Can I Tell My Therapist I’m Having Suicidal Thoughts?

There are some things people tell me they rehearse before coming to therapy.

How to explain their relationship.

How to talk about their anxiety.

How to describe their childhood.

But there is one sentence that many people never imagine they’ll say out loud: “I’ve been having suicidal thoughts.”

For some, those words feel too frightening to admit, even to a therapist. They’re worried about what will happen next. Will I be judged? Will my therapist think I’m unstable? Will they call the police? Will I lose control over what happens to me?

Those fears are incredibly common. In fact, I’ve had many clients tell me they waited weeks, months, or even years before saying anything because they were afraid of the consequences of being honest.

The first thing I want you to know is this: if you’ve ever had those fears, you’re not alone. And if you’ve been carrying thoughts like these, you don’t have to carry them by yourself anymore.

One of the biggest misconceptions about suicidal thoughts is that they always mean someone wants to die. In my experience, that’s often not what people are trying to tell us.

More often, they’re telling us they’re exhausted.

They’re overwhelmed.

They’re hurting in a way that feels impossible to explain.

They’re wondering how much longer they can carry the weight they’ve been carrying. What they want isn’t necessarily for life to end. They want the pain to end. Those are two very different things, and understanding that difference changes how we respond. When someone tells me they’re having suicidal thoughts, my first reaction isn’t panic. It’s curiosity and compassion. I want to understand what’s happening in their life. I want to know what has brought them to this point and what the thoughts actually mean to them. Every person’s experience is different, and it’s important that we don’t make assumptions.

One of the questions I’m asked most often is whether therapists have to report suicidal thoughts. The answer is no... not simply because someone has shared that they’re having them.

Therapists are trained to assess risk thoughtfully. We look at the whole picture. We talk about how often the thoughts are happening, whether there’s a plan or an intention to act, what support the person has around them, and what will help them stay safe. Many people are able to have these conversations in therapy without any emergency intervention at all.

There are times when someone is at immediate risk of harming themselves and can’t keep themselves safe. In those situations, we do have a responsibility to act. But those decisions are never about punishment or taking control away from someone. They’re about protecting life during a moment when the pain has become too overwhelming to manage alone.

If you’ve been afraid to tell your therapist because you thought you’d immediately lose your autonomy, I hope this helps ease some of that fear. Therapy should be one of the safest places to bring the thoughts you’re most afraid to say out loud.

If you’ve been struggling, please don’t wait until things feel unbearable before reaching out. You don’t have to convince yourself you’re “bad enough” or that your pain has reached some invisible threshold. If you’re hurting, that is enough.

Whether you speak to a therapist, your family doctor, a trusted friend, or a crisis service, let someone into what you’ve been carrying. Pain has a way of convincing us we have to manage it alone. Healing almost always begins when someone else is allowed to sit beside us in it.

And if you’re already in therapy, wondering whether today’s the day you finally tell your therapist the truth, I hope you do.

I can almost guarantee you’ll feel lighter having said the words than continuing to carry them alone. ____

If you or someone you know is in immediate danger, call 911 or go to your nearest emergency department. If you’re in Canada, you can also call or text 988 to reach the Suicide Crisis Helpline, available 24/7. You don’t have to face this alone.