Destigmatizing Suicide and Suicidal Ideation

Destigmatizing Suicide and Suicidal Ideation If you or someone you know is dealing with thoughts of suicide, you can call or text 988.

As a therapist-in-training, the thing that most scared me about starting to provide counseling to clients was having to discern whether or not a client is suicidal. I was taught how to ask questions and provided with checklists, but getting better at crisis response (in any context) requires real-world practice. I felt nervous every time I would go through my checklist with a new client. At first, when a client would disclose that they had attempted suicide in the past or that they frequently had thoughts about killing themselves, I would listen, ask questions, and secretly panic. After the session, I’d wonder: Did I miss something? Should I have asked more questions? Did I ask too many questions?

As I got to know my clients better, I felt more comfortable when I would have to go through my checklist. Just as clients build trust in their therapists, therapists build trust in their clients. Initially, I’d worry outside of sessions if a client would contact me in a crisis or if a client would be okay. I can only know what a client shares with me, but I can also do my best to create a space where anyone feels safe talking about difficult feelings, especially feelings related to suicide. As time went on, I learned to trust that by sharing negative thoughts with me, clients felt safe in doing so. Talking about suicide does not make it more likely that someone will attempt suicide.

Suicidal Ideation

Suicidal ideation is the term to describe thoughts related to suicide or “being better off dead.” Suicidal ideation could also be thoughts about wanting to go to sleep and never wake up. It is a spectrum, and more than two-thirds of people who experience suicidal ideation will never attempt suicide. It should still be taken seriously, and therapists and doctors can provide help to clients to reduce stress, reduce the frequency and intensity of thoughts, and provide suicide prevention support. Even with no plans to act on one’s suicidal ideation, it can be debilitating to live with constant thoughts of wishing you were not here.

Talking About It Helps

Suicide is highly stigmatized; people are often afraid to admit having thoughts about it, even if they have no intent to act on it. This leads to more suffering in silence and a lack of people getting the support they need. Destigmatizing suicide and suicidal ideations does not mean we are saying suicide is “okay.” It means we want to make it less scary to talk about, which makes it easier to treat. One notable change in the terminology around suicide is that clinicians are beginning to use the term died by suicide or completed suicide rather than committed suicide. The word “committed” implies criminality, which further stigmatizes it. It’s also unhelpful to frame it as a crime when the people who lost a loved one to suicide are grieving.

Confidentiality is essential to a good therapeutic relationship, but it’s also an ethical requirement for therapists. Breaking confidentiality with a client is harmful and unethical. There are, however, two exceptions where confidentiality must be broken. One is a therapist’s role as a mandated reporter; the other is if a client is threatening imminent harm to themself or someone else. So, as a clinician, if a client tells me about their plan to harm themselves, I am obligated to report it. Admittedly, this can also make it uncomfortable for therapists to talk about it openly. The limits of confidentiality are things I discuss at the start of any new therapeutic relationship. Acknowledging these limits is important to building a foundation of trust.

The Power of Destigmatizing

Normalizing open conversations about suicidal thoughts is essential to dismantling the shame that surrounds this kind of suffering. When we view suicidal ideation as a symptom, in the same way we treat anxiety, for example, we create room for more honest therapeutic relationships. That is where healing can begin. Destigmatizing suicidal ideation means acknowledging that these thoughts are a painful but human experience that can affect anyone. Talking about it—with friends, with a therapist, with a partner--creates a bridge to safety. The more comfortable we become sitting with these heavy conversations, the more effectively we can help others move through them.

Cleveland Clinic. (2025, July 21). Suicidal ideation (Suicidal thoughts). Cleveland Clinic. https://my.clevelandclinic.org/health/symptoms/suicidal-ideation

Klonsky, E. D., Dixon-Luinenburg, T., & May, A. M. (2021). The critical distinction between suicidal ideation and suicide attempts. World psychiatry : official journal of the World Psychiatric Association (WPA), 20(3), 439–441. https://doi.org/10.1002/wps.20909