What to Expect When You Talk to a Therapist about suicidal thoughts

Hey everyone,

Today, I want to address a topic that’s both crucial and often shrouded in fear and misunderstanding: what happens when you tell a therapist that you’re experiencing suicidal thoughts? September is Suicide Awareness and Prevention Month, so it’s a perfect time to delve into this important conversation.

The Fear Factor

First off, I get it. The idea of walking into a therapist’s office and admitting you’re having suicidal thoughts is daunting. You might have heard horror stories about people ending up in the hospital against their will. While safety is a top priority for therapists, immediate hospitalization isn’t always the go-to response. Let’s talk about what really happens.

Opening Up

When you sit down with a therapist and share that you’re having suicidal thoughts, the primary goal is to understand the intensity and immediacy of these thoughts. Therapists want to help you in a way that’s actually helpful. That doesn’t always mean calling 911 on the spot.

Assessing the Situation

The first thing therapists do is assess your safety. This involves asking specific questions about your thoughts:

• Are your thoughts passive? (e.g., “I wish I wouldn’t wake up tomorrow.”)
• Are your thoughts more specific? (e.g., “I have a plan to harm myself.”)

Passive thoughts are usually indicative of underlying issues like depression, which we can address through regular therapeutic interventions. When the thoughts are more specific, it signals a higher level of concern and requires a more immediate response.

The Safety Plan

For many people, the idea of a safety plan might sound clinical, but it’s actually a very personalized process. If your thoughts are more serious but not immediate, a safety plan can be a lifesaver (literally). This plan might include:

• Identifying coping mechanisms
• Listing people to call when you’re feeling low
• Outlining activities to distract yourself (e.g., going to Starbucks, reading a book)

The goal here is to help you manage those intense moments until you can work through the underlying issues in therapy.

When Hospitalization is Necessary

Sometimes, the situation might be severe enough that hospitalization is the safest option. This might sound scary, but think of it like going to the hospital for a physical health emergency. You wouldn’t ignore a broken arm, right? The same goes for severe mental health crises. The stay is usually short, just long enough to ensure you’re safe and stable.

Common Questions Therapists Ask

To assess the level of risk, therapists might ask:

• How often do you think about suicide?
• Do you have a specific plan?
• Have you ever attempted to harm yourself before?

These questions help us determine the best course of action to keep you safe.

The Therapist’s Reaction

I can’t speak for every therapist, but most of us are trained to handle these conversations with care and without overreacting. Early in my career, I might have had a big reaction out of fear and inexperience, but with time, I’ve learned to gauge my response to match the situation.

Coping and Regulating the Nervous System

One of the first interventions I often suggest is regulating the nervous system. When you’re feeling hopeless, it’s usually because your nervous system is stuck in a heightened state of stress. Simple techniques like deep breathing, mindfulness, or physical activities can help calm your system and make you feel less trapped by your thoughts.

Therapy as a Lifeline

You might wonder, “What can a therapist really do for me?” Especially if you’ve never been to therapy, it’s easy to feel skeptical. But therapy provides a space to discuss these feelings with someone trained to help. We use evidence-based interventions to address both the symptoms and the root causes of your distress.

Taking the Leap

If you’re thinking about reaching out to a therapist, compare it to standing on a high diving board. It’s scary, but the moment you decide to jump, you just have to go for it. The initial fear is normal, but the relief and support you’ll find can be life-changing.

Thanks for joining me on this deep dive into what it’s like to talk to a therapist about suicidal thoughts. Remember, reaching out for help is a sign of strength, not weakness. If you or someone you know is struggling, don’t hesitate to seek support. We’re here to help.

Stay safe and take care,