What Happens If I Tell My Therapist I Have Suicidal Thoughts?

Published: June 14, 2013
Dear What Happens If I Tell My Therapist I Have Suicidal Thoughts?,

What happens if I were to tell my therapist I have suicidal thoughts? I'm 18, I graduated in the top 10% of my class, I don't party, drink, do drugs, or sneak out. I'm going to college in the fall on a scholarship to become a nurse. I'm always smiling, laughing, and joking around. I have plenty of friends that love and support me. Despite all of that I have suicidal thoughts that will not go away. I'm recovering from an eating disorder and I have an anxiety disorder, I'm not currently in counseling but I am supposed to call and set up an appointment tomorrow. I know exactly how I would kill myself and I think about it all the time, even when I'm out with friends and having a good time. The thing is, I do not think I will ever follow through with it. I wish I could talk about it with someone, but I feel like if anyone mentions suicide they have to go to a hospital or intense treatment or something. I don't want that, I just don't want it to be a secret anymore. Also my parents don't acknowledge mental illness so I never want them to know anything about it. When I was in school I had weekly meetings with my school counselor, if I could tell anyone it would be her, but I know she would tell my parents.

Dear What Happens If I Tell My Therapist I Have Suicidal Thoughts?,

The purpose of psychiatric hospitalization when there are issues pertaining to suicide is to protect the person from any harm to him/herself and to stabilize that person so that they can be discharged and ready for some type of outpatient treatment (day treatment or weekly sessions with a therapist). Hospitalizations related to suicidal thoughts or actions might occur when someone has either had a suicide attempt or has intent to harm themselves, a plan of how to do it, and an inability to “contract for safety” (which basically means make a promise not to harm him/herself).

That said, if you have thoughts of suicide without any intent or plan to actually harm or kill yourself (referred to as passive suicidal ideation), hospitalization would generally not be necessary for that kind of issue. While hospitalization is usually not needed in cases of passive suicidal ideation, it is very important to share those thoughts with your therapist so that you and your therapist can work together to get a better understanding of what is contributing to those thoughts and feelings, as well as what issues need to be addressed so that those thoughts and feelings subside.

Given that you are 18, you would be considered an adult in your treatment and what you say in session should be kept confidential (unless you disclose intent and a plan to harm yourself or someone else). However, it would be a good idea for you to start your session by asking your therapist what his/her policies around confidentiality are, especially if your parents are going to be involved in the treatment (therapists will sometimes have different policies around confidentiality if they are working with someone individually versus in family or couples treatment).

TeenHealthFX imagines it must be very difficult for you that your parents do not “acknowledge” mental illness because it leaves you in a position of being without their support (and potentially feeling very alone) in dealing with these issues. Whether in a family session or in your own individual therapy, FX does think this issue is an important one to address in terms of whatever pain or anger you may be feeling about their not being there to provide you with comfort or support around this.

FX is glad that you do not want this issue to be a secret anymore. It is very important to have supports and not to carry these types of issues all on your own. We think it is wonderful that you will be calling to schedule a consultation for yourself. Therapy can be very beneficial in situations like you are describing, especially if you find a reputable and experienced therapist, such as a clinical psychologist or clinical social worker, who you find to be warm and non-judgmental.

It sounds like you have a therapist in mind who you will be calling, but consider the following if you need any additional resources:

  • If you live in northern New Jersey and need help finding a therapist you can call the Access Center from Atlantic Behavioral Health at 888-247-1400. Outside of this area you can log onto the US Department of Health and Human Services Substance Abuse and Mental Health Services Administration website for referrals in your area. You can also contact your insurance company to get a list of in-network mental health providers or check with your school social worker or psychologist to get a list of referrals in your area.
  • If you get to the point that you are seriously considering suicide or are afraid of your impulses then you need to seek help immediately. You can call 911 or go to your nearest hospital emergency room. In northern New Jersey you can also call the crisis hotline from Morristown Memorial hospital at 973-540-0100. Outside this area call the National Suicide Hotline at 1-800-SUICIDE (1-800-784-2433), available 24 hours a day, or the Suicide & Crisis Hotline, 1-800-999-9999, 24 hours, 7 days a week.
  • If you need some additional support, if you live in New Jersey you can call 2NDLFOOR, a confidential and anonymous helpline for teens and young adults, at 1-888-222-2228. If you aren’t from NJ, please call your local United Way or 211 for assistance and support.