsible for any actions taken or not taken as a result of the content provided. Always follow your local laws, licensing regulations, and professional ethical guidelines when responding to such situations.