How to Find a Therapist Who Does Not Panic

Therapists calm about suicideThe wonderful blog attemptsurvivors.com recently published a post, “Wanted, Therapists Who Won’t Panic.” Some therapists do in fact panic when faced with a client who says he or she wants to die by suicide. 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 Panic-Free Therapist

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.

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?

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.

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.

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. It is not necessary for a therapist to specialize in suicide prevention to be competent, well trained and experienced in working effectively 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 a suicide-related professional conference, used the CAMS approach (Collaborative Assessment and Management of Suicidality), or undergone specialized clinical training in suicide prevention. Specialists also are likely to belong to a suicide-specific professional group such as the American Association of Suicidology.

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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© Copyright 2013 Stacey Freedenthal, PhD, LCSW, All Rights Reserved. Written for www.speakingofsuicide.com

Photos purchased from Fotolia.com

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  1. Rudy says:

    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.

    • Stacey Freedenthal, PhD, LCSW says:

      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.

    • Annonymous says:

      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.

    • Stacey Freedenthal, PhD, LCSW says:

      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.

  2. Rudy says:

    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.

    • Stacey Freedenthal, PhD, LCSW says:

      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!

  3. Lou says:

    Thank you, Dr. Freedenthal, for posting this article. I read another of your articles first, and then saw the link to this one and read it as well. I have been thinking about suicide for months and can not think of a single person I’d feel safe speaking to about it. So I keep it inside. I lay awake at night and wonder how much longer I can keep going like this. After reading your articles, this morning, I googled therapists in my area. It’s a very rural area and there are only two, neither specializes in working with suicidal clients. Of the two, one specialized in “play therapy” and primarily works with children. The other works with adults and specializes in anxiety and depression. I called the second one and left a detailed message. If (a) she calls back, and (b) has experience with and/or is open to working with someone with suicidal ideation, and (c) takes my insurance, then I will give it a try. I would not have considered this had I not read your article about whether a therapist had an obligation to hospitalize anyone mentioning suicide, and I would not have known where to start to find a therapist had I not read your article about how to find one. So, thank you.

  4. Myrtle "Maggie" says:

    This is the number one reason therapists are saying “No” when suicide is an issue: If you commit suicide at any time during or after working with that therapist, he or she is fully liable for your death, including criminal charges such as 2nd degree manslaughter in some cases. The therapists’ insurance companies have forbidden them from having anything to do with anyone on the subject of suicide. (Imagine if you mentioned it, and they didn’t “do enough” in the eyes of the law, to save you, THEY are held responsible.) Hard to believe we live in a country where, by Roe v Wade, we have full control over our bodies, but suddenly that power goes away if we want to abort ourselves. It’s ridiculous. To get around this dilemma, go to Oregon or Vermont. There are no charges against therapists, even if you commit suicide right in front of them. Google it. Or hire a therapist via Skype in one of those states.(Google, tho, which law applies: the state YOU live in, or the state the therapist lives in.) Only other option is suicide hotlines, and I think THEY have to report you, too. It’s beyond ridiculous how deeply suffering suicidal patients are prevented from getting care in the US.

    • Stacey Freedenthal, PhD, LCSW says:

      Myrtle “Maggie,”

      I would love to know where you received the information you included above, because most of it is dangerously wrong. The myths you describe could deter people from getting help; they may believe that, as you assert, “deeply suffering suicidal patients are prevented from getting care in the U.S.”

      In fact, a great many social workers, psychologists, psychiatrists, counselors, and other mental health professionals are available to help people who have suicidal thoughts or behavior. These professionals provide such help to tens of thousands of people in diverse settings such as community mental health agencies, hospitals, schools, prisons, and private practices.

      Therapists are not fully liable when a client dies by suicide unless the therapist committed malpractice. Even then, the therapist has to be sued after the suicide (most therapists aren’t), and, even then, a jury has to find that the therapist committed malpractice (most juries don’t).

      Therapists are not subject to criminal charges if a client dies by suicide, unless the therapist aided and abetted the suicide in some way (like, for example, giving the suicidal person a firearm and advising the person to shoot himself or herself). In fact, if you try doing a Google search for articles with the words “psychotherapist,” “suicide,” and “manslaughter” in them, I suspect you won’t find a single article about a therapist being criminally charged with manslaughter for a client’s suicide, but if you do, please let me know. (If you do this Google search, you will need to use the “advanced search” function and instruct Google to omit articles about “Michelle Carter,” the teenager charged with encouraging her friend to die by suicide. Apparently, many articles were written in which mental health professionals shared their expertise about the case.)

      It is also not correct that therapists’ insurance companies have forbidden therapists “from having anything to do with anyone on the subject of suicide.” In fact, that’s one of the very reasons why therapists purchase malpractice insurance: The insurance company covers the legal fees, settlements, and judgments that can come from a malpractice suit, including those arising from a client’s suicide.

      Here’s what is partly correct in what you wrote above:

      Therapists have a “duty to protect” someone who is in foreseeable and imminent danger of dying by suicide. This applies only to cases where the imminent risk for suicide is evident (meaning, it’s foreseeable that the person will die by suicide within hours or days). It’s seldom necessary for a therapist to intervene (e.g., call 911) with people who seriously consider suicide or even attempt suicide, because most are not at imminent risk for suicide. Keep in mind that *nobody* is able to predict who will die by suicide. There is no test, no questionnaire, no wisdom that can predict this. So if a therapist assesses that a person is not at imminent risk for suicide and turns out to be wrong, this does not necessarily mean that the therapist committed malpractice. Mistakes in judgment are not malpractice if the therapist had sound reasons for making the decision that they made and followed the standards of their profession.

