A huge fear of many people who think about suicide is that they will go to a therapist who panics at the mention of the word “suicide.” Some therapists do, in fact, panic. This can take several forms.
A panicky therapist may all too quickly recommend psychiatric hospitalization, even when it is not really necessary. (Suicidal ideation alone is not reason enough for a person to be hospitalized. In fact, it is very difficult to be admitted to a psychiatric hospital these days, even if you are thinking of suicide!)
Some therapists get angry with a client who attempts suicide. Some even stop working with the client altogether. The therapist may say that the therapy obviously is not helping, and therefore the client needs a new therapist.
Finally, some therapists simply choose not to take on new clients who are suicidal. I worked at a telephone counseling line for several years, and I was shocked by how many therapists listed in our referral database had checked “no” when asked if they would accept new clients who were thinking of suicide or had recently made an attempt.
When people finally admit that they need help from a mental health professional, the last thing they need is rejection. And rejection from a mental health professional is probably the last thing they expect.
Finding a Therapist Who Doesn’t Panic about Suicidal Thoughts
There are ways to figure out if a therapist is one who will shy away from treating suicidal clients or overreact when they do. Here are some tips about areas to look out for:
Therapist’s Focus
Look for a therapist who states that suicidal crises are an area that they treat. Therapist-finder sites like Psychology Today, HelpPRO, and GoodTherapy.org allow therapists to list the problem areas in which they have expertise. If a therapist has not checked off the site’s category for suicidal thoughts, then the therapist may lack the experience, education, or interest necessary to work with suicidal clients.
Therapist’s Acceptance of Suicidal Clients
When you call to make an appointment, ask if they accept clients in a suicidal crisis. If the therapist immediately says “no,” then you are spared the heartache of going for an appointment, sharing exquisitely personal information about yourself, and being turned away afterward.
Even if the therapist says they accept suicidal clients as new clients, still pay special attention to their response. Do they qualify in any way their willingness to work with suicidal clients?
Therapist’s Training in Suicide Prevention
You might ask what training they have received on assessing a client’s risk for suicide and working with suicidal clients. Most graduate school programs do not require training in suicide assessment or intervention, and most therapists report having received scant, if any, training in the area.
Therapist’s Ability to Talk Openly about Suicide
In early sessions, make note of whether your therapist asks you about any possible suicidal thoughts – or, if you have already brought up the topic, whether they delve more deeply into your thoughts of suicide. Some therapists avoid bringing up suicide, out of fear that it will give clients the idea. Others may have personal experiences or attitudes about suicide that make them hesitate to introduce the topic. Also, be alert to whether the therapist openly addresses suicide or uses vague euphemisms like “hurt yourself” or “harm yourself.” (Self-harm might include suicide, but many people who harm themselves aren’t suicidal, and many people who are suicidal don’t view suicide as harming themselves.)
Therapist’s Ability to Listen Fully about Suicide
Along with asking about your suicidal thoughts, a therapist needs to listen. Does your therapist give you the space to tell your story? Do they gain an understanding of why you think about dying by suicide, and why the thoughts may or may not make sense to you? Do they respond with empathy rather than advice or judgment?
Some therapists ask a mental checklist of questions to assess the risk that you will make an attempt. Those questions are important. Equally important, if not more important, is offering you the space to tell your story, to be heard, and to be understood.
Therapists who Specialize in Suicide Prevention
Keep in mind that there is a difference between a therapist who works with suicidal clients and a therapist who specializes in working with suicidal clients. A therapist can be competent, well trained, and experienced in working effectively with suicidal clients even if they don’t specialize in working with suicidal clients.
If you do seek a specialist in suicide prevention, look for someone who has published research or clinical articles about suicide, participated in suicide-related professional conferences, been trained in specialized approaches such as cognitive therapy for suicide prevention or CAMS (Collaborative Assessment and Management of Suicidality), undergone other specialized clinical training in suicide prevention, or some mix of these. Specialists also are likely to belong to a suicide-specific professional group such as the American Association of Suicidology or the International Association for Suicide Prevention.
