For most, the decision to enter into treatment is a big deal, one that can bring up quite a lot of fear and apprehension. Clients often tell me how nervous they are at the start of therapy, feel unsure about what personal information to share and how to share it, and are worried about being judged harshly by their therapist, particularly if they have information to share that they harbor shame around.
Sharing about suicidal thoughts and ideations is one such topic that tends to be very difficult to talk about. Unfortunately, this is not only true for clients, but also for many therapists.
Most importantly, when you enter into therapy you must feel safe and secure to share any and all information with your therapist. AND your therapist must earn your trust by demonstrating warm, honest, non-judgmental, positive regard for you and your experiences, as well as offer appropriate support and feedback for your current treatment needs.
Let me be clear, not everyone deserves the right to hear your very personal and private information, not even a therapist. Simply having a fancy degree or title is not enough. Therefore, please choose a therapist who has extensive knowledge and training, proper credentials, and credibility in your community.
If you do not feel safe talking with your therapist about certain matters or if you therapist appears afraid, unsure, or avoidant of certain topics you want or need to discuss, then this may be an indication that your therapist cannot meet your needs.
However, when it comes to thoughts of suicide or a desire to self-harm, you MUST disclose this to your therapist, as it is pertinent to your treatment and well-being. Your therapist cannot adequately treat you if you fail to share the full scope of your symptoms and behaviors.
Now, I know how incredibly scary it can be to share this information. Culture, media, and strong beliefs about suicide have many worried about potential negative consequences that can come from sharing thoughts of suicide or self-harm.
So, to help, here are 5 things that your therapist wants you to know about your suicidal thoughts. I hope you will use these as a guide to determine when and how to disclose suicidal ideation to your therapist.
1. Suicidal ideation, or thoughts of suicide, are very common:
Although it may not feel like it, you are never alone. Many of us have shared experiences and commonalities, and suicidality may be one of these.
The Center for Disease Control (CDC) reports that suicide is within the 10th leading cause of death among adults in the U.S. and is the 2nd leading cause of death among people ages 10-24. These statistics are of those who have died by suicide, therefore, we can only image the staggering number of individual who may be considering suicide, but have not engaged in suicidal/self-harming behaviors.
Read more from the CDC here.
Your therapist knows just how common suicidal ideation is and does NOT think you’re “crazy,” “weird,” or “abnormal” in any way. Suicidal ideation is a very real symptom of many mental health disorders, including depression, anxiety, feeding and eating, mania, psychosis, and others. Often, suicidal thoughts are an indication of underlying needs that are not being met. Sharing these with your therapist is an opportunity to address your needs and wants head on so that you can start to work towards recovery and relief.
2. Those who have thoughts of suicide, often have feelings of ambivalence:
Our thoughts and feelings are often broken into parts, so that two seemingly opposing beliefs can coexist at the same time, making it possible for one to have feelings of love and hate, anger and sadness, or excitement and nervousness all at the same time.
More often than not, those who have thoughts of suicide also experience feelings of ambivalence, or conflicting emotions about whether or not to engage in behaviors that may be life threatening. Although this may be confusing, ambivalence does NOT negate severity of the situation or mean that the person is not serious about threats of suicide.
Ambivalence about suicide can make it particularly challenging for the person experiencing such thoughts, as they may minimize or explain away suicidal thoughts or even latch onto thoughts that may cause anxiety or discomfort, further exacerbating symptoms that can increase suicidal ideation.
On the other hand, ambivalence can also be protective for the individual experiencing suicidal ideation, as it allows us to look more at the part of the induvial that wants to live and use this to instill hope and get unstuck with forward thinking movements.
3. Feel free to open a dialogue with your therapist about suicide:
Unlike most settings, therapy is a place for dialoguing and open-ended conversations, that don’t necessarily have to have a beginning, middle, or end, or even a point, where one doesn’t need to have an answer, nor do they need to do anything particular about it.
Therapy is a place for you to share thoughts, feelings, and ideas and anything you like and in any way that you like.
Yes, you can even have an open dialogue about suicide.
A good therapist wants to have these kinds of conversation with their clients in a way that is transparent and honest, so that they may understand the client’s perspective, validate their experience, and collaborate with them on what to do or how to improve the situation if possible.
4. Sharing about suicidal thoughts doesn’t necessarily mean you will be hospitalized:
Probably the number one reason people are most afraid to share thoughts of suicide with their therapist, is the fear that they will be taken against their will to a hospital. However, simply sharing about suicidal thoughts is not enough to warrant hospitalization. In fact, more often than not, when clients share with me about thoughts of suicide there is NO hospitalization at all.
Hospitalization may be initiated by a therapist, but only in the most severe cases in which the client is truly at risk of hurting themselves or others and is unable or unwilling to create a safety plan with the therapist.
Also, it is important to note, that a therapist likely can only initiate the process for the client to be assessed by a medical professional, usually at an ER or hospital, who will ultimately make the final decision about whether they will be admitted inpatient. Only few therapists who have special training and credentials can actually complete an involuntary psychiatric hold.
5. It’s all about safety planning:
If you decide to share your suicidal ideation with your therapist (and I hope you do), your therapist will first complete an assessment with you to understand the full picture of your suicidal thoughts. This means your therapist will ask you a series of questions and will want to know any underlying contributing factors, exacerbating symptoms and behaviors, duration and severity, intent or plan to harm yourself, commitment to life, and how you are able to work towards safety.
With this information, your therapist will work with you to create a safety plan, which will include preventative and reactive measures for safety, such as therapeutic coping skills, activities that improve mood, calling and notifying loved ones, seeing a physician/psychiatrist, utilizing community resources (i.e. crisis line, group therapy services, community center, local hospitals), and numbers for who to call in case of an emergency. Also, your therapist will most likely make a plan to increase the frequency of contact with you, in person and/or by phone.
Creating a safety plan with your therapist is a really great way to communicate your commitment to life and willingness to take steps to keep yourself safe.