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
The last therapist I went to asked me at one point what I would do if I thought my physical health problems could not be resolved. I said: I don’t think I could go on.
She didn’t follow up on that. I didn’t mind though (not that she wasn’t a terrible therapist, in general). It might be “irresponsible” on her part, but I wouldn’t have been completely honest in answering follow-up question anyway; and I still don’t accept the “responsibility” of therapists to involuntarily commit someone for seriously considering suicide. (Stacey keeps emphasizing that it’s not a crime, but it’s treated like one. In fact, the non-law against suicide is enforced much more harshly than many actual laws.)
I finally had the courage to tell my therapist that I always had a plan. She was disappointed and said that I had been dishonest. The truth is that I was scared that she would have me hospitalized against my will. In addition, she no longer believed me when I told her I was having ideations with no intent to self harm. She did recommend that I go to the ER for an evaluation. When I refused, she gave me two options: (1) have my spouse escort me to the ER; or, (2) she could file an emergency petition for evaluation. I agreed to #1 but ended up leaving the office before spouse arrived so therapist had no choice but to implement #2. I do think she overreacted. However, had I been in her shoes I most likely would have done the same thing.
Needless to say I was upset. I made a stupid, impulsive decision that I truly regret. I was impulsive, angry, hurt and through this pain terminated our relationship. I told her this but she now says she no longer has an available time slot.
I’m a lucky one. I found a therapist who doesn’t shame me, doesn’t guilt me, accepts my feelings for what they are, and yes, I’ve talked with her many times about suicide. She is against ”forced hospitalization” for people who talk about suicide. Now I’m sure if I told her I was going home and swallowing every pill in the house she would do something. But I’ve been able to talk about methods with her. And when I’m not suicidal, and when the thoughts begin to cloud my mind again. She knows my full story and the multiple traumas I have been through the last few years. Instead of guilt or shaming me she tells me anyone in my position would feel how I feel.
When you’re suicidal you figure you must be ”crazy” (a word I seriously dislike) so someone telling me what I feel is normal, I have a right to feel this way, and she will help me no matter is what has kept me alive. And helps me to keep trying.
I tend to be very introverted. (It’s become more extreme due to the chronic health issues.) I think being forced into a situation where I was under anyone’s watchful eye 24 hours a day, would push me over the edge. I also would be extremely angry with anyone who had me involuntarily committed, and quite possibly would take revenge once I got out.
Rudy,
Your comment captures a couple of the critiques I’ve read and heard of involuntary hospitalization. And there are many others.
Although I view involuntary hospitalization as something to be avoided in all but the most extreme circumstances, I do want to point out that some people do emerge from it without anger or trauma. Some* people even experience gratitude about having been protected from doing harm to themselves, especially those who were in a florid psychotic state when they were hospitalized. But there are many people who feel traumatized, so much so that a few researchers investigate what they call “hospital-related PTSD.” (For example, see Trauma in Relation to Psychosis and Hospital Experiences, by Katherine Berry and colleagues.)
As before, with your previous comment, I appreciate your comments.
Yes I truly understand. As someone who is very introverted and sensitive and does not like doctors to begin with I was with my psychiatrist who I trusted and was not suicidal but just got a little upset because I had tried a lot of meds and was getting frustrated. The next thing I know he leaves the room and says it’s done. In a few minutes the police and ambulance arrive and in front of the clinic staff. I panic. They coerce me onto the gurney and I am taken to a well known hospital where I had worked and had attended IOP several times in the past. I am put in the psych ER. The purple pod. A special part of the ER for psych patients which is an absolute zoo with screaming people and police some who make fun of the patients. I am literally scared to death. I am admitted and yet told by some members of the staff. “Hope you have enough money to pay for being here”. Once on the ward I am taunted by patients who threaten to stick pencils in my ears and another roommate who claims to be the devil and will torture me. A woman draws a pornographic picture and gives it to me. I never suffered from hallucinations before and these were not. I am also visited by a former coworker who I did not want to see who “heard” I was there. What happened to confidentiality? I was there for several weeks and did not sleep. I became a nervous wreak and only became extremely suicidal after that admission. If I hear sirens or see an ambulance or police even on TV I panic. There is more but I can’t write anymore. It is too upsetting. I am a 64 yo professional adult who now is afraid to leave my house or drive. I have struggled with emotional issues beginning as a teenager but with various therapies and meds and sometimes without meds have struggled through life sometimes barely coping. Enough. I am tired yet can’t rest or relax. I never feel safe.
