Building a Safety Plan in Therapy: A Step-by-Step Guide
Safety planning is one of the most important interventions a therapist can provide. The Stanley-Brown Safety Planning Intervention is considered a best practice by the VA, SAMHSA, and the Joint Commission — and research shows it reduces suicide attempts by approximately 45% when implemented properly.
Yet many therapists report feeling underprepared to create one. Not because they lack clinical skill, but because they were never walked through the mechanics of building a good safety plan collaboratively with a client.
Here's a practical guide.
What a safety plan is (and isn't)
A safety plan is a prioritized list of coping strategies and resources that a client can use during a crisis. It's created collaboratively — not handed to the client as a worksheet. The plan is personalized, specific, and ordered from least to most intensive interventions.
A safety plan is not a no-suicide contract. Contracts ask clients to promise they won't attempt suicide. The research on contracts is mixed at best, and they place the burden on the client to manage a crisis alone. Safety plans do the opposite — they provide a concrete roadmap of what to do and who to contact when distress escalates.
The six steps of the Stanley-Brown model
Step 1: Warning signs
Start by identifying the internal experiences that signal a crisis is building. These are the thoughts, feelings, images, moods, or behaviors that the client recognizes as early warning signs.
Ask: "What are the first signs you notice when things start to get really bad? What do you feel in your body? What thoughts come up?"
Be specific. "Feeling anxious" is too vague. "Waking up at 3 AM with racing thoughts about being a burden" is actionable. The client needs to recognize these signals as a cue to pull out the safety plan.
Good warning signs are early. The earlier in the escalation cycle a client can recognize what's happening, the more effective the plan will be.
Step 2: Internal coping strategies
These are things the client can do alone, without contacting anyone, to manage distress. The goal isn't to solve the crisis — it's to create enough of a pause to think clearly.
Ask: "When you've been in a tough spot before, what helped — even a little? What can you do on your own to take the edge off?"
Examples might include going for a walk, listening to a specific playlist, doing a grounding exercise (5-4-3-2-1), taking a shower, journaling, or doing breathing exercises. These need to be things the client will actually do, not things they think they should do.
Write down three to five strategies. Be specific about what each one looks like. "Exercise" becomes "walk around the block twice while listening to my calm playlist."
Step 3: Social contacts and social settings for distraction
This step isn't about asking for help — it's about being around people or in environments that naturally reduce isolation and provide distraction. The client doesn't have to disclose what they're going through.
Ask: "Are there people you can be around, or places you can go, that help you feel less alone? Who could you call to just talk about normal stuff?"
This might be calling a friend to talk about sports, going to a coffee shop, visiting a family member, or attending a regular group activity. The point is to break the isolation that often accelerates a crisis.
Step 4: People to ask for help
Now the support becomes more direct. These are specific people the client can contact to tell them they're struggling and ask for help.
Ask: "Who in your life would you feel comfortable telling that you're having a hard time? Who would you trust to listen without panicking?"
For each person, record their name and phone number. Discuss what the client would actually say. "I'm having a rough night and I need someone to talk to" is a script the client can use when they can't find the words on their own.
Include at least two or three people. If the first person doesn't answer, the client needs a next step.
Step 5: Professionals and agencies to contact
List specific professionals and crisis resources with phone numbers.
This includes the client's therapist (with guidance about when and how to reach out), their psychiatrist if they have one, local crisis lines, the 988 Suicide and Crisis Lifeline, and the Crisis Text Line (text HOME to 741741).
If the client has a relationship with a specific crisis center or emergency contact, include that. The more specific and personalized, the more likely the client will use it.
Step 6: Making the environment safe
This step addresses means restriction — reducing access to lethal means during a crisis. Research overwhelmingly shows that restricting access to means saves lives, particularly for firearms and medications.
This is often the most difficult conversation. Approach it directly but without judgment.
Ask: "Are there things in your environment that you're concerned about during a crisis? Medications, firearms, anything that worries you?"
Interventions might include having a trusted person temporarily store firearms, locking up medications, or removing other means. The conversation should be practical and specific.
Common mistakes to avoid
Making it a worksheet exercise. A safety plan created by filling in blanks on a form in the last ten minutes of a session isn't a safety plan. It's a compliance exercise. Take the time to discuss each step, make it specific, and ensure the client actually believes the strategies will help.
Being too generic. "Call a friend" doesn't work in a crisis. "Call Marcus (555-0147) and tell him I need to talk" works. Specificity is what makes a safety plan usable when cognition is narrowed by distress.
Not reviewing it. A safety plan should be revisited periodically. Life changes. Phone numbers change. Coping strategies that worked six months ago might not work now. Make it a living document.
Not making it accessible. If the safety plan is in a file cabinet at your office, it's useless during a crisis at 2 AM. The client needs it on their phone, in their wallet, or somewhere they can access it immediately.
Digital safety plans
Paper safety plans get lost. Digital ones live on the client's phone — which is almost certainly within arm's reach during a crisis.
Theracharts includes safety plan tools as part of the 26 session tools available to therapists. Build the plan collaboratively during a session, and the client can access it from their portal anytime. It's there at 2 AM when they need it, not in a desk drawer at your office.
The platform also tracks clinical alerts from assessment scores, which can help you identify when a safety plan review is needed — before the client reaches crisis.