Talking about Suicidal Thoughts

My approach to suicide risk management combines assessment, crisis support, problem solving, and prevention of future crises. Talking about suicide does not put the idea in someone’s head or increase risk. In fact, asking clear, direct questions—like ‘What would make you more likely to harm or kill yourself?’—can be lifesaving. Over the years I’ve noticed that many clinicians feel uneasy talking with clients about suicidal thoughts—often out of fear of liability—so they quickly recommend hospitalization or hand the assessment off to someone else. While safety is always the priority, that kind of immediate reaction can unintentionally shut people down, make them distrustful, and discourage them from opening up. That’s why I focus on normalizing these experiences, as was shown in the video we watched.

When someone is withdrawn or hesitant to answer my questions, I slow down and normalize what they’re feeling. This can help reduce shame and make it easier for them to talk. On the flip side, some clients feel tremendous relief to finally be able to talk about their pain openly. It’s essential to learn directly from the person at risk—they’re the ones who will be doing the hard work of building a life with less danger of suicide or self-harm.

Because suicide risk is particularly high in the LGBTQ+ community, it’s vital to be comfortable asking about self-harm. When I shadowed a physician in Salt Lake City who works with many transgender clients, she explained that she often begins with simple, direct questions about mood as a way to assess suicidality.

My job as a therapist is to address suicide directly, listen without judgment, and empower clients to be active in their own care. Collaborative management of suicide risk gives people hope and a sense of control. It helps them build confidence and resilience so they can thrive long after therapy ends.