Talking to Your Therapist About Suicide

When you are experiencing passive or active suicide ideation, reaching out to talk with a professional is a great step toward keeping yourself safe and creating a space to talk about these difficult feelings and thoughts.

While some people feel comfortable sharing suicidal thoughts and behaviors with their therapist, there are many reasons why a person may be hesitant to open up this conversation. Here are some common reasons why people are reluctant to talk about suicide with their therapist, as well as helpful information to encourage you to be more honest in the therapeutic space.

Concerns about confidentiality.

There are only specific instances in which a therapist must break confidentiality, including if they believe a client is in immediate danger of killing themselves. Best practice from a therapist includes having all conversations around this up front, and not making any sudden decisions without the client’s consent and understanding (unless absolutely necessary). It can be helpful to check in with your therapist about confidentiality as you begin to consider talking about suicide and let them know that one of your concerns is privacy.

Worried they will call the police/have you admitted into a psychiatric care facility.

Therapists do not want to have to call for emergency crisis care, and it is often a last option after all other attempts to keep the client safe have not worked. Best practice around this looks like making a crisis phone call together, and/or the therapist walking you through the steps of the process, so you understand what is going on and can have some control. It can be helpful to bring this up with your therapist and ask them how they’d manage a client emergency.

Worried about the therapist’s mental health and them being able to emotionally tolerate the conversation.

A therapist is trained to hold the difficult feelings that our clients have. It is our job to regulate ourselves and be prepared and ready to be present for these conversations. We want you to be talking to us about suicide if that is something that is coming up for you. It can be helpful to let your therapist know that you are concerned about their feelings when approaching difficult topics, as this is good feedback for your therapist so they know how to support you.

Not being confident that your therapist will know what to do with what you are telling them.

This is a valid concern. Some therapists are better at handling certain topics than others. While all therapists are trained on addressing suicidality, some have more experience in this area than others. It can be helpful to bring this up to your therapist, so they are aware of how you are feeling. Signs that a therapist knows how to handle suicide ideation include non-judgmental responses, validating your feelings, not immediately activating crisis unless absolutely necessary, continuing the conversation around suicide, asking you questions about suicide, not ignoring the topic when brought up.