What happens if I tell my therapist that I have suicidal thoughts?
MY NAME IS SARAH LEE AND I'M A PSYCHOTHERAPIST WORKING IN MANCHESTER CITY CENTRE IN THE UK AND ON SKYPE.
I'm Sarah Lee, a UKCP registered psychotherapist. I work in Manchester City Centre helping people suffering from depression, anxiety and low self esteem. I have a special interest in working with clients with depression and survivors of long term abuse. If you're further afield you can work with me on Skype. If you have any questions, you can call me on 07853490358 or send me a message.
If you're considering therapy or you're looking for a psychotherapist, you might be wondering what happens if you're feeling suicidal or having suicidal thoughts. You might fear telling a therapist about what you're feeling because you don't know what they might say or do. Are you more likely to take action once you have told someone? Will you be committed or sectioned if you tell someone you are suicidal? Will they call the police?
I'm here to talk a bit about how I manage suicidal clients in therapy, what steps I take to keep clients safe and suggestions I make to them about who to contact if they concerned they might take action. I hope this will dispel some misunderstandings and encourage people to talk to someone about their feelings be it a therapist, a doctor a friend or someone working for a suicide prevention charity.
How do you react to suicidal clients?
Firstly, it's normal to have concerns about telling me you're suicidal or having suicidal thoughts. You might worry I will panic or won't let you talk about what you're thinking. You might worry I will be upset or won't be able to handle your thoughts and feelings. These are legitimate concerns and this can happen with people who don't have in depth knowledge or training in suicidal thoughts and behaviours (and shouldn't happen with a psychotherapist). It is not uncommon for clients to mention having or having had suicidal thoughts and I am not shocked when someone shares this with me (although I am saddened). If you tell someone about your suicidal thoughts and they can't handle them or dismiss your concerns, please find someone who will take you seriously.
If you're not yet in therapy or counselling you might worry that your therapist or counsellor will refuse to work with you if you have suicidal thoughts. I am certainly happy to take on clients who have thoughts of suicide if I feel we are a good fit. I won't panic, and I will take you seriously. I am in regular supervision where I can process my work in a confidential setting, so you do not need to worry about my feelings. I do feel sad when clients are in pain and are thinking about suicide but I am not going to cry and you don't need to take care of me. Therapy is your time and you are the priority.
It is worth pointing out here that some therapy services might not deal with suicidal clients perhaps because of the level of experience of their therapists (some services are staffed by volunteer counsellors who are still studying for example) or because they are classed as low intensity and are not intended to deal with at risk clients. If you are contacting a service looking for support for suicidal thoughts, it is worth being honest so that you can be referred to the relevant service. If you are looking for a therapist, you can ask them if they work with suicidal thoughts and see how they respond.
Does Talking about suicide make it more likely for someone to take action?
Contrary to some beliefs, talking about suicidal feelings does not make the person more likely to suicide. It can be a relief for clients to tell me their thoughts around suicide. They might not feel able to tell their friends or family or worry that they are somehow abnormal. They might wonder how it’s possible to stop intrusive thoughts and not know how to handle them.
I do ask clients in our initial session if they have made previous suicide attempts (this increases the risk of suiciding). I also ask if they have made a plan about what they would do and if they have access to anything they might use to carry out their plan. This indicates that they have thought about the logistics of suiciding and it is not just a fleeting thought.
I will also discuss whether they intend to suicide or whether they feel unable to bear their current situation or feelings. Thoughts of suicide (also known as suicidal ideation) may not be about the person wanting to end their life. They may feel trapped or overwhelmed, they might feel ashamed, overcome with grief, concerned about how to deal with a relationship breaking down or debts they have incurred. They may feel worthless or unloved or unsupported. They might not be able to imagine a time when they could feel differently or could not imagine their situation changing to one where they feel able to manage their feelings.
What will you do if you're concerned that I'm a risk to myself?
If I am concerned about a client’s safety, my first point of action would be to contact their GP and let them know. I will ask permission to do this, but if I feel the situation is urgent and am concerned for their safety I will contact them as a matter of course (this is mentioned in my initial session - it is an ethical requirement that I take action if I am concerned for someone’s safety and is one of the exceptions when I am permitted to break confidentiality).
Calling the police would be a last resort if someone were imminently about to attempt suicide or if an attempt were underway. The police, a doctor or other mental health professional do have powers to section people for assessment and treatment if necessary (between 24 hours up to 6 months if required). I do not have powers to section anybody and can only escalate my concerns to the relevant person or authority.
With clients who are struggling with suicidal thoughts, we may have a process in place whereby they have a list of people to contact if they are overwhelmed by their thoughts. This might include supportive family or friends, me (if I am available), their doctor or hospital or a suicide prevention charity such as the Samaritans or Papyrus (which is a suicide prevention charity for young people).
How does psychotherapy help someone who is suicidal?
Suicidal thoughts or feelings need not be a constant. In my experience, clients who have these thoughts frequently feel isolated, alone or powerless. They might never have felt supported, so therapy can be the first time they feel heard or taken seriously. Suicide can feel like a 'good option' to someone who feels hopeless, so we work on extending their support network, finding the right people they can trust and learning to reach out when they do need help. Feeling that are overwhelming may feel stuck so we look at safe outlets for these feelings, how to identify when they are building up and how to express this to others who might be able to help.
I feel privileged to be able to hold the hope that a client's situation can change until they are able to hold it for themselves and having worked with suicidal clients I know it is possible. Developing a connection with me in therapy can provide the spark that someone needs to feel that there is a possibility for their situation to change. Other times, when a situation cannot be changed, simply sitting with someone and their feelings, without judgement and without attempting to shut them down can be enough to help them feel heard and less alone.