Culturally competent discussions about firearms in therapy

Authors: Dr. Sallie Mack, Dr. Danielle Currin and Dr. Alban Foulser, on behalf of Atlanta Behavioral Health Advocates

As psychologists, we have an ethical obligation to promote safety and prevent harm. Given that suicide attempts using firearms are extremely deadly (Cai et al., 2022), we need to talk to our clients about firearm safety. However, this process may be particularly difficult given the divisive nature of our current sociopolitical climate regarding firearms. It may be difficult for suppliers to deal with customers who are reluctant to restrict access to their firearms. Additionally, attempts to restrict access to firearms may unintentionally backfire, as customers who feel pressured by their suppliers to give up firearms are more likely to become defensive and dishonest (Wolsko et al., 2020). Consistent with the APA Resolution on Strategies for the Safe Storage of Firearms and Lethal Agents to Prevent Suicide (2024), we recommend adopting a culturally competent approach. Cultural competence is a lifelong journey of becoming more effective in overcoming cultural differences by increasing knowledge, awareness, and skills (Sue & Torino, 2005). Conceptualizing firearm ownership as a cultural value associated with it identitywe can better understand our customers and adapt to them.

While it is beyond the scope of this post to describe a comprehensive security assessment and planning process, below we provide information, prompts for further consideration, and specific 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 you better understand today’s gun culture. “Gun culture” was originally coined to represent the social importance of protecting the right to bear arms, consistent with the values ​​of protecting individual rights and democracy (Hofsradter, 1970; Boine et al., 2020). Today, firearm ownership is common, with a 2023 Gallup survey showing that 42% of American households own a firearm (Gallup, 2023). So “gun culture” is not a monolith. Firearm subcultures include recreation (e.g., hunting, target shooting), self-defense, and Second Amendment protection (Boine et al., 2020). Reasons for purchasing firearms have changed in recent years, with self-defense becoming an increasingly common motivator (Boine et al., 2020). Subcultures may also vary by state, political identification, occupation or veteran status, and place of residence. We can work to increase our knowledge of historical and current firearms practices and laws in the US and our states, as well as the various subcultures involved.

Awareness

Self-awareness involves insight into one’s cultural identity and values ​​and how these may influence our point of view (Sue & Torino, 2005). Increasing awareness of our personal beliefs, emotions, reactions and biases regarding firearms can help us become more objective in assessing safety issues and adapt to our customers.

Questions to promote self-awareness:

1. What are my beliefs about firearms?
2. What immediate reactions occur when someone says they have a firearm?
3. What is my comfort level with talking about firearms? What emotions emerge in these discussions?
4. What previous experience do I have with firearms? How might they influence my beliefs now?
5. What is my sociopolitical position on firearms (e.g., what do I think about gun control or the right to bear arms)?
6. What assumptions might I have about what kind of person owns a firearm?

Awareness of the other involves insight into and understanding of the identity and cultural values ​​of others. Increasing awareness of others helps us better cope with differences and find common ground together. We are able to combine our self-awareness and knowledge to implement skills that ask about our clients’ views, values ​​and emotions related to firearms. For example, we may investigate customers’ firearms history, personal and political beliefs, and identity.

Skills

Skills include our behavioral responses related to our knowledge and awareness that help us work more effectively with clients (Sue and Torino, 2005). Consistent with the APA resolution, we recommend the use of skills to collaborate with clients to promote lethal force safety strategies (APA, 2024). By combining customer values ​​with our professional knowledge of security threats, we can co-create security plans that emphasize both. Potential skills that could be included in security assessment and planning practices include:

• Prioritize building trusting relationships with customers to increase their comfort with disclosing firearms (Marino et al., 2016; Pruitt et al., 2022).
• Use non-judgment and empathy; limit making demands when discussing firearm safety (Betz and Wintemute, 2015; Pruitt et al., 2022).
• Reaffirm your clients’ right to possess firearms and emphasize the temporary nature of firearms restrictions in security planning, as this may increase clients’ willingness to restrict access (Marino et al., 2018; Wolkso et al., 2020).
• Find common ground by framing together goals and values ​​(e.g. increasing safety, improving health, preventing impulsive decisions). Firearm owners often place a high value on firearm safety and may be more aligned with a generalized safety-focused approach (Wolsko et al., 2020).
• Work together to increase the time and distance between suicidal drives and access to firearms. The different levels of access include: temporarily relinquishing firearms (e.g., asking a trusted friend knowledgeable about firearms to store them) and secure storage options (e.g., gun safes, lock boxes, cable locks). Discussing various secure storage options based on customers’ needs and preferences allows them to make the most feasible and effective choice (Betz and Wintemute, 2015).

Potential questions:

• What is your level of willingness to temporarily remove firearms from your home?
• What concerns do you have about restricting access to firearms?

Consider having resources (e.g., national and local suicide hotlines), safety plans, and motivational reminders (e.g., family photos) at client firearm storage locations and providing on-site gun locks or resources for obtaining secure storage facilities. The VA provides one large-scale example fatal means safety programand Project ChildSafe provides information on how to obtain free safety kits.

We hope that the approach presented here will be a useful tool for engaging in emotionally and politically charged conversations. We also acknowledge that this process may at times require stronger provider-led interventions and actions decision making when risk seems imminent. We encourage psychologists to incorporate cultural competence into an ongoing and dynamic process of safety assessment and planning.

If you or someone you love is considering suicide, seek help immediately. For 24-hour support, call the National Suicide Prevention Lifeline at 988 or contact the Crisis Text Line by texting TALK to 741741. To find a therapist in your area, visit Psychology Today therapy directory.