Trigger warning: This piece contains mentions of suicide and suicidal thoughts.
Having suicidal thoughts can feel scary, and while talking about these thoughts can help, taking the first step can sometimes add another layer of fear. Even with a trusted therapist, common misconceptions about suicidal ideation can make it difficult to disclose this information or cause severe anxiety. The fear that a therapist might suggest hospitalization can often be enough to stop a person from opening up, even if talking would relieve some of the pain.
According to experts, however, suicidal thoughts are surprisingly common among those living with depression and anxiety, navigating grief, or working through an emotional rough patch, and rarely require immediate in-patient care. And while fears of being institutionalized or involuntarily “locked up” can still be difficult to overcome, experts also told Allure these myths don’t paint an accurate picture of what it’s like to talk to a therapist about suicidal thoughts, or how these conversations often go.
Suicidal Ideation and Stigma
“Unfortunately there's a lot of stigma around suicidal ideation,” says Seth J. Gillihan, a clinical assistant professor of psychology in the psychiatry department at the University of Pennsylvania, author of The CBT Deck: 101 Practices to Improve Thoughts, Be in the Moment & Take Action in Your Life, and coauthor of A Mindful Year: 365 Ways to Find Connection and the Sacred in Everyday Life. “I've definitely found in my clinical work that many people are reluctant to bring it up and will refer to it obliquely, hoping to convey their experience without saying something they think will cause me to have them committed to an inpatient facility.” According to Gillihan, this is a common misunderstanding among clients experiencing suicidal thoughts, but there’s no reason to worry. “Trained professionals know that simply having suicidal thoughts is not a reason to have a person committed to the hospital.”
Gillihan explains that suicidal thoughts might come up during episodes of depression or periods of severe stress and anxiety, and they look different for different people. For some, suicidal thoughts might feel like a dull, persistent hum, which can still be distressing but don’t necessitate immediate intervention or alarm. “Many people continue to function with some degree of suicidal thoughts and feelings, with a low enough risk that hospitalization is not only not needed but would be counterproductive.”
How to Talk to a Therapist About These Thoughts
The best way to begin a discussion about these thoughts with a therapist is to just be as straightforward as possible. “Personally, I'd find it more concerning if a person were evasive about what their thoughts have been, versus someone who says, ‘To be honest, I've thought that maybe I should end it all. I don't plan to, and I have a lot of reasons to live, but that thought does come to mind,’” he explains.
If you’re still worried about talking bluntly with your therapist about your own suicidal thoughts, you can start by talking about why the topic gives you such pause. “It can be helpful to start by discussing with them any concerns you have about speaking openly about suicide in order to give the therapist an opportunity to share with you how they see the two of you working on this together,” adds Doreen Marshall, VP of programs at the American Foundation for Suicide Prevention (who also has a Ph.D. in psychology). “The therapist will want to know more about the thoughts you are having — how specific, frequent, and intense they may be, what preceded them, and whether you’ve ever taken any action on those thoughts.”
Deborah Serani, a senior professor at Adelphi University who also serves as a disaster mental health specialist for the American Red Cross, tells Allure that many therapists may already sense that a client is struggling with suicidal thoughts and will likely respond with compassion and curiosity. Suicidal ideation exists on a spectrum, and a good therapist will want to know the full story. “When someone comes in and shares that he or she may be feeling suicidal urges, there is much to explore,” Serani says. “Remember that you and your therapist are there for the same goal — to help you feel better and lead a meaningful life. What you share with your therapist isn't going to scare them or shock them.”
What Happens Next
When a client discloses suicidal thoughts, mental health practitioners will typically assess the intensity of these thoughts before suggesting further treatment options. “A therapist will begin with a gentle detailed inquiry, and based on the shared disclosures, will determine with you what is the best treatment approach to deal with suicidal thinking,” explains Serani. Usually, there’s a lot that therapists can do to help. “If a person shares that they have no plan or intent, or that the thoughts come and go, increasing treatment sessions to twice or three times a week will reduce thoughts and urges and address depressive symptoms,” she says. Additionally, she tells Allure that if the person is taking medication (including antidepressants), an increase in dosage may be discussed to reduce mild to moderate suicidal thinking.
If passing suicidal thoughts become more intrusive, frequent, or are accompanied by a specific plan, it’s important to share this with a therapist as well. “Phrases like ‘I don't want to live anymore,’ ‘I wish I could just sleep forever,’ ‘Everyone would be better without me,’ or ‘I feel like I can't do this anymore’ are urgent and need clarification with a mental health specialist,” says Serani. “The best way is to be open and honest.”
A therapist might suggest further intervention if a client poses an imminent risk of harming themselves or others, but involuntary hospitalization isn’t necessarily required or helpful. More commonly, a therapist will help their client create a safety plan for how to deal with suicidal thoughts based on how severe they are when they come up, and how to address the factors that led to suicidal thoughts in the first place.
“Feeling you can't control your thoughts or feelings is a very scary thing. When you begin to realize that self-destructive thoughts are plaguing you, you feel helpless, and wanting to share this with others is actually very good,” explains Serani. “When you get proper care, you can recover and find good health again.”
Opening Up to Friends and Family
Sharing this information with friends, family, or a partner can also help you feel supported during particularly tough times, though it might not be helpful for everyone. “Keep in mind that loved ones might have a strong reaction to hearing statements like, ‘I've been thinking of ending my life,’” says Gillian. “That statement can mean so many things, all along that range of risk, from having passive thoughts to making a specific plan. So be as clear as you can about your experience.”
If you do talk to your friends and loved ones about your thoughts, it can be helpful to try to do so for the first time during a moment when you feel you’re both up to the conversation. It can also be helpful to be clear about what kind of support helps you, whether it’s loving words of affirmation, space, or something in between — but also be aware that the person you’re talking to may be dealing with things you’re not aware of as well, and be open to the idea they might not have as much support to offer as what you need. Talking about mental health with loved ones can be difficult and is best approached with as much love and understanding as possible.
Continuing the Conversation
Talking about suicidal thoughts takes incredible courage, and sharing this with a therapist can mark an important step toward feeling better. “People may not understand that suicide, at its core, is a health issue. Myths about the causes of suicide — for example, believing that it is a matter of will or a cry for attention — only further isolate and cause shame to those who are struggling,” explains Marshall. “The more we understand suicide as a health issue that can benefit from treatment — just like other health issues — the less likely those who struggle will do so in silence and without getting the help they need.”
No one should have to suffer silently, or fear rejection when they’re struggling the most. “It's a very brave moment when you let another person know you are in pain and distress, and therapists want to help,” Serani says. “That's what we are: helpers.”
If you or someone you know is struggling with suicidal thoughts, reach out to the National Suicide Prevention Hotline at 800-273-8255.
Read more stories about mental health:
- The Reality of Navigating the Mental Health System as a Black Woman
- The Complicated Benefits of Coming Out
- 9 Things You Should Know About Borderline Personality Disorder, From Someone Who Has It
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