In Closing
You will not really know how well a therapist will work with you in a suicidal crisis until you actually work with them. But these tips will help you find somebody who is committed to working with suicidal clients and who can work relatively comfortably with suicidal clients.
I say “relatively comfortably,” because even the most experienced psychotherapists feel some fear or discomfort when a client is in extreme danger of dying by suicide. Healthy concern for your safety is not the same as panic.
A Question for You
For those of you in therapy, how have you determined whether a therapist can talk openly, and listen fully, about suicide without overreacting?
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This post was updated on March 11, 2021.
© Copyright 2013 Stacey Freedenthal, PhD, LCSW, All Rights Reserved. Written for www.speakingofsuicide.com. Photos purchased from Fotolia.com
I don’t ever post comments. I guess it’s a fear of being “seen”. But I read through a number of comments, and each one sounded like me, in many ways. And as I read each one, the more I felt overwhelmed, and closer to my freak out/anxiety/overwhelm/panic attacks. I’ll need to think about the “why” of that, later…when I’m not in the middle of this headspace.
I found this link after doing some surfing through the subreddit group on suicide. The other day, when I first visited that subreddit, it was really because I imminently needed help. As with every time we find ourselves in one of the places our heads go, I don’t feel that way, today. I wanted to mention that because its the most potent tool I have, to talk me out of the bad places. Change is mandatory, in life. And because of that, just because I feel a certain way, today, doesn’t mean I’ll feel this way tomorrow, or next week, even next month, or year. I can realize that, and understand that the bad places my head goes aren’t permanent. I can survive this moment, just as it is. Because once its here, the next moment goes by and then it is gone. Its nice to know that, when you can’t tolerate these feelings any more.
I saw the subsequent replies from M, one didn’t seem answered. M, I hope you’re okay, today. I first was struck by your comment about being abandoned by your kids. My daughter hasn’t spoken to me in 3 years, and it does indeed feel as though I were abandoned. Thinking about it makes me have feelings I’m not sure I’m brave enough to feel. I say that, yet, obviously I have survived those feelings of heartbreak. But then, you mentioned packing up your car, with your insulin…and that took me for a loop, too. I’ve taken insulin for over three decades, and am familiar with the packing-up-of-it, including in the mode you mentioned. Again, I hope you’re okay. Just wanted to tell you that I have similar experiences, and you aren’t alone, there.
Then there was the person who commented how they’d been failed by their therapist…under Kaiser. I’m completely familiar with that, too. When I left them, I found out how they had documented copious notes of what I said…specifically, with the end result that indicated to my former practitioners that they needed to practice CYA. Amazing, learning my medical history had been altered, over time. Labwork changed. Practitioner notes. She let them know, and all of a sudden, EPIC’s MyChart was used to their advantage. I have to keep reminding myself of that…it’s way too easy for me to slip into a state of denial, and start waxing romantic about how I had the best team of practitioners I’d ever had, over there with them. Did they seem awesome? Sure. Were they? Not likely. So while I experienced injury the most from other healthcare received, outside of K, I’m sure the injuries still add up, when you look at K.
I was adding this site to a bookmark folder I’ve created:
Health/Mental Health/Toolbox
Because I haven’t felt as though I’ve had a decent toolbox for years. When I hit my lows, I’d like to have somewhere concrete I can turn. Create your own toolbox, add this and other tips in there. I wish you all well.
Lana,
I’m terribly sorry for the long delay in posting your comment. It got mixed in with literally hundreds of spam links, and I just now found it.
What you wrote is so powerful — both how you identify with many of the people here, and how you cope by reminding yourself that everything changes: “Change is mandatory, in life. And because of that, just because I feel a certain way, today, doesn’t mean I’ll feel this way tomorrow, or next week, even next month, or year. I can realize that, and understand that the bad places my head goes aren’t permanent. I can survive this moment, just as it is. Because once its here, the next moment goes by and then it is gone. Its nice to know that, when you can’t tolerate these feelings any more.”
