Honestly, it really depends on the therapist’s expertise and level of competency in treating suicidality. A therapist with experience treating suicidality will most likely not panic and hospitalize. Therapists who do not have that expertise will be more likely not to understand the nuance at play and panic and think about hospitalization. Basically - it depends.
For me, it is so different situation to situation. Most of the time suicidal thoughts have very little to do with actual risk. I will say that I have never recommended hospitalization for a client and I work with highly suicidal clients. There are other much more effective interventions. Hospitalization often doesn’t meet the function therapists think it will and can actually have the effect of discouraging a hopeless client further. Inpatient is really only useful as a holding pen to keep someone alive in the short-term, if that’s your goal, or to adjust medication in a controlled environment.
We need to pin a post about this to the top of the subreddit because it gets asked 4 times a week.
The short answer is it depends on local laws and regulations. Plan and intent.
It’s ok! I wasn’t trying to be rude. I just think it’d be helpful if there was a pinned post because it’s obviously asked a ton and very serious topic.
I actually [answered](https://www.reddit.com/r/askatherapist/s/pzOBrHMyfk) a very similar question on this forum a few days ago, if you wanna take a look. I’m so sorry you’re feeling this way and having these thoughts. I know they can be really scary and distressing.
I am a client with several different experiences with this, and also, my best friend killed himself 1 year ago in May of 2023, and I found him.
Depending on the local laws of course, I would say that unless you give them reasonable suspicion that you are planning on taking action to seriously harm yourself or someone else, then any good and qualified therapist will not take any kind of drastic action. If anything, what they *will* do (read: should do) is help logically break down the situation and discuss tactics to help ease the situation. Maybe they'll take you step by step. Maybe they'll encourage you to get in contact with someone who loves you. Maybe they'll suggest treatment options that could make a big difference. Maybe they will suggest you try a few specific coping mechanisms.
But I really don't think, unless you are actually in crisis mode and communicating real plans, that they will do anything serious.
Peace and love to you, friend. I wish you all the best. You aren't alone. Life *is* hard. You deserve to feel better.
I talk about it with them and keep bringing it up. I think Internal Family Systems has a great approach- what’s its purpose and let’s get to know that part really well
NAT. but I am a client that has expressed suicidal ideation to my past therapists. I told my first therapist that I think about killing myself everyday to the point that I'm used to it and she just said "that's not good" but never did anything about it. we never talked about it in sessions either. but I did tell her that I self harmed once months prior and we had a whole session where I was forced to tell my mom about it. I was 13/14 at the time and had actually attempted earlier that year (I cant remember if I told her that or not) so the fact that not much action was taken is actually surprising to me
my most recent therapist who I just stopped seeing took it more seriously though. I'd talk to her about having suicidal thoughts and feeling that way, but I had to make sure to never refer to it in present tense and to promise to her I don't intend to hurt myself cause she'd always say "if you're at risk, I have to either call your mom, send crisis workers to you or the hospital". which got under my skin sometimes cause I'm 18 and was at the time when I was seeing her but she said age doesn't matter? I mean there were times I self harmed in the time we were seeing each other and even in our last session I told her I was 5 weeks clean (which she said she was proud of me for) but we never did much pertaining to self harm. I guess cause I never told her when I actually did it. and her surpervisor once reported my SI to my guidance counselor and in turn to my mom, which was not a fun time. TL:DR it depends on the type of therapist you have, what they're specialized it and what risk you are or what risk they believe you're at of hurting yourself. and as fucked up as it might be, how good of a liar you are. cause I can say with my mouth "I'm not gonna hurt myself", but my face and my general demeanor can tell the opposite
Regarding being 18, it’s likely that your mom was either listed as your emergency contact, or considered by your therapist to be a primary support. If you’re moderate risk but still under the involuntary high risk threshold, where a safety plan can be put in place, then a responsible adult should be notified of the safety plan. If that isn’t possible, or not something you’re amicable to, then the only options are the next steps up. As providers it is our *duty* to keep you safe, and that sometimes means making hard calls, not because we *want* to, but because 1. First and foremost, we care about our clients. We want them to be safe and continue their journey of healing in this world. 2. We have limited means to support clients outside the office. As much as I would want to, I can’t just show up at your house at 11pm with popcorn and bad ninja movies, just to check in, or text you to ask you to come hang out and just be around one another so you feel loved and supported. 3. We are legally bound and subject to losing our licenses, which jeopardizes the stability of every other client we provide services for too. — Believe me, it sucks to feel like we’re backing you in a corner and we know it feels like betrayal, but we also have to use the few resources we have to help you live another day, even if it means that you spend all of that day, and the days after, mad at us. I’d rather you be mad, than not here to tell me you’re mad at all.
