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
Thank you for your article. Suicide enters my thoughts daily and has been
scaring me.For the most part therapists have been open. But always seem to suggest hospitalization. My family situation has deteriorated since the death of my dear husband a few months ago.
I have five children. All married with families of their own.I don,t hear from most of them, ever. Is it possible for me to overcome this heartbreak?
Where do you suggest that I go for help?They have me blocked from communication, only one answers my calls.and he is getting annoyed.
Debbie,
That must be so painful for you to be alone and not have your children maintain contact with you. I extend my sympathies about your husband’s death, too.
I wonder, have you called a hotline or warmline? In the U.S., you can call 988 to reach an area hotline affiliated with the Suicide and Crisis Lifeline. And you can find a list of warmlines here: warmline.org/warmdir.html#directory The Lifeline operates 24/7. Warmlines tend to operate fewer hours but are a good option, too.
Also I wonder if you’re still in therapy. If so, I hope you’ll share with them the comment you posted here, so they can know how much you’re suffering and better help you.
Thanks for sharing here, and I’m hoping things get at least a little better for you soon.
I am an attempt survivor and have had the no-fun experience of trying to find a therapist who doesn’t panic over SI a couple times now. I just recently moved to a different state and at it again. I just had my first experience of what you described as rejection. Before, I’ve done the rejecting. I ask them how they handle suicidality. The worst response I’ve had was, “I call the police and wait with you while they arrive to transport you.” I told her that was an inappropriate response near the end of the appointment and I wouldn’t be returning.
This time though I asked and they passed and said it’s case by case, etc. Still, once she found out I had attempted twice, the most recent not too long ago, all of the sudden she no longer had any availability. “I’ll have to check my calendar – my current patients come first and it depends on their needs.” It was a very hurtful rejection. As someone who struggles with feeling permanently broken, not worthy, and never going to be rid of those feelings, it sent me pretty low. I find it unconscionable how some therapists act towards suicidal people.
I found this site by accident. I live in Denver CO. As I write this, I expect an ambulance to be sent to get me. Suicide attempt May 2022, called 911 on myself, screaming for help and for the pain to stop. My inusrance, KPermanente does not do therapy, they do IOP or meds. I begged for tools to help me cope with my new life. Got none. Months later, my PDP has stayed with me & counsels me, I thought that was great but he said to trust him and tell him my thoughsts. I did and he put it all in notes which in KP go to everyone. I cling to him more than I should & it leaves me in a delicate place, and i now know he is a doctor only, not my friend so his concern is not for me personally as a friend. That is the problem, I am in this depression because the death of my husband and brother right before Christmas triggered something to got me depressed. They were the only people left in my life who were part of my circle/my support group in life. So, I am what is called now an orphaned baby boomer. I am not progressing as fast aa they want me to & I am told I can be forced into a facility and medicated. I just wanted someone to teach me how to do this, I am smart & will learn. Problem is when you are alone, you have NO support that is safe…no one to hold you, listen to you w/o judging, no love, no human touch, so I am isolated and not thriving. Yes, I do the finding a church, go to the senior center to work out, etc but it is cold and empty & I can’t deal with this severe loneliness because no matter what I do or comply with , none of that will give me at 68 yo a support base again, and I have chronic progressive condtions that make me feel more vulnerable. So, yesterday I vented a bit to my doctor, I cried again and now he does not call me, respond to my emails, he said I should be further along. I am terrified of being put away, my little house is all I have for independence…I do my own shopping/cleaning & finances. I am feeling very adrift without my family/2 best girlfriends to love me. Since 2000 i have lost 17 people, including 3 husbands. I think I have a right to traumatized a bit. I was a volunteer for elderly (the most vulnerable) and hospice for 35 yrs. Crossed some of people over, watched all die. Now, I sit here without my doc to talk to me and now more scared than ever. What got my doc mad was I mentioned assisted suicide and he was not happy, I got in trouble for talking about it. I want to pack my car, insulin and meds and just leave the state…just drive til I can’t do it anymore, at least I would be free. No relatives to go to, no family. I am not a criminal, won’t hurt anyone and yet I feel shamed and judged with no love.