I hope you see this message, and thanks for commenting here!
Thank you for your article. Suicide enters my thoughts daily and has been
scaring me.For the most part therapists have been open. But always seem to suggest hospitalization. My family situation has deteriorated since the death of my dear husband a few months ago.
I have five children. All married with families of their own.I don,t hear from most of them, ever. Is it possible for me to overcome this heartbreak?
Where do you suggest that I go for help?They have me blocked from communication, only one answers my calls.and he is getting annoyed.
Debbie,
That must be so painful for you to be alone and not have your children maintain contact with you. I extend my sympathies about your husband’s death, too.
I wonder, have you called a hotline or warmline? In the U.S., you can call 988 to reach an area hotline affiliated with the Suicide and Crisis Lifeline. And you can find a list of warmlines here: warmline.org/warmdir.html#directory The Lifeline operates 24/7. Warmlines tend to operate fewer hours but are a good option, too.
Also I wonder if you’re still in therapy. If so, I hope you’ll share with them the comment you posted here, so they can know how much you’re suffering and better help you.
Thanks for sharing here, and I’m hoping things get at least a little better for you soon.
I am an attempt survivor and have had the no-fun experience of trying to find a therapist who doesn’t panic over SI a couple times now. I just recently moved to a different state and at it again. I just had my first experience of what you described as rejection. Before, I’ve done the rejecting. I ask them how they handle suicidality. The worst response I’ve had was, “I call the police and wait with you while they arrive to transport you.” I told her that was an inappropriate response near the end of the appointment and I wouldn’t be returning.
This time though I asked and they passed and said it’s case by case, etc. Still, once she found out I had attempted twice, the most recent not too long ago, all of the sudden she no longer had any availability. “I’ll have to check my calendar – my current patients come first and it depends on their needs.” It was a very hurtful rejection. As someone who struggles with feeling permanently broken, not worthy, and never going to be rid of those feelings, it sent me pretty low. I find it unconscionable how some therapists act towards suicidal people.
I found this site by accident. I live in Denver CO. As I write this, I expect an ambulance to be sent to get me. Suicide attempt May 2022, called 911 on myself, screaming for help and for the pain to stop. My inusrance, KPermanente does not do therapy, they do IOP or meds. I begged for tools to help me cope with my new life. Got none. Months later, my PDP has stayed with me & counsels me, I thought that was great but he said to trust him and tell him my thoughsts. I did and he put it all in notes which in KP go to everyone. I cling to him more than I should & it leaves me in a delicate place, and i now know he is a doctor only, not my friend so his concern is not for me personally as a friend. That is the problem, I am in this depression because the death of my husband and brother right before Christmas triggered something to got me depressed. They were the only people left in my life who were part of my circle/my support group in life. So, I am what is called now an orphaned baby boomer. I am not progressing as fast aa they want me to & I am told I can be forced into a facility and medicated. I just wanted someone to teach me how to do this, I am smart & will learn. Problem is when you are alone, you have NO support that is safe…no one to hold you, listen to you w/o judging, no love, no human touch, so I am isolated and not thriving. Yes, I do the finding a church, go to the senior center to work out, etc but it is cold and empty & I can’t deal with this severe loneliness because no matter what I do or comply with , none of that will give me at 68 yo a support base again, and I have chronic progressive condtions that make me feel more vulnerable. So, yesterday I vented a bit to my doctor, I cried again and now he does not call me, respond to my emails, he said I should be further along. I am terrified of being put away, my little house is all I have for independence…I do my own shopping/cleaning & finances. I am feeling very adrift without my family/2 best girlfriends to love me. Since 2000 i have lost 17 people, including 3 husbands. I think I have a right to traumatized a bit. I was a volunteer for elderly (the most vulnerable) and hospice for 35 yrs. Crossed some of people over, watched all die. Now, I sit here without my doc to talk to me and now more scared than ever. What got my doc mad was I mentioned assisted suicide and he was not happy, I got in trouble for talking about it. I want to pack my car, insulin and meds and just leave the state…just drive til I can’t do it anymore, at least I would be free. No relatives to go to, no family. I am not a criminal, won’t hurt anyone and yet I feel shamed and judged with no love.
