I just realized that I am way more comfortable with the term "calculated risk" than I am with "go with your gut".

I am coming across many borderline personality disorder folks. Part of the diagnostic criteria of BPD is chronic suicidality. They feel compelled to threaten suicide to get the attention, care and support they are needing. As there is often very little family and relationship support available to them, they rely heavily on their therapist and other care providers.

With the knowledge of client's diagnosis missing, I found myself with - what appeared to be - severe suicidality. I could not get clear answers from them that would help me determine how severe their suicidal intent was. They knew if they gave me answers that spell out severe risk, we would have to get them to go to the hospital. Because these clients visit the centre with suicide risk 2-3 times a week, everyone has learned to manage the risk. These clients had no previous history of an attempt which would put them at a higher risk. Again, with lack of information and only hearing the presence of suicidal thoughts, I stayed engaged with them to get to a resolution for way longer than I should, or they became antagonistic towards me. By the end of the sessions, I felt like a failure because I was not able to reach a resolution. One of the clients kept me up for much of the night. I kept worrying about what I had done and should have done.

I felt better when I got to debrief the next day. I learned of her diagnosis and how other people have had a difficult time working with her too.

I have been told that in a crisis situation, I should go with my gut about what needs to be done; if police must be involved. I have found that rather confusing. I realize I need to stay calm on a much deeper level to hear my "gut" speak - which is hard to do when you have an emotional, agitated, suicidal client.

While reading up on some publications on BPD and suicidality, I came across a suggestion for therapists to not be afraid of client's suicidality and take a "calculated risk" to determine the next steps. And that term instantly put me at ease.

I can do calculated risks. My evidence- based rationality-based education makes it impossible to justify "gut" for clinical decisions (and for everything else, really).