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Why I stopped using no-harm contracts in my practice

Many therapists were trained to view them as important clinical tools, but they’re not evidence-based.

Dr. Anum Ali
Dr. Anum Ali, LPCTherapist

For many years, no-harm contracts were seen as a go-to tool in therapy when working with clients experiencing suicidal ideation or self-harm. These documents, typically written agreements where clients promise not to harm themselves and to contact their therapist or emergency services if they feel at risk, were widely used with the best of intentions. But over the course of my career as a Licensed Professional Counselor, I’ve come to understand the serious limitations of these contracts and why a more collaborative, person-centered approach is not only more ethical but more effective.

The rise of no-harm contracts

No-harm contracts gained popularity in the 1990s and early 2000s as therapists, hospitals, and state agencies sought a way to formalize safety discussions and reduce liability. They were especially common in outpatient settings and among early-career clinicians, often presented as a standard part of managing suicide risk.

The premise was straightforward: Get a client to agree in writing not to harm themselves and to contact emergency services or their therapist if suicidal ideation intensified. The hope was that the document would deter self-harming behaviors and act as a therapeutic touchstone during crises.

At the time, it felt like a proactive way to protect clients and create accountability. Many of us, working in high-acuity settings, were trained to view these contracts as essential clinical tools. But their widespread use wasn't backed by strong evidence and over time, the drawbacks became harder to ignore.

The problem with no-harm contracts

While no harm contracts may still be used in some settings, they are widely considered ineffective and ethically problematic. Here’s why many therapists, including myself, have stopped using them:


  • They’re not evidence-based. Studies, including a 2000 study by Jerome Kroll in the American Journal of Psychiatry and a 2007 article titled “Suicide and Life Threatening Behavior” by Lisa McConnell Lewis, have shown no correlation between the use of no-harm contracts and decreased suicidal behavior. They do not reliably predict or prevent suicide.
  • They can create a false sense of clinical security. A signed contract may appear reassuring, but it does not mean the client is safe or that the risk has been adequately addressed.
  • They may feel coercive. According to National Library of Medicine research, clients can experience pressure to sign in order to continue treatment, even if they don’t feel confident in their ability to uphold the agreement. This can potentially discourage open communication between patients and providers, rupturing the therapeutic alliance.
  • They undermine autonomy and transparency. A client might avoid disclosing suicidal thoughts in the future for fear of being asked to sign another contract or being hospitalized if they refuse.
  • They divert focus from meaningful safety planning. Rather than identifying internal coping strategies or social supports, these contracts often reduce safety to a binary promise: “I will or won’t hurt myself.”


I recall working with a young adult client navigating persistent suicidal ideation. When I offered a no-harm contract early in our work together, she hesitated. “I don’t want to lie,” she said. “I want to stay safe, but I can’t promise I always will.” That moment shifted how I approach suicide risk. I stopped asking for promises and started asking better questions.

How I’ve replaced no-harm contracts in my work

Instead of using no-harm contracts, I now rely on evidence-informed, collaborative safety planning approaches. The most foundational tool in my practice is the Stanley-Brown Safety Planning Intervention (SPI), which has strong empirical support and is widely used across clinical settings, including outpatient therapy, crisis response, and primary care.


The SPI is structured yet adaptable, walking clients through six personalized steps:

  1. Identifying warning signs
  2. Developing internal coping strategies
  3. Engaging in social settings or distractions
  4. Reaching out to supportive contacts
  5. Contacting professionals or crisis lines
  6. Reducing access to lethal means


This intervention is client-centered, developed collaboratively in session, and revisited regularly. It doesn't rely on vague promises but instead focuses on concrete, achievable actions.

In addition to SPI, I integrate DBT-informed skills for clients who struggle with emotion dysregulation, and I often use motivational interviewing techniques to enhance engagement around safety.


For example, a client recently developed a safety plan that included:

  • A daily grounding routine (guided by a self-recorded voice note)
  • A photo album of people and places that anchor her emotionally
  • A list of “reasons to live” statements in her phone’s notes app
  • A plan to temporarily stay with a friend during high-risk periods


It was practical. It was hers. And it worked because it respected her autonomy and her lived experience.

What I’m excited about going forward

The shift away from no-harm contracts is part of a larger, promising movement in our field: trauma-informed, collaborative care. We’re recognizing that safety isn’t imposed, it’s built through connection and trust.

I’m especially interested in the growth of digital safety planning tools, many of which now allow clients to carry their plans with them on their phones, share them with loved ones, and update them dynamically. There’s also encouraging research into peer support models that help clients build relational safety nets beyond the therapy room.

As clinicians, we’re increasingly being trained to view suicide prevention through a lens of empowerment, not control. I believe this direction will continue toward strategies that honor clients’ voices, foster resilience, and support real-world safety.

Headway allows providers to focus on care.

As therapists, we know our energy is best spent building trust and supporting healing — not navigating insurance panels or chasing down reimbursements. That’s where Headway comes in.

Headway streamlines scheduling, billing, and credentialing so you can stay grounded in your clinical work. Whether you're managing a full caseload or building a private practice, Headway takes care of the operational lift so you can focus on your clients. Headway also offers a library of clinician-vetted resources and tools, including worksheets, therapy frameworks, and client-facing materials — all designed to support ethical, effective care.

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