      Physician-assisted suicide (also known as “death with dignity”) is legal in Oregon and Vermont, along with Washington State, Montana, and, very soon, California. This means that therapists do not have a duty to protect someone from dying by suicide if that person is deemed by other medical professionals to be terminally ill and to have fewer than 6 months of life left to live. If a person who does not have a terminal illness discloses a plan to die by suicide within hours or days, therapists in those states still have a duty to protect that person.

      Finally, I should note that most if not all hotlines do use the technology available to them to identify the source of a call and send the authorities to protect someone who is a danger to himself or herself. If you want to discuss your suicidal thoughts with someone and absolutely want to be sure that there will be no intervention to protect you, the Samaritans in the UK have a non-intervention policy even in cases of high risk. They offer assistance by email for this purpose for people around the world; the address is jo@samaritans.org.

      As for therapists’ “duty to protect” people from suicide, this is a contentious issue and I worry that it ends up hurting more people than it helps. As I note in the article above, some therapists panic. But many (and I believe most) therapists do not panic. Most therapists can calmly help suicidal people without resorting to unnecessary hospitalization.

      I hope this information is helpful to you and to anyone reading this who might yearn to reach out for professional help, but who is afraid to do so.

  5. Helen says:

    I just wanted to say it is possible to find a therapist who doesn’t panic, but says all the things you need to hear. I was most of the way through a 12 week course of CBT for anxiety when I became suicidal (not for the first time). My therapist not only noticed the shift but asked enough questions with quiet concern to get me to admit the truth out loud for the first ever time. He didn’t panic, but gently helped me to see that suicide wasn’t the only option, and that it was possible to recover. I’m not quite there yet as sadly the sessions still had to end after 12 (I’m in the UK & that was the NHS allotted number), but he gave me hope and the knowledge that there are CBT therapists who have compassion, concern & experience. I wish all those who come here some peace in their lives & the chink of hope that I have been given. It is possible, people do care, and you are worth fighting for.

  6. Jean E says:

    Of course, poor people in the public system rarely get to choose their therapist. One is assigned to them.

    • Stacey Freedenthal, PhD, LCSW says:

      That is an excellent point, Jean, and it is well taken. It is a privilege to be able to “shop” for a therapist and choose the best one.

  7. Anonymous says:

    I have found that there are some thoughts regarding suicide ideation, reasons for thinking about suicide, and suicide attempts, that simply can’t be shared with anyone, period. I have found that revealing these thoughts cause more harm than good, and that, in the end, the proper solution should have been to withhold the information or to lie about one’s intentions. Some people may be best served by using anonymous sites like the Samaritans. I find it best to keep to those sites and simply to not trust anyone. Trusting others face-to-face has usually caused irreversible loss.

  8. Olivia says:

    I am lucky enough to have a therapist who is very open to talking about suicide. When I went in for an evaluation by the mental health program in my county it already stated I had three attempts in under two years and I had just run away from an abusive situation. The first time my therapist actually met me was two weeks later while I was out on treatment pass from a psych stay after an almost fatal overdose.

    I have been working with this therapist now for just over two years. She understands where my urge of self-control and suicidaity comes from especially during triggering times of the year. It actually catches me off guard sometimes how fast she is to talk about it, but it makes my treatment so much better to work with.

    • Stacey Freedenthal, PhD, LCSW says:

      Hello Olivia, it sounds like you have a good therapist who does not panic in the face of a client’s suicidal thoughts or behavior. This allows you to speak freely and explore what lies underneath your suicidal thoughts. I know that there are many others who similarly have a rewarding relationship with their therapist. Thank you for sharing your experience so that others can know that such experiences are possible!

  9. Jo Ellen says:

    My daughter has been admitted numerous times, long term twice. The hospital stay May have helped her get past the crisis but only by keeping her under observation. We did not find that the counseling they offered to be much benefit.

  10. Leslie Robertson says:

    I am a grad student who will be opening a private practice specializing in suicide. Your site is wonderful!

    • Stacey Freedenthal, PhD, LCSW says:

      Thank you, Leslie. Good luck with your practice, and welcome to the field of clinical suicidology!

    • Becky says:

      Where will your practice be?

    • Stacey Freedenthal, PhD, LCSW says:

      I have a psychotherapy practice in Denver, CO.

    • Becky says:

      I was asking that particular commenter Leslie Robertson where she will be starting her practice.

    • Stacey Freedenthal, PhD, LCSW says:

      Oops! I wondered why you were using future tense. On my WordPress app, I can see only one comment when they’re in the moderation queue. I can’t see the comment it’s in response to.

  11. Stacey! I’ve been away from your blog for too long! And, oh, my gosh! Look at the wealth of information you have curated here! I’m so impressed! What a wonderful resource for all of us!

    I love this post. It seems so commonsensical in hind sight to spell this all out; but, the truth is that no one ever talks about how to find the right therapist for someone who considers suicide. You’ve done a great job and a great service to spell this out in bite-sized pieces of info.

    Thank you for sharing what you know so generously! I’ll be happy to refer colleagues and clients, too, to your website.

    • Stacey Freedenthal, PhD, LCSW says:

      Tamara, you are very kind. You were a great help and inspiration in my creating this website, so your words mean a lot. Thank you!

      I appreciate your referring folks to the site and helping to spread the word about suicide prevention.

  12. It is important to find a therapist who can really help you deal with your issues in life and not just give up on you when things are already beyond their control or if it would seem they simply can’t handle you. There is a reason why you chose to seek help and therefore they should help you work things out.

    • Stacey Freedenthal, PhD, LCSW says:

      Very well put, Helen. I completely agree. To refuse to treat a suicidal client is like a physician telling a patient, “Sorry, I can’t treat you because you have an illness.” Isn’t that what someone goes to a physician for, to feel better? Same with people who go to therapists!

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