Culturally competent firearms discussions in therapy

By Sallie Mack, Ph.D., Danielle Currin, Ph.D., and Alban Foulser, Ph.D., on behalf of the Atlanta Behavioral Health Advocates

As psychologists, we have an ethical obligation to promote safety and prevent harm. Since suicide attempts with firearms are extremely lethal (Cai et al., 2022), we need to discuss firearm safety with our clients. However, this process can be particularly difficult given the divisive nature of our current sociopolitical climate regarding firearms. Providers may find it difficult to align with customers who are reluctant to restrict access to their firearms. Furthermore, attempts to restrict access to one’s firearms may inadvertently have the opposite effect, as clients who feel pressured by their providers to give up their firearms are more likely to become defensive and dishonest (Wolsko et al., 2020). In accordance with the APA Resolution on the Safe Storage of Firearms and Lethal Means, Safety Strategies to Prevent Suicides (2024), we recommend taking a culturally competent approach. Cultural competence is a lifelong journey of increasing effectiveness in dealing with cultural differences through increasing one’s knowledge, awareness, and skills (Sue & Torino, 2005). By conceptualizing firearm ownership as an associated cultural value identitywe can better understand and align our customers.

While describing the comprehensive process of safety assessment and planning is beyond the scope of this article, below we provide information, guidance for further consideration, and concrete skills for incorporating cultural competency (knowledge, awareness, and skills) into your practices.

Knowledge

Knowledge involves the process of learning about another person’s culture, values, heritage, and beliefs (Sue & Torino, 2005). Understanding the historical context and importance of firearms can help better understand today’s gun culture. The “gun culture” was originally coined to represent the social importance of protecting the right to bear arms, in line with the values ​​of protecting individual rights and democracy ( Hofsradter, 1970 ; Boine et al., 2020 ). Today, firearm ownership is prominent, with a 2023 Gallup poll finding that 42% of American households own a firearm (Gallup, 2023). So the ‘gun culture’ is not a monolith. Firearm subcultures include recreation (e.g., hunting, target shooting), self-protection, and Second Amendment protection (Boine et al., 2020). The reasons for purchasing firearms have changed in recent years, with self-protection becoming an increasingly common motivator (Boine et al., 2020). Subcultures can also vary by state, political identification, occupation or veteran status, and urbanicity. We can work to increase our knowledge of historical and current practices and laws surrounding firearms in the US and in our respective states, as well as the various subcultures affected by them.

Conscience

Self-awareness involves understanding one’s own cultural identity and values ​​and how these can influence our perspectives (Sue & Torino, 2005). Increasing awareness of our personal beliefs, emotions, reactions and biases around firearms can help us increase our objectivity in assessing safety issues and align us with our customers.

Questions to promote self-awareness:

1. What are my views on firearms?
2. What immediate reactions do I get when someone says they own a firearm?
3. What is my comfort level discussing firearms? What emotions emerge in these discussions?
4. What previous experiences do I have with firearms? How might these affect my beliefs now?
5. What are my sociopolitical positions regarding firearms (e.g., how do I feel about gun control or the right to bear arms)?
6. What assumptions might I have about what kind of person owns a firearm?

Other awareness involves insight and understanding of the cultural identity and values ​​of others. Increasing the awareness of others helps us better deal with differences and find common ground together. We can combine our self-awareness and knowledge to implement skills that ask questions about our clients’ beliefs, values, and emotions related to firearms. For example, we can explore clients’ histories with firearms, personal and political beliefs, and identities.

Skills

Skills include our behavioral responses that relate to our knowledge and awareness and help us work more effectively with customers (Sue & Torino, 2005). In accordance with APA’s resolution, we recommend using skills to work with clients to promote lethal agent safety strategies (APA, 2024). By combining clients’ values ​​with our professional knowledge of safety risks, we can co-create safety plans that emphasize both. Potential skills that can be integrated into safety assessment and planning practices include:

• Prioritize building trusting relationships with customers to increase their comfort with firearm disclosure (Marino et al., 2016; Pruitt et al., 2022).
• Use non-judgment and empathy; limit demands when discussing firearm safety (Betz & Wintemute, 2015; Pruitt et al., 2022).
• Affirm your clients’ right to own firearms and emphasize the temporary nature of firearm restrictions in safety planning, as this can increase clients’ willingness to restrict access (Marino et al., 2018; Wolkso et al., 2020).
• Find common ground by formulating shared frameworks goals and values ​​(e.g. increasing safety, improving health, preventing impulsive decisions). Firearm owners often place great value on firearm safety and may be more aligned with a general, safety-oriented approach (Wolsko et al., 2020).
• Work together to increase the time and distance between each other suicidal urge and access to firearms. Different levels of access include: temporarily giving up firearms (e.g., asking a friend who is familiar with firearms to store them) and secure storage options (e.g., gun safes, key boxes, cable locks). By discussing multiple secure storage options based on customer needs and preferences, customers can make the most feasible and effective choices (Betz & Wintemute, 2015).

Possible questions:

• How willing are you to temporarily remove your firearms from your home?
• What concerns do you have about restricting access to your firearms?

Consider having resources (e.g., national and local suicide hotlines), safety plans, and motivational reminders (e.g., family photos) where clients’ firearms are stored, and having gun locks available on-site or providing resources for obtaining secure storage devices. The VA gives an example of large-scale deadly means safety programand Project ChildSafe provides information on how to obtain it free safety kits.

We hope that the approach presented here is a useful tool in navigating emotionally and politically charged conversations. We also recognize that this process may sometimes require stronger and provider-led interventions decision-making when the risk seems imminent. We encourage psychologists to embed cultural competency into the ongoing and dynamic process of safety assessment and planning.

If you or someone you love is considering suicide, seek help immediately. For help, call 988 24/7 for the National Suicide Prevention Lifeline, or contact the Crisis Text Line by texting 741741. To find a therapist near you, visit the Psychology Today Therapy Directory.