Monday, October 31, 2011

Ask the Doc: How do I talk to my therapist about suicidal thoughts?

Sometimes I think it would be better for everyone if I wasn't around. I don't think I'd ever kill myself, but I'm worried that if I tell my therapist about it she'll have me committed to the hospital. Can she do that?

First, I'm sorry to hear that you're feeling that way. You'd probably be surprised at how many people share that feeling with you on any given day. One of the things that I've learned in my work as a therapist is that it is nowhere near uncommon to have suicidal thoughts once in a while. According to the American Foundation for Suicide Prevention, nearly a million people make a suicide attempt each year. For every one of those attempts, there are many more people in the situation you describe - not really wanting to die, but wondering how it would be to just not exist. We call this "abstract suicidal ideation" in psychology parlance, and it's a very uncomfortable thing to experience.

What you need to know is that your therapist is very willing to talk to you about what you're thinking, and unless you are unwilling to say that you'll keep yourself safe, she's not about to send you to the hospital. I've had clients who have had significant suicidal thoughts for months at a time, and the last thing I wanted to do was have them hospitalized. The fact is that, even though they were thinking about suicide and what it would mean, they were also continuing to function at work, at school, and in their relationships, and they were willing to keep themselves safe with a plan that we had worked on together.

Saying "I wonder what it would be like to kill myself" or "I've thought about suicide" are big flashing red warning signs for people around you, and I can certainly understand why you're keeping them to yourself around friends and family. Your therapist looks at things differently than your friends - that's why they're your therapist. Times like these are what we train for. We learn to ask questions about your level of intent, about whether you've got a specific plan, and about what you've got in your life that prevents you from acting on your thoughts. We learn to work with you to determine your level of risk, and to make a safety plan that fits your personality and your lifestyle.

If you truly don't feel as though you can keep yourself safe outside the hospital, that's another story. Don't keep that information from your therapist, because suicide is a permanent solution to what often turns out to be a set of temporary problems. But, if you know you're safe, and you need to pour your feelings out to someone without fear of overreaction, please talk to your therapist. Human life is a beautiful, valuable thing, and we're here to help you get the most out of it. To do so, we need to know what's going on with you. All of it.

One final note: if you're considering suicide, or just feel pretty awful, and you don't have a therapist, today is the day to start your search. As I said, life is beautiful. Consider this an opportunity to show yourself the love you'd show to a friend in the same situation, and get some help getting back on the path.

Best wishes, and thanks for reading!

*Thanks to reader Melinda F. for the suicide stat update!

11 comments:

  1. Brilliant and compassionate post.

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  2. I've had my times of thinking of suicide. Most recently this last year. My therapist was more than willing to let me ramble on about the myriad ways life would be better without me in it before making me come to the same number of ways life would be worse off. She then worked with me to make a plan to keep me safe. At no point in time was a hospital ever mentioned. I <3 my therapist.

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  3. I'm really glad you had someone to talk to!

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  4. I really like this post! I think about suicide often (daily almost) but not in a serious way more like a curious way... thinking 'what would it all be like if...' but not because I am sad or anything, just wondering. I am always scared of bringing it up with my therapist because I think she thinks there is way more wrong with me than there actually is anyway.

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  5. Thank you for writing this. I'm going to save a link to it, because it's just THAT good, and I want to be able to point people at it.

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  6. Thanks for reading! You can "like" Doc Blog on Facebook and link from there if you want, too. Please feel free to share wherever you'd like. :)

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  7. <3

    This is the sort of post that makes my heart heavy and light at the same time.

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  8. I'm really behind on this, but I just wanted to say thank you for posting. I also wanted to add (or reinforce, I suppose) that the hospital is not that bad, if that's what you need to stay safe. I was put on an involuntary hold when I told my psychiatrist that I was planning to go home and attempt suicide earlier this year, and those six days ended up being very helpful. Hospitals get a bad rap that they don't always deserve.

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  9. Thank you for this post. I often do my own personal research, as I am doing now, before making a tough decision to become vulnerable. I want to get help and trust someone I just want to make sure I do it right and in an informed way. This post enabled me to do that.

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  10. I'm really glad that it's helped you. Comments like this inspire me to get back here and do more writing.

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