What Happens When You Mention ”Suicide” in Therapy

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It is okay to say the word “suicide,” even to your therapist. You are not alone if you are having thoughts about suicide or have had suicidal thoughts in the past. The Centers for Disease Control’s provisional data for 2022 showed a record high of 49,369 suicide deaths, coming after modest declines in 2019 and 2020.  

Suicide is not easy to discuss, especially with your therapist, as you may feel misunderstood or scared. However, talking about suicide, especially with a safe person like a therapist, can allow you to receive the help you deserve. Your therapist is trained to help you navigate these discussions and offer resources and ways to help.  

Many people assume that if they mention the word “suicide” to their therapist, then it automatically means they are sent directly to a hospital for 48-72 hours for a psychiatric evaluation. Because of this notion, many people refrain from discussing suicide in therapy.  

However, this is not always true, as it is possible to discuss suicide with your therapist without making it an automatic emergency. Therapists and other clinicians generally consider it a positive sign when an individual discusses thoughts of suicide; it’s much more concerning when a suicidal individual says nothing and thus remains at higher risk.

Assessing your risk

It is important to be honest about your thoughts and feelings with your therapist regarding suicide. If you are not fully comfortable sharing everything, tell your therapist that you are only comfortable sharing certain information now. Your therapist will want to assess your suicide risk and will ask you a set of standard questions that involve the following:

1. Thoughts of wanting to die (passive suicide ideations) 
2. Thoughts of actually harming or killing oneself (active suicidal ideations) 
3. A desire to commit suicide 
4. A plan to commit suicide 
5. Steps you have taken to prepare for suicide (giving away possessions, taking out a life insurance policy, preparing a will, etc.) 

Available access to the means for suicide (possession of a gun, pills, etc.)

Depending on your risk of suicide, your therapist will determine what is the right path for you. If you are thinking about dying, you are at a much lower risk than if you have taken steps to prepare for suicide and have reasonable means. Your therapist may also ask why you do not want to commit suicide (leaving behind loved ones, etc). A high level of danger, such as having a plan, taking steps to prepare for suicide, and having the means to do so, may be deemed an emergency and require hospitalization. A lower risk of suicide, such as thoughts of suicide or a desire to commit suicide, may warrant an agreed-upon safety plan set up by you and your therapist.

If your therapist deems no emergency, they will discuss warning signs and triggers, healthy coping strategies, the importance of a support system, and professional suicide prevention resources.

Formulating a safety plan

You and your therapist must work together to formulate a suicide safety plan. Often, when therapists form a safety plan without the client’s input or having a client sign a “suicide contract,” the client may feel as though the therapist is trying to protect themself, or the individual may feel coerced into signing a contract. Formulating a suicide safety plan strengthens the client-therapist bond, also known as the therapeutic alliance.  

You must speak up and give your thoughts when discussing a safety plan with your therapist. After all, you want a safety plan that works for you. Aspects of a safety plan include the following: 

1. Identifying warning signs that increase your risk for suicide: These can be thoughts, behaviors, surroundings, people, and situations.  
2. Adopting self-coping strategies can help you work through these triggers: These can be things like writing, meditating, listening to music, exercising, etc.  
3. Contacting trusted people who can help you seek relief: If your self-coping strategies are helping you work through your triggers, then it is important to have a list of trusted individuals you can contact to take your mind off things. You don’t have to mention your suicidal thoughts necessarily to them, but these support people are put in place to provide you with some relief. Maybe going to see a movie, going for a walk or a hike, grabbing lunch, or going to the park with this trusted person.  
4. Contacting a trusted friend or family member to ask for help: This includes providing names and contact information in your safety plan of those you feel safe to confide in about your suicidal thoughts if none of the above are helping. This means having an open and honest discussion with a loved one about how you are feeling so that they are aware and can assist you in navigating professional help.

Contacting professional mental health resources: This includes your therapist, suicide hotlines, or an emergency room.

Remember that your therapist is there to help you navigate these dark times. They want the best for you and want to protect you. Opening up to your therapist about your thoughts can allow your therapist to get to know you better and work with you to create a safety plan to help manage your thoughts and keep you safe.
 

If residential treatment feels like the safest plan, please reach out to Akua Behavioral Health as soon as possible. We have a 24-hour hotline and can help guide you through our quick 2-step admissions process. Call us anytime to speak with someone who understands: (888) 629-6707.