How to Talk to Your Therapist About Suicidal Thoughts

Suicide is not an easy subject and talking about suicidal thoughts in therapy can be scary. Having thoughts of harming yourself can be frightening. You might feel ashamed. You might feel that nobody will understand you. You might be wondering what happens if you tell your therapist you're suicidal. The truth is, you’re not alone. In 2020, suicide was the 12th leading cause of death in the U.S. While there are differences in suicide rates and attempts based on age, gender, and ethnicity, suicide occurs in all demographic groups. 

Help is available and you need to speak up, whether it’s with a therapist or with someone you know and trust. Here’s what you can expect when you open up about thoughts of suicide with your therapist. 

Why is it important to seek help for suicidal thoughts?

Many people are afraid of saying they have had thoughts of suicide. They may be afraid of their therapist’s reaction. They may feel ashamed. But your therapist is trained to help you in these discussions. Your therapist will not judge you. In fact, if you say nothing, your therapist would be concerned. Saying nothing and not getting treatment could prevent you from getting the help that you need, increasing your risk of acting on your suicidal thoughts. 

Therapy works. According to the American Psychological Association, 75% of people who undergo psychotherapy (also known as “talk therapy”) show improvement. Your therapist will determine how much danger you are in, then work with you to develop a safety plan so that you know how and when to get help in the future.

How do I prepare to talk to my therapist about suicidal thoughts?

It can be intimidating to talk to your therapist about your thoughts but remember that there is no shame in getting help. Here are some tips to help you prepare:

• Be honest. Your therapist has heard it all. They will not judge you. Therapy is a safe space, so you should feel comfortable opening up. Even things that may seem unimportant to you might be important in helping your therapist understand you so they can guide your treatment.
• Write down your thoughts. Sometimes it may be hard to remember things during a therapy session. So write down your thoughts. Bring them to your session and share them with your therapist. 
• Write down your questions. If you have questions, write them down. Bring them up with your therapist during your session. No question is too big or too small. Make sure that you leave your session with all your questions answered or ask for a follow up with your therapist. 
• Start small. Opening up to your therapist takes strength. Tell your therapist what’s comfortable for you. But remember that if you have any thoughts of harming yourself, you need to let your therapist know. This way, they can help guide you and get you the help you need.

When you open up to your therapist, you are strengthening your relationship with them. This relationship is called the therapeutic alliance and it’s key to your success in therapy. Having a strong relationship with your therapist makes communication easier and helps your therapist get to know you better so they can best help you. 

What should I expect from having a conversation with my therapist about suicidal thoughts?

When you let your therapist know that you may have thoughts of harming yourself, your therapist will ask you some more questions. These questions might feel like a lot, but they’re a way for your therapist to assess whether you’re in immediate danger of harming yourself. They might ask you questions such as:

• Do you have thoughts of wanting to die
• Do you think you would be better off dead (this is called “passive suicidal ideation”)
• Do you have thoughts of harming or killing yourself
• Do you have a plan for killing yourself
• Have you prepared for suicide, for example, have you started to give away your possessions
• Do you have easy access to means of suicide, for example, firearms or drugs 

Your therapist’s goal is to make sure that you are safe to move forward. To do that they will help you prepare a plan to keep you safe as you undergo the process of therapy.

How can I create a safety plan with my therapist?

A safety plan is a plan that you and your therapist develop together. The plan will have coping strategies and support resources that you can use before or during a crisis. It will usually be a series of steps, similar to the one below, that will help you identify what to to do when you notice the warning signs of suicide:

1. Know the warning signs that increase your risk of suicide.

‍These signs could include behavior or thoughts. If you identify these signs, you will go to step two.

2. Use coping strategies that you’ve identified with your therapist.

‍This could be exercising or listening to music. 

4. Spend time with other people.

Social support is important to your mental well-being. Having a group of people who you can call upon to go to the movies or have dinner with can help provide distraction and relief.

5. Contact specific people for immediate help.‍

If you are in crisis, you will need someone to turn to specifically for help. This could be a friend, family member, or your therapist. You’ll work with your therapist to come up with this list and their names and contact information. 

6. Use mental health resources.

‍These will include your therapist, local urgent care services, as well as crisis lifelines such as 988 from the National Suicide Prevention Lifeline.

Confidentiality in therapy‍

Rest assured that what you talk about with your therapist is kept confidential. Maintaining your privacy is part of your therapist’s professional code of ethics and a condition of their professional license. Your therapist will not share what you share unless it is in these situations:

• If you reveal that you plan to hurt yourself or others, for your protection and others
• If there’s abuse, exploitation or neglect of children, the elderly, or people with disabilities
• If a court case is involved, for example, the therapist notes are subpoenaed. This can happen even after therapy is over.
• You agree to include a partner or family member in your treatment
   

Remember, your therapist is there to help and protect you. Opening up in therapy lets your therapist get to know you and create a treatment and safety plan to help you manage your suicidal thoughts and keep you safe.