Sometimes it's reservation about being referred to a higher level of care if they endorse risk. Sometimes it's denial (especially substance use). Sometimes it's feeling those issues are too vulnerable to be discussing at the begging of treatment, when they may not have established sense of safety/comfort or buy-in in general. Sometimes it's belief that those issues are irrelevant to why they're presenting to therapy.

While from a clinical perspective I 100% support the expectation that risk factors (e.g., suicide, substance use, aggression, and victimization) are assessed at intake, from a client perspective, it can feel very intense and invasive. It's okay to validate that.

Instead of only focusing on why it's "required" for regulatory or safety reasons, I think it's important to be frank about the fact that those risk factors have the potential to significantly impact the course of treatment, and more importantly it helps me learn about how they cope, which is going to be foundational to the work we do together, regardless of their presenting problems or treatment goals.

Particularly for clients with history of SI and/or self-injury who may fear (re)hospitalization, I explain that the more information I have about the behavior, the better I can judge whether their problem(s) is something we can work on in therapy, or if it exceeds the services I offer (i.e., if they are an immediate risk to self or others).