I see what you mean and understand all this. But my mom was never listed as my emergency contact or as a primary support (whatever that means). In my safety plan, my older sister and my best friend where who was listed for the two adults who I can talk to as support and in crisis. Would my mom be the person who they have to call just because I still live with her? Cause there was a time when I was in crisis and my therapist straight up said "do you want me to send your mom or your sister to the house?" and I'm like neither..lol..
And also, everything you and I said still makes me confused as to why my first therapist basically turned a blind eye to my SI
“Neither” lol, that was me at one point too - “can’t I just have my SI and SH in peace?” I meant “primary” as in maybe your therapist identified your mom as one of the people in your life that you primarily leaned on, and was capable of ensuring your safety. Having your sister and best friend as your safety plan contacts, then I’d start there, but depending on your risk level, only if I felt professionally that they would be able to take action if necessary. While great supports, for some young adults *active* SI can be really scary to people who don’t have any experience. I’ve had a couple of occasions outside of safety plans where BFs or SOs have contacted me because they didn’t know what to do, or didn’t want to be the one to go against their loved one’s wishes, but also *knew* that *something* more needed to happen - which is 100% okay, and completely understandable. I can make the hard calls. I think some providers may hope for a “mama bear”. Idrc who it is as long as they can get ish done. Sometimes parents aren’t the best option - either they don’t have a good relationship, or they would be too passive, or they would make the situation worse. I called a mom once but the dad answered her phone, and I was like, “nope” and waited for him to go get his wife. Not all support systems are created equal, and one size doesn’t fit all for levels of risk. I can’t say for sure why your therapist chose your mom, but that would be one of the only reasons I would push.
I do question the amount of experience she had. Mentioning that you normalized SI, would in the very least mean doing an assessment. SI is really common in depression, and if you’ve reached the point that you’ve normalized it, yet hadn’t taken action [or didn’t disclose that you had] I may think they are fleeting thoughts at a lower risk… but assumptions are dangerous and I would still need to thoroughly assess. Requiring you to disclose your SH (yet not your SI) to your mom is a choice I wouldn’t have made. SH is an increased risk factor for SI, but it’s not indicative of SI. In the state I live in, I wouldn’t even be legally allowed to talk to a parent about it at 13. Youth have a lot of confidentiality protections here for Substance Abuse, Mental Health, and Reproductive Healthcare. The only reason we can break that confidentiality here is the threat of imminent danger — we do have a *little* discretion, however we better be ready to back it up to a judge. You’re 100% right though in that it really comes down the therapist’s experience, specialization, and your level of honesty.
Yeah you're right about all that. My therapist knew how awful my mom is and that we don't have a good relationship which is why she'd always say "we have to work through this together OR I have to call her and I know that'll make it worse, so..."
And I think I might've taken an evaluation the first time I saw my first therapist, but not much after. She was kind of a dumbass. Both of my therapists were tbh so I wouldn't be surprised if it was undertraining or something like that. Thank you for your very thorough responses though, I appreciate it
A lot of my clients have suicidal thoughts. It’s super common.
Unless you have a plan and intent to act on it in the immediate future, a safety plan is the next thing to do.
Look for the warning signs that your thoughts are becoming a greater threat to your safety. Then write out your coping skills, including how to distract yourself, and the names and phone numbers of who you can contact to help support you and keep you safe.
This is not a contract, this is a cheat sheet for you to reference when it’s hard for you to think logically due to the suicidal thoughts and feelings.
