What will happen if I tell my therapist I feel suicidal?

[BlueSkiesAhead]

I have my first face to face therapy session in a couple of weeks (I have had a few phone appts up to this point).

Over the last couple of months I have been struggling with suicidal thoughts. Sometimes it’s a fleeting thought and other times like today it’s pretty constant and I have to work really hard to ignore them and not act on them.

Yesterday I was struggling and the only think that helped was to self harm. After I had done that the thoughts went away for a little while, well until now. I also a couple of weeks ago was taking painkillers for pain and I took a few extra ones. It was in no way a dangerous amount but I don’t really know why I did that.

It’s hard to explain but sometimes I really want to do it. Like in my head I want to do it and it seems like a good idea - the thoughts are all consuming. I want everything to stop, I don’t see anything getting any better and I’m scared that nothing will change. The only reason I don’t do it is family because it would hurt them. If I didn’t have family I wouldn’t be here still but I don’t know if that will always be enough.

I have filled out risk assessments and depression questionnaires at past phone consultations so the therapist is aware I have thoughts of being better off dead etc but we haven’t spoken about it further.

I’m so conflicted on what I want to do. I know I should talk to him about it so he knows exactly what’s going on but I also don’t want to say something I can’t take back and then things will be out of my control.

I have been hospitalised in the past after a suicide attempt but that was years ago now. I guess I want him to help me stop the thoughts but I don’t want to end up going to hospital etc.

I’m also worried that he might then say he can’t see me any more and will have to refer me or something.

Does anyone have any advice on how to approach this topic or would mind sharing what happened (good and bad) when you spoke to your therapist about feeling suicidal?

 

[Innordinate]

I guess I want him to help me stop the thoughts but I don’t want to end up going to hospital etc.

then tell him that.

he'll probably ask you if you have active plans. If you think you're a risk to yourself.
Just answer honestly. Would going to the hospital if you are at risk be such a bad thing anyways?

I've had this go three ways.
1) I've been put on outpatient therapy/groups.
2) Once I went in and said I didn't trust myself and felt I was a danger, so basically volunteered, asked to go to the hospital.
3) And other times I've been certified and hospitalized - but these were when i was beyond dysregulated and had already been in the ER two or three times for mental health problems within a weeks time.

You don't sound out of control so chances are he might ask if you want to go to the hospital but probably won't make you.

worried that he might then say he can’t see me any more and will have to refer me or something.

This is unlikely to happen. Suicidal patients are pretty much part of the job description. If he does want to refer you to someone else it's probably because he realizes you might need a specialized therapy. Which, would probably also be a good thing, but doesn't mean you can't also work with him right.

How to approach it?
I would start off with it, when you first get there.
I don't know what your t does but mine always says "what's new" or "whats up" when I walk through the door.
So if this was me I would say "I'm starting to feel like I can't do this anymore. That I should end my life. I want help getting past these thoughts" something like that.
Maybe write down your thoughts on it now, before t, so you can keep it a straighforward conversation? But honesty is the biggest thing.

 

[flowerapple]

For me, I found that describing exactly how I've been thinking and feeling about suicide was helpful. Like for me, I would make clear to them the difference between me feeling suicidal like I cannot go on anymore and me actually having the intention of committing suicide. Thinking that you are tired and not wanting to be here and thinking that you would be better off dead is different from me having a plan about how I would go about doing it.

Your therapist will most likely try to determine the risk and level of danger you pose to yourself, and work with you to develop a plan for if you ever get to the point of wanting to do it. Try to be as open and honest as possible.

I had the same worries about speaking to my therapist about suicide and how I feel. I actually called the suicide hotline for help on how to go about doing it. They have tips that might be helpful, and maybe you could actually call them as practice for when you go to your therapist. Try telling them first and explaining it to them, and see how you feel after that, and maybe they might even give you some tips on how to talk about it, and then you could work from that.

 

[BlueSkiesAhead]

then tell him that.

he'll probably ask you if you have active plans. If you think you're a risk to yourself.
Just answer honestly. Would going to the hospital if you are at risk be such a bad thing anyways?

I've had this go three ways.
1) I've been put on outpatient therapy/groups.
2) Once I went in and said I didn't trust myself and felt I was a danger, so basically volunteered, asked to go to the hospital.
3) And other times I've been certified and hospitalized - but these were when i was beyond dysregulated and had already been in the ER two or three times for mental health problems within a weeks time.

You don't sound out of control so chances are he might ask if you want to go to the hospital but probably won't make you.



