What To Expect When Talking About Suicide With Your Therapist
You’ve been struggling with the dark thoughts of death and suicide for awhile and you’re ready to start talking about it in therapy. Regardless if this is a new therapeutic relationship or if this is someone you’ve been seeing for awhile, it can be pretty intimidating sharing these thoughts. Here’s what to expect when talking to your therapist about suicide.
We Want To Make Sure You’re Safe
If you can recall at the beginning of therapy, you may have been told about the limitations to confidentiality. Everything is going to be kept in the room EXCEPT if you’re an imminent danger to yourself or others. So what does this actually mean?
Assess For Safety
Having thoughts of suicide isn’t in of itself evidence that you are a “danger to yourself.” Thoughts of suicide just means you are having thoughts of suicide. Your therapist will probably ask questions about the thoughts, whether or not you have created plans, you ability to access means for the plans, and the intent. It’s not for interrogation purposes, but to determine how safe you are in this moment or if there is a potential crisis. As I tell my clients when we start the therapeutic relationship, it’s hard to do therapy if you’re dead, in the hospital, or in jail.
Determine When To Seek a Higher Level of Care
Your therapist is mandated to keep you safe and has to determine if you are needing something more intensive (aka a “higher level of care”). It means exactly as it sounds: you are needing a level of care that your therapist isn’t able to give to you in order for you to be safe. This might mean adding a case manager if you’re at an agency or it might mean going to a crisis unit to help de-escalate the crisis. Or you might not need a higher level of care. It all depends on how severe your symptoms are, but ideally, therapists do not want to go to a higher level of care unless it is absolutely needed. For me as a therapist, hospitalization is the last place I want you to end up AND sometimes it might be necessary.
Identify Supports and Resources
For the most part, if your thoughts are just thoughts, we will explore them, give you some information, and teach you coping skills to help you process and cope. It can be scary or exhausting or frustrating to have suicidal thoughts and feelings.
However, if it is something that needs a higher level of care, there are steps to that, too. Remember: most therapist want to save hospitalization on a as-needed basis.
Who will be a good support for you to help you through any crises?
These can be supports who know that you are struggling with suicidal thoughts and can talk you through the crisis or provide you the emotional support. It can also be people that you spend time with to distract you from the intense feelings, thoughts, and urges. Both are incredibly helpful when trying to maintain safety.
Are there any locations that you can go to help ride the wave of the urges?
If no one is available and you’re not in immediate danger, your therapist will help you brainstorm where you can go to distract yourself or comfort yourself. This might taking a walk in a park, going for a drive if it’s safe to do so, or shopping in a store.
Are there any coping skills that will be particularly helpful?
This is where your therapist may give you specific skills to practice when you’re not in crisis or explore what has worked for you in the past.
Do you have the emergency contact numbers?
This could be the local crisis hotline number or the National Suicide Prevention Lifeline number (1-800-273-8255) or 911.
If you are experiencing a crisis and would like support (validation, problem solving, etc.) a crisis hotline may be a good option. DISCLAIMER: Just like with any relationship, some crisis counselors are the perfect fit for you and some are not. It does not mean that there is anything wrong with you, but that individual may not have the capability to give what you need. You can always ask to speak to someone else or to call another hotline.
If it is an emergency, 911 will be your best option.
The most important thing is for the client to feel safe, otherwise it will be difficult to talk about the things that contributes to the suicidal thoughts.
If you are in California and would like to work with me, I am currently accepting clients for individual therapy and group therapy. Contact me to schedule a consult.