What should a social worker do FIRST when a client with borderline personality disorder verbalizes destructive thoughts but denies any intention to act on them?

The most appropriate first step when a client with borderline personality disorder expresses destructive thoughts, even while denying any intention to act on them, is to complete a suicide risk assessment. This is critical because such assessments are designed to identify the severity and immediacy of potential risk to the client.

Individuals with borderline personality disorder often experience intense emotions and unstable relationships, which can lead to impulsive behaviors or suicidal ideation. Even if the client insists they do not intend to act on these thoughts, it’s essential for the social worker to thoroughly assess any underlying factors that could indicate a risk.

A comprehensive risk assessment allows the social worker to gather information about the client's mental state, past behaviors, support systems, and potential vulnerabilities. This insight is vital to determine the necessary interventions and to ensure the client’s safety.

Conducting therapy sessions focusing on coping strategies, referring the client to a psychiatrist, or developing a safety plan are also important steps, but they should follow after the risk assessment is completed. Understanding the client's risk level first informs the appropriate course of action regarding their care and safety.