This is unlikely to happen. Suicidal patients are pretty much part of the job description. If he does want to refer you to someone else it's probably because he realizes you might need a specialized therapy. Which, would probably also be a good thing, but doesn't mean you can't also work with him right.

How to approach it?
I would start off with it, when you first get there.
I don't know what your t does but mine always says "what's new" or "whats up" when I walk through the door.
So if this was me I would say "I'm starting to feel like I can't do this anymore. That I should end my life. I want help getting past these thoughts" something like that.
Maybe write down your thoughts on it now, before t, so you can keep it a straighforward conversation? But honesty is the biggest thing.

Thank you for replying and sharing your experience, it’s really helpful to get another perspective. Writing it down might be a good idea actually as then if I’m struggling I can just hand over what I wrote.

When I was in hospital last time it didn’t help plus I have really bad social anxiety and the thought of being stuck with loads of people I don’t know is horrible.

I don’t feel out of control on a whole but today for example has been really hard with thoughts. And when I have the thoughts I do feel a bit out of my control then because I’m those moments I do want to do it. Like now I keep thinking okay just take two boxes of tablets and see what happens (I have a few). I don’t know where the thoughts come from or why they seem to be so relentless sometimes and fleeting others but I find the difficult to deal with.

Only another week and a bit and I will hopefully be able to talk to the therapist about them.

 

[Fadeaway]

I have found the best way to approach it if I feel safe is to say, "I am not going to act on it, but I am having unwanted thoughts about wanting to die."

By saying you aren't going to act on it first, it reassures them that you are keeping yourself safe. Now, if you are planning on acting on it, please ignore this advice.

Letting them know the thoughts are unwanted also helps reassure them and helps them identify the fact they are intrusive thoughts, not a deep seated desire.

You don't want to needlessly go to the hospital if managing intrusive thoughts is the issue. Which seems to be the case here.


Side note, I just figured out I could edit!

 

[BlueSkiesAhead]

For me, I found that describing exactly how I've been thinking and feeling about suicide was helpful. Like for me, I would make clear to them the difference between me feeling suicidal like I cannot go on anymore and me actually having the intention of committing suicide. Thinking that you are tired and not wanting to be here and thinking that you would be better off dead is different from me having a plan about how I would go about doing it.

Your therapist will most likely try to determine the risk and level of danger you pose to yourself, and work with you to develop a plan for if you ever get to the point of wanting to do it. Try to be as open and honest as possible.

I had the same worries about speaking to my therapist about suicide and how I feel. I actually called the suicide hotline for help on how to go about doing it. They have tips that might be helpful, and maybe you could actually call them as practice for when you go to your therapist. Try telling them first and explaining it to them, and see how you feel after that, and maybe they might even give you some tips on how to talk about it, and then you could work from that.

Thanks for replying and sharing your experience I really appreciate it.

See I’m confused about it and where I would fall on that as I do want to do it sometimes especially when I’m stuck with suicidal thoughts running through my head. I don’t have a plan such as a date but it would be more on an impulse when I’m struggling with the thoughts. I do have the means also but when I’m not struggling with the thoughts it feels like more of a backup plan. In the thick of it I do want to do it and I struggle to rationalise and not do it. The last few times it has gotten this bad I have self harmed which helped ease the thoughts for a little while but I know that’s also not a good coping strategy in the long run but it helps.

That’s a good idea about the hotline I might try but I have horrible social anxiety and struggle to talk to people I don’t know etc. I hope you have managed to speak to your therapist and they have helped Witt how you’re feeling.

 

[BlueSkiesAhead]

I have found the best way to approach it if I feel safe is to say, "I am not going to act on it, but I am having unwanted thoughts about wanting to die."

By saying you aren't going to act on it first, it reassures them that you are keeping yourself safe. Now, if you are planning on acting on it, please ignore this advice.

Letting them know the thoughts are unwanted also helps reassure them and helps them identify the fact they are intrusive thoughts, not a deep seated desire.

You don't want to needlessly go to the hospital if managing intrusive thoughts is the issue. Which seems to be the case here.


Side note, I just figured out I could edit!

Thank you for taking the time to reply what you have said about mentioning unwanted thoughts is really helpful.

I don’t actively seek out these thoughts at least I don’t think I do, I could be watching tv and then they’re there and I can’t get rid of them. But they can be pretty relentless and hard to ignore.