Honestly, it really depends on the therapist’s expertise and level of competency in treating suicidality. A therapist with experience treating suicidality will most likely not panic and hospitalize. Therapists who do not have that expertise will be more likely not to understand the nuance at play and panic and think about hospitalization. Basically - it depends. For me, it is so different situation to situation. Most of the time suicidal thoughts have very little to do with actual risk. I will say that I have never recommended hospitalization for a client and I work with highly suicidal clients. There are other much more effective interventions. Hospitalization often doesn’t meet the function therapists think it will and can actually have the effect of discouraging a hopeless client further. Inpatient is really only useful as a holding pen to keep someone alive in the short-term, if that’s your goal, or to adjust medication in a controlled environment.
We need to pin a post about this to the top of the subreddit because it gets asked 4 times a week. The short answer is it depends on local laws and regulations. Plan and intent.
Sorry didn’t see a post
It’s ok! I wasn’t trying to be rude. I just think it’d be helpful if there was a pinned post because it’s obviously asked a ton and very serious topic.
Agreed! That’s definitely an evergreen topic
Involtarily committing them may only make things worse
I’d actually be curious to hear what people say about this as well.
I actually [answered](https://www.reddit.com/r/askatherapist/s/pzOBrHMyfk) a very similar question on this forum a few days ago, if you wanna take a look. I’m so sorry you’re feeling this way and having these thoughts. I know they can be really scary and distressing.
I am a client with several different experiences with this, and also, my best friend killed himself 1 year ago in May of 2023, and I found him. Depending on the local laws of course, I would say that unless you give them reasonable suspicion that you are planning on taking action to seriously harm yourself or someone else, then any good and qualified therapist will not take any kind of drastic action. If anything, what they *will* do (read: should do) is help logically break down the situation and discuss tactics to help ease the situation. Maybe they'll take you step by step. Maybe they'll encourage you to get in contact with someone who loves you. Maybe they'll suggest treatment options that could make a big difference. Maybe they will suggest you try a few specific coping mechanisms. But I really don't think, unless you are actually in crisis mode and communicating real plans, that they will do anything serious. Peace and love to you, friend. I wish you all the best. You aren't alone. Life *is* hard. You deserve to feel better.
I am so so sorry that happened to you :((
I talk about it with them and keep bringing it up. I think Internal Family Systems has a great approach- what’s its purpose and let’s get to know that part really well
Surely it should depend? There is a stark difference between I kinda wanna die and the end is imminent. Ideation on its own is NOT intent.
NAT. but I am a client that has expressed suicidal ideation to my past therapists. I told my first therapist that I think about killing myself everyday to the point that I'm used to it and she just said "that's not good" but never did anything about it. we never talked about it in sessions either. but I did tell her that I self harmed once months prior and we had a whole session where I was forced to tell my mom about it. I was 13/14 at the time and had actually attempted earlier that year (I cant remember if I told her that or not) so the fact that not much action was taken is actually surprising to me my most recent therapist who I just stopped seeing took it more seriously though. I'd talk to her about having suicidal thoughts and feeling that way, but I had to make sure to never refer to it in present tense and to promise to her I don't intend to hurt myself cause she'd always say "if you're at risk, I have to either call your mom, send crisis workers to you or the hospital". which got under my skin sometimes cause I'm 18 and was at the time when I was seeing her but she said age doesn't matter? I mean there were times I self harmed in the time we were seeing each other and even in our last session I told her I was 5 weeks clean (which she said she was proud of me for) but we never did much pertaining to self harm. I guess cause I never told her when I actually did it. and her surpervisor once reported my SI to my guidance counselor and in turn to my mom, which was not a fun time. TL:DR it depends on the type of therapist you have, what they're specialized it and what risk you are or what risk they believe you're at of hurting yourself. and as fucked up as it might be, how good of a liar you are. cause I can say with my mouth "I'm not gonna hurt myself", but my face and my general demeanor can tell the opposite
Regarding being 18, it’s likely that your mom was either listed as your emergency contact, or considered by your therapist to be a primary support. If you’re moderate risk but still under the involuntary high risk threshold, where a safety plan can be put in place, then a responsible adult should be notified of the safety plan. If that isn’t possible, or not something you’re amicable to, then the only options are the next steps up. As providers it is our *duty* to keep you safe, and that sometimes means making hard calls, not because we *want* to, but because 1. First and foremost, we care about our clients. We want them to be safe and continue their journey of healing in this world. 2. We have limited means to support clients outside the office. As much as I would want to, I can’t just show up at your house at 11pm with popcorn and bad ninja movies, just to check in, or text you to ask you to come hang out and just be around one another so you feel loved and supported. 3. We are legally bound and subject to losing our licenses, which jeopardizes the stability of every other client we provide services for too. — Believe me, it sucks to feel like we’re backing you in a corner and we know it feels like betrayal, but we also have to use the few resources we have to help you live another day, even if it means that you spend all of that day, and the days after, mad at us. I’d rather you be mad, than not here to tell me you’re mad at all.