I’m reading this now and don’t really know what to say. I hope you’re still here with us. But I understand if you no longer are and I respect your decision. I cant imagine living the life you live and yet I know one day I will, and it’s terrifying so I can understand why you feel the way you do.
V,
Thanks for commenting here and offering support and empathy! I’m often overwhelmed by the volume of comments the site receives (10,000 and counting, not including thousands of spam comments every month). I regret not being able to reply to them all, and I especially regret not reading M’s fully until you left your comment here. Thanks for bringing hers to my attention. And I hope you’re able to challenge your certainty about the life you’ll live in the future, because for now, do you know it’s true? Then again, even if you can’t know, those are your fears, and they’re painful. Thanks for sharing them here.
M,
I’m so sorry. You left this comment six weeks ago, and the comment by V brought it to my attention. I read every comment before posting because some comments aren’t fit for publication, but sometimes I skim — and I’ll never do that again, based on what happened here! You wrote here because you felt so alone and hopeless, and I can only imagine how it felt not to get a reply for six weeks.
I hope you’re still here with us, and I hope you’ve gotten help that feels safe and is truly helpful. And thank you for sharing here.
I cant take it anymore and swallowed what i thought would kill me. It didnt now im more lost
Robin,
I’m sorry you’re hurting so badly that you tried to kill yourself. I really hope you’ll get some kind of help. Have you tried at least talking with someone at the National Suicide Prevention Lifeline? They’re reachable at by calling 988 if you’re in the U.S. I also list resources at http://www.speakingofsuicide.com/resources/#immediatehelp. Also, please see my post Are You Thinking of Killing Yourself?
I am sitting here feeling alone and I want to pack up my car and drive away. My doctor saw me yesterday, he is my PCP who is trying to counsel me on my past suicide attempt in May, I called 911 on myself. I have a team thru my Kaiser insurance, but psychiatrist won’t work with me unless I take several meds and the therapist won’t work w me because I won’t do IOP. I begged for tools, help me to cope with this new life I have…therapists in the past have give me great help with tools & I thrived my whole adult life with depression, worked it and beat it each time. But, I had a life back then, a full life with a great circle of people for support. I found out that my PCP is NOT my friend, only my doctor…so when I open to him it goes into notes and the others read and make notes, I am informed I am NOT healing as fast as I should be. I am labeled as bad for non-compliance, and many other “bad pt” adjectives. No, I don’t want to be medicated, tried in past and my therapist took me off them because they did not help, made it worse and therapy always worked. . Now I totally alone, isolated and scared now they will come for me. Since my appt w my PcP yesterday he has not retuned my emails. Problem is my PCP is the only person I know now, my trauma that triggered me was losing my husband and brother right before this last Christmas and they were the last of my family /circle in my life. Bang, I wake up from taking husband off life support and realize I am 68, chronic progressive conditons and now am what is called an orphaned baby boomer who only has her PCP left whose face I know. I lost 17 ppl since 2000, including 3 husbands, parents, brothers and my 2 BFF’s. Crossed some of them over, I volunteered with hospice for yrs and with elderly lonely ppl for 35 yrs. I want to pack my car up and leave, will not be put back in that psych facility again, the one I was in for my May suicide attempt broke me, it was harsh / violent / scary and shameful…no help at all, no love, no one glad you lived, only that I can’t even get a suicide right…loser, failure etc. I want to go before they admit me involuntarily. I harm no one, independent and go to the senior center, volunteer on the phone with lonely elders. I just keep crying and they don’t like my emotions. THEY go home to wives, family, dogs…they get hugs / support / love/ NO judging….I don’t have that, and it is breaking me more and more….I have material needs, but NO love, NO hugs. Just want to vent, I know I am a mess, but I am not a criminal, and I would like to see these docs survive better with losing their worlds. I am terrified of all of this.