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
You cannot avoid damaging your step son if you step out of this life. He’ll carry it with him forever as well as strangers and acquaintances that you may never know who care. That’s a fact, there’s no sugarcoating it and there is no letter after the fact that will either. You are not alone in your feelings. You are not alone in having no family or an unloving one and having no friends. Many are in the same boat with you my friend and are. still paddling having had multiple traumas that continue in this life. Don’t give up, reach out for help. If that person doesn’t help, keep trying until you find someone who will. This life is difficult. Anyone who tells you different is just hiding their own pain. Distract yourself with the beauty of nature even if only on youtube, read encouraging books, write quotes that help on your bathroom mirror, take a walk anywhere every time you feel the edge of despair nearing. Be the person that beats the odds and is a beacon of hope to others. I’m rooting for you Bryan. If a therapist can’t deal with suicidal ideation, they are in the wrong because that’s what we become therapists for. Find one that will weather the storm with you. You hold on, hope is on its way.
I am in real danger of committing suicide. And can think of no good reason not to. I don’t see a light at the end of this dark tunnel. My family had rejected me and i have no friends. All i know right now is im afraid that my essentially step son might have potentially long lasting effects, mentally if i do it. So how can i avoid that. Can i leave him a note explaining that i don’t want him to hurt or feel bad about it. What can i do???
A friend of mine has been struggling with her depression a lot lately, so she is considering going to a therapist soon. I like your point about choosing a therapist that is willing to talk about suicide. I think she would want to openly talk about this with someone so I’ll be sure that she finds someone who doesn’t panic during these talks.
Derek,
She’s lucky to have you give her that advice. Many people do not consider that the therapist they talk to about suicidal thoughts might overreact.
Caution: Be careful when seeking a therapist through the Psychology Today website. They do not thoroughly screen providers.
My brother holds a doctorate in counseling but is a registered sex offender and so is not licensed. Psychology Today listed him a a Verified Provider. Every time I contact PT to have his (mulitple) listings removed, he just turns around and opens up a new listings with them.
Throw enough money at Psychology Today, and they will list anyone.
I feel like I can help someone understand ones urge to cease existing. It isn’t ugly. it’s a feeling our surroundings will be unaffected by our absence. Unaffected. Even grief dulls with time and our negativity, once gone, won’t plague our loved ones. I fell in love with Jesus Christ as a child. The fact that He was dead was so comforting to me. The urge to be gone is not a reaction to anything. NOTHING. Nothing. It’s just the thought of being not here is so smooth.