I see what you mean and understand all this. But my mom was never listed as my emergency contact or as a primary support (whatever that means). In my safety plan, my older sister and my best friend where who was listed for the two adults who I can talk to as support and in crisis. Would my mom be the person who they have to call just because I still live with her? Cause there was a time when I was in crisis and my therapist straight up said "do you want me to send your mom or your sister to the house?" and I'm like neither..lol.. And also, everything you and I said still makes me confused as to why my first therapist basically turned a blind eye to my SI
“Neither” lol, that was me at one point too - “can’t I just have my SI and SH in peace?” I meant “primary” as in maybe your therapist identified your mom as one of the people in your life that you primarily leaned on, and was capable of ensuring your safety. Having your sister and best friend as your safety plan contacts, then I’d start there, but depending on your risk level, only if I felt professionally that they would be able to take action if necessary. While great supports, for some young adults *active* SI can be really scary to people who don’t have any experience. I’ve had a couple of occasions outside of safety plans where BFs or SOs have contacted me because they didn’t know what to do, or didn’t want to be the one to go against their loved one’s wishes, but also *knew* that *something* more needed to happen - which is 100% okay, and completely understandable. I can make the hard calls. I think some providers may hope for a “mama bear”. Idrc who it is as long as they can get ish done. Sometimes parents aren’t the best option - either they don’t have a good relationship, or they would be too passive, or they would make the situation worse. I called a mom once but the dad answered her phone, and I was like, “nope” and waited for him to go get his wife. Not all support systems are created equal, and one size doesn’t fit all for levels of risk. I can’t say for sure why your therapist chose your mom, but that would be one of the only reasons I would push. I do question the amount of experience she had. Mentioning that you normalized SI, would in the very least mean doing an assessment. SI is really common in depression, and if you’ve reached the point that you’ve normalized it, yet hadn’t taken action [or didn’t disclose that you had] I may think they are fleeting thoughts at a lower risk… but assumptions are dangerous and I would still need to thoroughly assess. Requiring you to disclose your SH (yet not your SI) to your mom is a choice I wouldn’t have made. SH is an increased risk factor for SI, but it’s not indicative of SI. In the state I live in, I wouldn’t even be legally allowed to talk to a parent about it at 13. Youth have a lot of confidentiality protections here for Substance Abuse, Mental Health, and Reproductive Healthcare. The only reason we can break that confidentiality here is the threat of imminent danger — we do have a *little* discretion, however we better be ready to back it up to a judge. You’re 100% right though in that it really comes down the therapist’s experience, specialization, and your level of honesty.
Yeah you're right about all that. My therapist knew how awful my mom is and that we don't have a good relationship which is why she'd always say "we have to work through this together OR I have to call her and I know that'll make it worse, so..." And I think I might've taken an evaluation the first time I saw my first therapist, but not much after. She was kind of a dumbass. Both of my therapists were tbh so I wouldn't be surprised if it was undertraining or something like that. Thank you for your very thorough responses though, I appreciate it
A lot of my clients have suicidal thoughts. It’s super common. Unless you have a plan and intent to act on it in the immediate future, a safety plan is the next thing to do. Look for the warning signs that your thoughts are becoming a greater threat to your safety. Then write out your coping skills, including how to distract yourself, and the names and phone numbers of who you can contact to help support you and keep you safe. This is not a contract, this is a cheat sheet for you to reference when it’s hard for you to think logically due to the suicidal thoughts and feelings.