Anonymous,
I’m so sorry that happened to you. There are trauma therapies, such as EMDR, that might help you to heal from your experience, but I understand that, at least now, it might seem incomprehensible to trust a mental health professional again. Not everyone overreacts, I promise.
Your account of what happened to you is very compelling, well written, and painful. It could be useful for others to learn from. The site MadinAmerica.com publishes personal accounts, and if you’re interested in pursuing that, here’s the link: https://www.madinamerica.com/submitting-personal-stories/.
Thank you for sharing here, and I hope for you to feel safe again soon.
I too had something like this happen. Here’s a bit of my story;
I found out my husband of 40 yrs has cheated several times during our marriage. In an argument where HE had been drinking he wanted to leave by driving the car. I stood in front of the vehicle and refused to let him leave. He wrestled with me so I called the police
To make a long story a bit shorter… the police took me to the psych ward and said I was suicidal ( because I stood in front of a car with a drunk driver) Here’s the funny part… they let him drive away as they took ME in.
I had to go through intense questions regarding my thoughts, behaviors and how I should have handled it differently.
I CALLED FOR HELP!
I was released and needed to go to a psychologist on a weekly basis.
She made me feel like I was nuts. I will never be the same after this. It was terrible being in there for 10 days. I AM still married but very very unhappy and very angry towards him for a lifetime of lies and cheating which resulted in my being incarcerated… I use that word because that’s exactly how it felt to me.
Anyone looking for help dig deep into the right doctor. My doctor refused to see me anymore. Just said she couldn’t help me. I just never understood this. Maybe she lacked the education it took to help me
Agree, Rudy.
This is a real dilemma for me. I have felt suicidal off and on for many years now and have possibly come close to making that decision in a few cases. (I think it’s difficult to “know” how close one has actually come. There are times when it’s as if my brain has simply re-set itself, as if a decision against suicide has been made on some deeper, instinctual level.) I have recently dabbled with therapy for the first time in a couple decades at least. I have been very cautious about letting any therapist know how suicidal (plans, means, etc.) I have actually been at times. I always downplay how bad things are, or how bad things have been in the past. I am afraid of being involuntarily committed (however temporarily). I am also unwilling to go on psychiatric medications. My suicidal tendencies are driven by ongoing physical health problems (but there is also a lot of unrelated, unresolved pain related to my past, which does not help). Suicide’s illegality casts a long shadow on the therapeutic relationship, subverting client trust.
Rudy,
It sounds like you have a lot of insight into your suicidal thoughts. Talking about past experiences with suicidal thoughts, urges, and behaviors would be a good way to get a feel for a therapist’s stance, because there is no justification for panic when the situation is in the past.
I do want to point out what might seem like hair-splitting, but suicide’s not actually illegal. The challenge, in terms of the threat to therapeutic trust and confidentiality, is that society expects, allows, and in a few jurisdictions mandates therapists to protect someone who appears to be in imminent danger of suicide. That said, Thomas Szasz argued that suicidality is treated as a crime, with involuntary hospitalization being the punishment.
I hope that you are able to learn how your therapist would react if in the future you are suicidal, and that their stance fits with your needs.
Thanks for joining the conversation!
I can’t understand why you think suicide is illegal? It’s above all laws. Anyway, if you’re still alive you should consider meds. If you had diabetes or a sinus infection you would use meds. Our minds get sick too.