Safety Planning in Therapy: Steps, Scripts, and What Actually Works
By Kristen McClure, MSW, LCSW | TherapistWorksheet.com
Safety planning is one of the most clinically and legally significant tasks a therapist performs. Done well, it is a genuine collaborative process that gives a client a concrete tool for their worst moments. Done poorly, it is a box-checking exercise that provides false reassurance and inadequate protection.
What Safety Planning Is (and Is Not)
A safety plan is a personalized, written plan that a client can use when they are in suicidal crisis. It is distinct from a no-harm contract — which has no evidence of effectiveness and some evidence of harm. Safety planning, particularly the Stanley-Brown Safety Planning Intervention, has a growing evidence base for reducing suicidal behavior and hospitalizations.
A safety plan is not:
- A promise not to attempt suicide
- Something you fill out for the client
- A one-time document that never gets revisited
- A substitute for a higher level of care when one is indicated
The Six Steps of Safety Planning
Step 1: Warning Signs
What does it look like when the client is moving toward crisis? Thoughts, images, moods, behaviors, situations. This is client-specific — not generic. “When I start thinking ‘everyone would be better off,’ that’s a warning sign for me.”
Step 2: Internal Coping Strategies
Things the client can do alone to distract or self-soothe before reaching out to anyone. The goal is creating space between the impulse and the action. Physical activity, sensory grounding, distraction — whatever works for this specific client.
Step 3: Social Contacts Who Provide Distraction
People the client can spend time with who will provide distraction — not people they necessarily have to disclose to. The goal here is connection and distraction, not necessarily asking for help.
Step 4: People to Ask for Help
Trusted people the client can contact specifically to say they are struggling. Explicit names and phone numbers. This is different from Step 3 — these are people the client can be direct with about their crisis.
Step 5: Professional Resources
Clinician contact information, after-hours lines, crisis lines (988), emergency rooms. Order these by preference and accessibility. The client should know what to do when the therapist is unavailable.
Step 6: Making the Environment Safer
Means restriction — removing or securing lethal means, particularly firearms and medications. This is the most evidence-supported suicide prevention intervention available. Do not skip it because it feels uncomfortable.
Scripts for Safety Planning Conversations
Introducing the safety plan
“I want to make sure you have something concrete to hold onto when things get hard — not because I think you’re about to do something, but because I want you to have a plan before you need it. Can we build one together?”
Asking about means
“Part of what we want to do is think about whether there are any means — medications, weapons, anything like that — that might be worth removing or securing when you’re feeling this way. Is that something we can talk about?”
When a client is reluctant
“I hear that this feels unnecessary right now. I want to do this with you, not to you — so what would make this feel more useful? Is there something about it that doesn’t fit your situation?”
When Safety Planning Is Not Enough
Safety planning is an outpatient intervention. If a client cannot identify a single reason to stay safe, cannot commit to following any step of the plan, has access to means they are unwilling to restrict, or has a current plan with intent — those are indicators for a higher level of care. Safety planning does not replace appropriate clinical judgment about level of care.
Frequently Asked Questions
Should the safety plan be written or verbal?
Written, and the client should have a copy. A plan the client leaves with is more effective than one that stays in the chart. The Stanley-Brown model uses a small card the client can keep with them.
How often should I review the safety plan?
Review it whenever risk elevates. For clients with ongoing suicidality, review it regularly and update it — particularly if warning signs or contacts change. A plan that is never revisited is not a plan, it is a form.
What do I document after safety planning?
Document that you conducted a safety assessment, the specific risk and protective factors you identified, the content of the safety plan, and the client’s engagement with the process. If you made a clinical judgment not to hospitalize, document your reasoning explicitly.
What about the 988 Lifeline — should it always be on the plan?
It should be available as an option. Whether it is the client’s primary resource depends on the client. For clients who have had negative experiences with crisis lines, forcing 988 as Step 1 may mean they do not use the plan at all.
Kristen McClure, MSW, LCSW is a licensed therapist who creates practical clinical tools to help therapists navigate the hardest moments in their work.