So…taking the first step to engage in mental health therapy can be jarring enough, especially when experiencing suicidal thoughts. If you have already taken this step, you should be so proud of yourself because this is a difficult step to take! 

Sometimes when we are seeking therapy, we have more on our minds than the day to day stressors and/or desire to vent to a neutral source. Sometimes, we are dealing with suicidal thinking, whether we realize it or not. And this can be quite frightening for some, while it feels fairly normal for others. So as a therapist, when I hear someone say something that may indicate suicidality, it is essential for me to take a closer look at what’s happening. 

Also, side note…if anyone in your life makes what you feel may be a suicidal statement, please make sure that you are asking questions, supporting them, and/or getting them connected to the appropriate professionals. Whether it is yourself suffering with suicidal thinking or a loved one, it is best to call the suicide hotline at 988 (press 1 for veterans) and/or call 911 or get to your nearest emergency room in the event that you or a loved one feels unsafe regarding suicidal thinking. Click here for additional resources.

Different Types of Suicidal Thoughts

I want to clarify the different types of suicidal thoughts that can happen for people so we all have a better understanding of varied experiences with suicidal thinking. 

Passive Suicidality

First, there is passive suicidal thinking. This type of thought is passive in nature, hence the name. When people have thoughts like this, such statements and/or questions may run across their mind like, “Maybe it would be better for everyone if I weren’t here”; “I wish I were dead”, “I want to die”, “why am I here?” or “I wish I could go to sleep and not wake up”. When people are dealing with passive suicidal thoughts, this tends to mean that there is no plan or intent to harm or kill themselves in place. In therapy, if we as clinicians have determined that you are safe at the time that passive suicidality is discussed, then we discuss creating a safety plan together and talk about safety contacts (trusted people and/or emergency contact) in case one no longer feel safe and they feel they cannot safely utilize their safety plan.  

What’s a safety plan? 

A safety plan is a tool that is created in a therapy session with one’s therapist for the purpose of having it at their disposal when suicidal thoughts creep back up. A safety plan will prompt one to list out triggers that contribute to suicidal thinking, plan, and/or intent; ways one can remain safe independently (go on a walk, read a book, spend time with a pet); who the trusted people in their lives are and who can be called by client for distraction (not discussing the problem) or for help (discussing the problem); listing out places that bring one a sense of peace and/or distraction, where they can go when feeling upset and/or overwhelmed; listing out emergency contact in safety plan (who can a therapist call in the event thatthere are concerns for safety and client is not reachable); listing out Suicide Crisis Line Phone Number- 988 (press 1 for veterans); list out 911 on safety plan; and list out nearest emergency room closest to client’s home where they may go in the event of a suicidal crisis/emergency.

Active Suicidality

Another kind of suicidal thinking is referred to as active suicidal thinking. With this comes thoughts of not only wanting to die and/or “not be here” anymore, but this has escalated to the point of the sufferer wishing to take their own lives, having formulated a plan and/or has intent to harm or kill themselves. For example, someone may tell you that they are feeling depressed, worthless, and life is no longer worth living. They then go on to say that they are ready to exit this world and plan to jump off of a bridge that very night. When something like this is said, immediate action should be taken. By immediate action, I mean calling the Suicuide Crisis Line and/or 911 or bringing your loved one to the emergency room. There is no tip toeing around this. If someone with active suicidal thinking has a plan and/or intent to harm or kill themselves, they need immediate safety and stabilization. No ifs, ands, or buts about it. They may be upset with you for calling the crisis line, the police, and/or taking them to the emergency room, but this is for their own safety and well being. 

Why take action?

Often times, those who survive suicide attempts are grateful they did and are more motivated to start a new chapter in their lives. Suicide is a permanent solution to a temporary problem. Suicidal thoughts are treatable! Therapy can help those who suffer with suicidal thinking to learn healthy coping skills,learn to reframe negative thinking and find news ways to navigate their lives in a way that feels worth while and meaningful.  

The Bottom Line

If you tell your therapist that you are suicidal, much more questioning needs to occur first before anything else. So you may get a slew of questions that seem redundant, but they are necessary to have the best grasp on what your clinical and safety needs are at that time. Oftentimes, we as therapists are able to formulate safety plans together and check in on this together regularly. However, there are some times when we need to call 911 and/or get you to an emergency room. Sometimes, this may result in a psychiatric inpatient hospitalization in order to keep you safe and have another treatment team in the hospital evaluate your safety and needs. This is all done in the name of safety and genuine care for our clients. We’d rather you be upset with us and get help than not be here tomorrow. 

The concept of psychiatric hospitalizations seems scary to some people, especially if you have never been hospitalized this way before. As someone who used to work in inpatient psychiatric hospitals, I can confidently confirm that the first goal at intake is discharge. Inpatient treatment teams seek to quickly stabilize and get patients out of the hospital safely with plans in place in the community to prevent future hospitalizations. 

We as therapists are here to support you no matter what. We just ask because it can save a life. Please see our emergency resources page if you are struggling with suicidal thinking.

- Jackie Martinez, LMSW

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