Yes I really don’t want to go to hospital i just want to not keep feeling like this and thinking about suicide. I get a horrible feeling like impending doom in my chest when the thoughts are bad and anxiety, it’s not great. Hopefully if I manage to speak to the therapist he will be able to help with some coping skills that help.

 

[flowerapple]

See I’m confused about it and where I would fall on that as I do want to do it sometimes especially when I’m stuck with suicidal thoughts running through my head. I don’t have a plan such as a date but it would be more on an impulse when I’m struggling with the thoughts. I do have the means also but when I’m not struggling with the thoughts it feels like more of a backup plan.

I guess it might be good to talk about what it is that stops you from doing it when you do have these thoughts and feelings.

Also, I often would say that I can easily come up with ways to
do it, after all I've done it before. But still I have not decided on one specific way as my plan. For me, I don't think it's hard to come up with ways to do it, but it's about which one I would want to do, and when, and things like that.

For the impulse thing, I found the 24 hour rule helps, because a lot of the times it is more of an impulsive thing when things get too much and I don't feel I can go on much longer. So waiting 24 hours for any change in my feelings, and even the slightest positive change or improvement, means I would have to start over the 24-hour clock.

 

[Fadeaway]

It really sounds like you are struggling with intrusive thoughts and not actual suicidal ideation.

The impending doom feeling says alot. That is such a horrible feeling. So sorry you experience this.

 

[EveHarrington]

You could see if the therapist will contract for safety with you.

Of course, you only get one shot at fcking this up. If you contract, and then harm without going to the ER, your trustworthiness is shot, and next time you’re much more likely to be forced inpatient.

If I’m not feeling safe, I’ll contract for safety because if I promise, then I won’t hurt myself. I’m not about to lose the trust of my therapist.

 

[BlueSkiesAhead]

I guess it might be good to talk about what it is that stops you from doing it when you do have these thoughts and feelings.

Also, I often would say that I can easily come up with ways to
do it, after all I've done it before. But still I have not decided on one specific way as my plan. For me, I don't think it's hard to come up with ways to do it, but it's about which one I would want to do, and when, and things like that.

For the impulse thing, I found the 24 hour rule helps, because a lot of the times it is more of an impulsive thing when things get too much and I don't feel I can go on much longer. So waiting 24 hours for any change in my feelings, and even the slightest positive change or improvement, means I would have to start over the 24-hour clock.

Thank you. I think the 24 hour thing is a great idea and I will definitely try and remember this when I’m struggling.

It really sounds like you are struggling with intrusive thoughts and not actual suicidal ideation.

The impending doom feeling says alot. That is such a horrible feeling. So sorry you experience this.

Thanks for replying. Oh, maybe! I get so confused by how I feel but often the thought will come into my head, usually if I find myself thinking about negative events and things from type past etc. But I do feel like they get out of control and I struggle to stop them.

You could see if the therapist will contract for safety with you.

Of course, you only get one shot at fcking this up. If you contract, and then harm without going to the ER, your trustworthiness is shot, and next time you’re much more likely to be forced inpatient.

If I’m not feeling safe, I’ll contract for safety because if I promise, then I won’t hurt myself. I’m not about to lose the trust of my therapist.

Thanks for the suggestions Eve. I’m in the UK and im not sure if a safety contract is something they typically do here but I guess I will find out next week when I see him face to face, so scared about it all.

It’s great that the safety contract works for you, it’s good to hear the different ideas and suggestions on ways to keep safe during hard times. I really appreciate all the replies.

 

[Meredith Grant]

For me the first time I had to tell my therapist about this was truly a big moment of her gaining my trust. She was very calm and in no way threatened me with commitment (obviously had it come to it she would have done what she needed to to protect me). This experience genuinely was a big part of what saved my life. From that point on I knew that no matter how scary the thoughts and intentions were I had a place where I could talk about them and let them live somewhere other than in my own head. The first time I couldn’t verbalize it and all I could do was sit there and cry. To a certain extent I think she knew what I needed to tell her so she offered me a pen and paper and I wrote it down. Even then I had a really hard time handing it over. To this day it’s one of the hardest things that I ever had to do but all it took was 1 sec of bravery to throw that piece of paper her way and a lot of growth and trust building came out of it. I wouldn’t be here if it weren’t for me telling her this. I finally felt a little less alone. I eventually ended up in an intensive outpatient program but because we had an open line of communication around the topic it was a mutually agreed upon decision. Most therapists are comfortable in these conversations and are not likely to overreact to what you’re saying. It’s hard. Even having the desire to think about telling someone is so brave.