How in the world am I supposed to tell my therapist that I’m having suicidal thoughts? Are they going to freak out and call 911 immediately? Are they going to drop me like a hot potato? Are they going to downplay my thoughts and feelings until I swallow them up again?

These are all completely understandable fears–it’s really hard to talk about suicide, even with a mental health professional. Suicide prevention week is the 7th-13th of this month, and what better time to tackle a difficult question? If you think you need to talk about your suicidal thoughts but you’re afraid of what comes next, this is for you.

Am I alone?

First, thank you for even thinking of sharing these feelings with your therapist. Suicidal ideation can be a very isolating experience, but you are far from alone. The American Foundation for Suicide Prevention found that suicide is the 11th leading cause of death in the US. In 2023, an estimated 1.5 million suicide attempts were made and 50,000 Americans died by suicide. These statistics are heartbreaking, but hopefully they can offer one small piece of encouragement: you are not the only one who feels this way.

What’s going to happen in the session?

If you let your therapist know you’re struggling with suicidal thoughts, their first step should be to help you assess your safety level. They may ask you questions such as “How often do you have these thoughts?” “Have you ever thought of a way you may hurt yourself?” “Do you feel like you can keep yourself safe?” Oftentimes, the next step is to develop a safety plan–writing down resources and coping strategies you can use when these thoughts come up. If your thoughts are really loud and you don’t think you can keep yourself safe, your therapist will help connect you with local emergency services.

You may fear that bringing up suicidal thoughts will fundamentally change your relationship with your therapist. Here’s the truth: we understand that so many people experience suicidal ideation, and we want to work through that with you. It is possible that your therapist will guide you to a higher level of care–more frequent and supportive treatment–until you feel ready to be back in outpatient therapy. Suicidality can feel like a big and scary concept, but it’s something your therapist is trained to help you through.

Where else can I turn for help?

• If you’re experiencing immediate thoughts of harming yourself, please call the suicide and crisis hotline at 988.
• Your local emergency room is always a good option if your suicidal thoughts sound loud–they can do a mental health triage and help you access extra support.
• The Trevor Project is a resource for LGBTQ youth who are struggling with self-harming thoughts.
• Text 838255 for the Veterans Crisis Line.

What if I’m still scared?

If you’ve had a negative experience bringing up suicidal thoughts to a mental healthcare worker in the past, it can be terrifying to try again. With all the courage it takes, please reach out again for help. You deserve to find care that helps you find hope again. The journey through suicidal thoughts can be long and twisty, but there is a therapist waiting to walk along that path with you.

If you or someone you know is struggling with suicidal thoughts, please do not hesitate to call 988 in an emergency or reach out to us at Optimum Joy for therapy.