Should I tell my therapist I’m suicidal?

When life gets overwhelming, our brains sometimes try to find a way to escape the chaos. This can include thoughts such as, “I don’t want to be here anymore” or “I wish I could just go to sleep and not wake up.” 

When these thoughts rise to the surface, it can feel shocking and scary. You may be feeling powerless and hopeless. It may feel as if that thought is controlling you, versus you controlling your thoughts.

You’re not alone.

Many people have experienced felt suicidal at some point in their life. Research from the Substance Abuse & Mental Health Services Administration (SAMHSA) shows that roughly 9 million American adults have suicidal thoughts and feelings each year. Over 2 million of these adults make a plan to die by suicide, and just over 1 million make an attempt. 

Children and teens can also have suicidal feelings. In 2015, the Centers for Disease Control & Prevention (CDC) found that 17% of teens in 9th-12th grade seriously considered suicide, and 13% made a plan. 8% made a suicide attempt.

It can be scary to talk about your suicidal thoughts.

For most people, the thought of telling anyone you’re suicidal is terrifying. This is especially true when you think about telling your therapist; in my experience, this is oftentimes because clients are afraid of being hospitalized. 

This fear of hospitalization comes from a very real place. It wasn’t even 50 years ago when this was happening frequently. The idea that forced hospitalization is the therapist go-to is often reinforced through movies, television, and novels, even to this day. 

I’m here to assure you that that is not the case anymore. 

Most people who have suicidal thoughts are treated outside of the hospital.

While I can’t promise you that you will never be hospitalized for mental health treatment, I can promise you that our team of therapists will explore every possible option before bringing up hospitalization. I hope that this article can grant you some insight as to how we, as therapists, handle suicidal feelings among our clients. 

As therapists, we understand how common suicidal feelings can be.

First off, as research shows, suicidal feelings are common. And as therapists, suicide is something we talk about with our clients often. When you tell your therapist you’ve been having some suicidal thoughts, your therapist shouldn’t panic. Most of us are trained to work with suicidal thoughts and feelings. If a therapist has not been trained in this area, and they seem to panic or dismiss your concerns, please ask to speak with someone else. 

What will my therapist say when I tell them I’ve had suicidal thoughts?

Every therapist will respond slightly differently. However, when you bring up feeling suicidal, you can generally expect that your therapist is going to want to ask some more questions about it. How often are you having these thoughts? How long do those thoughts and feelings last? By asking these types of questions, we’re able to determine how intense those thoughts and feelings are. Knowing if the thoughts last a few minutes (versus a few hours) will help guide your therapy treatment. This will also be important information for us to know if the thoughts and feelings start lasting longer or feeling more severe. 

Your therapist is also going to ask if you have any intention of dying. This is another way we measure those suicidal thoughts and feelings. Most of the time, suicidal individuals don’t actually want to die-- they want to escape the current moment and its pain. Whether it’s stressful meetings with your boss, feeling overwhelmed in managing a household, or thinking about past traumas, the pain you’re experiencing feels too great to bear. 

We may have some uncomfortable conversations.

As therapists, our primary goal in talking to you about suicide is to keep you safe. This may include talking to you about any firearms in your home. Research shows that guns are the most lethal, and most available, means of dying by suicide. With a gun in the home, the risk of a deadly suicide attempt is far higher. We may talk to you about having a family member lock up the firearm, keep ammo separate from the gun, etc., all to keep you safe. We may also talk to you about the medications you’re taking, if you’ve been saving any pills for a planned attempt, and if those medications need to be locked up by a family member. 

Therapists are problem-solvers. Upon learning about your suicidal thoughts, we’ll work with you to create a safety plan. How are we going to keep you safe in your home? We may involve family members in this plan, or other community members, such as a trusted church official. The safety plan is guided by you and your circle of trust. We’ll monitor those suicidal thoughts and feelings in each session, just like any other mental health symptom. 

What if I DO need to be hospitalized?

Hospitalization is the therapist’s final option for dealing with suicide. Your therapist should only bring up the topic of emergency hospitalization if they are concerned you’re going to die upon leaving your appointment, if you cannot agree on a safety plan, if you have the intent to die, and if you have the means of attempting (firearm, pills, etc.). 

If you need to be hospitalized, your therapist will be working with the hospital team to receive updates on your care, and to help you transition back to your home after your stay. Hospitalization doesn’t cure suicidal thoughts or make them go away; it just keeps you safe for the time being, if there are no other options to do so. 

The truth is, us therapists are highly invested in keeping our clients alive. Not only would losing you shake our entire professional career, it would change our personal lives and how we view the world, just as it does for any other human who has lost a loved one to suicide.

So please, tell your therapist if you’re feeling suicidal. We will work with you to keep you safe, and to diminish the stress that’s causing those suicidal thoughts.

Help for Suicidal Thoughts

You want to be excited about life again. Right now, the depression is holding you back. The problem is that nothing you’ve tried has helped. In fact, you’re feeling more hopeless than ever. Our therapists believe you CAN feel better and that you deserve the support and tools to get there.  We have skilled therapists who have helped countless others overcome depression and create lives that are truly worth living.  

So, if you’re having suicidal thoughts, please call us at (573) 328-2288 or reach out online to schedule a free consultation with one of our therapists.  You don’t have to keep fighting the weight of depression. Things CAN get better. 

If you are concerned for your safety, please call 911 or the National Suicide Prevention Lifeline at 1-800-273-8255. You can also text TALK to 741741.

Other Counseling Services

In addition to counseling for depression, Aspire Counseling offers a wide range of mental health services online in Missouri and in our Columbia, MO counseling office. Our specialties include LGBTQ+ affirming therapy, PTSD treatment/trauma therapy, grief counseling, anxiety treatment & teen counseling.

About the Author

Madison Phillips is a therapist at Aspire Counseling. She helps clients with a wide variety of mental health concerns but has a particular interest in helping those who self harm. She’s trained in Dialectical Behavioral Therapy which is an evidence based treatment for self harm and hopes to soon be able to offer comprehensive DBT services through a consultation team. Madison is a caring, reassuring therapist who goes the extra mile to help her clients.