I’m reading this now and don’t really know what to say. I hope you’re still here with us. But I understand if you no longer are and I respect your decision. I cant imagine living the life you live and yet I know one day I will, and it’s terrifying so I can understand why you feel the way you do.
V,
Thanks for commenting here and offering support and empathy! I’m often overwhelmed by the volume of comments the site receives (10,000 and counting, not including thousands of spam comments every month). I regret not being able to reply to them all, and I especially regret not reading M’s fully until you left your comment here. Thanks for bringing hers to my attention. And I hope you’re able to challenge your certainty about the life you’ll live in the future, because for now, do you know it’s true? Then again, even if you can’t know, those are your fears, and they’re painful. Thanks for sharing them here.
M,
I’m so sorry. You left this comment six weeks ago, and the comment by V brought it to my attention. I read every comment before posting because some comments aren’t fit for publication, but sometimes I skim — and I’ll never do that again, based on what happened here! You wrote here because you felt so alone and hopeless, and I can only imagine how it felt not to get a reply for six weeks.
I hope you’re still here with us, and I hope you’ve gotten help that feels safe and is truly helpful. And thank you for sharing here.
I cant take it anymore and swallowed what i thought would kill me. It didnt now im more lost
Robin,
I’m sorry you’re hurting so badly that you tried to kill yourself. I really hope you’ll get some kind of help. Have you tried at least talking with someone at the National Suicide Prevention Lifeline? They’re reachable at by calling 988 if you’re in the U.S. I also list resources at http://www.speakingofsuicide.com/resources/#immediatehelp. Also, please see my post Are You Thinking of Killing Yourself?
I am sitting here feeling alone and I want to pack up my car and drive away. My doctor saw me yesterday, he is my PCP who is trying to counsel me on my past suicide attempt in May, I called 911 on myself. I have a team thru my Kaiser insurance, but psychiatrist won’t work with me unless I take several meds and the therapist won’t work w me because I won’t do IOP. I begged for tools, help me to cope with this new life I have…therapists in the past have give me great help with tools & I thrived my whole adult life with depression, worked it and beat it each time. But, I had a life back then, a full life with a great circle of people for support. I found out that my PCP is NOT my friend, only my doctor…so when I open to him it goes into notes and the others read and make notes, I am informed I am NOT healing as fast as I should be. I am labeled as bad for non-compliance, and many other “bad pt” adjectives. No, I don’t want to be medicated, tried in past and my therapist took me off them because they did not help, made it worse and therapy always worked. . Now I totally alone, isolated and scared now they will come for me. Since my appt w my PcP yesterday he has not retuned my emails. Problem is my PCP is the only person I know now, my trauma that triggered me was losing my husband and brother right before this last Christmas and they were the last of my family /circle in my life. Bang, I wake up from taking husband off life support and realize I am 68, chronic progressive conditons and now am what is called an orphaned baby boomer who only has her PCP left whose face I know. I lost 17 ppl since 2000, including 3 husbands, parents, brothers and my 2 BFF’s. Crossed some of them over, I volunteered with hospice for yrs and with elderly lonely ppl for 35 yrs. I want to pack my car up and leave, will not be put back in that psych facility again, the one I was in for my May suicide attempt broke me, it was harsh / violent / scary and shameful…no help at all, no love, no one glad you lived, only that I can’t even get a suicide right…loser, failure etc. I want to go before they admit me involuntarily. I harm no one, independent and go to the senior center, volunteer on the phone with lonely elders. I just keep crying and they don’t like my emotions. THEY go home to wives, family, dogs…they get hugs / support / love/ NO judging….I don’t have that, and it is breaking me more and more….I have material needs, but NO love, NO hugs. Just want to vent, I know I am a mess, but I am not a criminal, and I would like to see these docs survive better with losing their worlds. I am terrified of all of this.
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.
The last therapist I went to asked me at one point what I would do if I thought my physical health problems could not be resolved. I said: I don’t think I could go on.
She didn’t follow up on that. I didn’t mind though (not that she wasn’t a terrible therapist, in general). It might be “irresponsible” on her part, but I wouldn’t have been completely honest in answering follow-up question anyway; and I still don’t accept the “responsibility” of therapists to involuntarily commit someone for seriously considering suicide. (Stacey keeps emphasizing that it’s not a crime, but it’s treated like one. In fact, the non-law against suicide is enforced much more harshly than many actual laws.)
I finally had the courage to tell my therapist that I always had a plan. She was disappointed and said that I had been dishonest. The truth is that I was scared that she would have me hospitalized against my will. In addition, she no longer believed me when I told her I was having ideations with no intent to self harm. She did recommend that I go to the ER for an evaluation. When I refused, she gave me two options: (1) have my spouse escort me to the ER; or, (2) she could file an emergency petition for evaluation. I agreed to #1 but ended up leaving the office before spouse arrived so therapist had no choice but to implement #2. I do think she overreacted. However, had I been in her shoes I most likely would have done the same thing.
Needless to say I was upset. I made a stupid, impulsive decision that I truly regret. I was impulsive, angry, hurt and through this pain terminated our relationship. I told her this but she now says she no longer has an available time slot.
I’m a lucky one. I found a therapist who doesn’t shame me, doesn’t guilt me, accepts my feelings for what they are, and yes, I’ve talked with her many times about suicide. She is against ”forced hospitalization” for people who talk about suicide. Now I’m sure if I told her I was going home and swallowing every pill in the house she would do something. But I’ve been able to talk about methods with her. And when I’m not suicidal, and when the thoughts begin to cloud my mind again. She knows my full story and the multiple traumas I have been through the last few years. Instead of guilt or shaming me she tells me anyone in my position would feel how I feel.
When you’re suicidal you figure you must be ”crazy” (a word I seriously dislike) so someone telling me what I feel is normal, I have a right to feel this way, and she will help me no matter is what has kept me alive. And helps me to keep trying.
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.
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.
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.
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.
I too had something like this happen. Here’s a bit of my story;
I found out my husband of 40 yrs has cheated several times during our marriage. In an argument where HE had been drinking he wanted to leave by driving the car. I stood in front of the vehicle and refused to let him leave. He wrestled with me so I called the police
To make a long story a bit shorter… the police took me to the psych ward and said I was suicidal ( because I stood in front of a car with a drunk driver) Here’s the funny part… they let him drive away as they took ME in.
I had to go through intense questions regarding my thoughts, behaviors and how I should have handled it differently.
I CALLED FOR HELP!
I was released and needed to go to a psychologist on a weekly basis.
She made me feel like I was nuts. I will never be the same after this. It was terrible being in there for 10 days. I AM still married but very very unhappy and very angry towards him for a lifetime of lies and cheating which resulted in my being incarcerated… I use that word because that’s exactly how it felt to me.
Anyone looking for help dig deep into the right doctor. My doctor refused to see me anymore. Just said she couldn’t help me. I just never understood this. Maybe she lacked the education it took to help me
Agree, Rudy.
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.
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!
I can’t understand why you think suicide is illegal? It’s above all laws. Anyway, if you’re still alive you should consider meds. If you had diabetes or a sinus infection you would use meds. Our minds get sick too.
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.
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.
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.
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.
Of course, poor people in the public system rarely get to choose their therapist. One is assigned to them.
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.
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.
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.
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!
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.
I am a grad student who will be opening a private practice specializing in suicide. Your site is wonderful!
Thank you, Leslie. Good luck with your practice, and welcome to the field of clinical suicidology!
Where will your practice be?
I have a psychotherapy practice in Denver, CO.
I was asking that particular commenter Leslie Robertson where she will be starting her practice.
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.
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.
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.
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.
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!