What might happen if you tell your therapist you're thinking of hurting yourself?
Updated: Sep 14
Talking about suicide or thoughts of hurting yourself can be difficult. You might worry about what will happen if you tell someone.
Will they panic? Will they call someone? Will you lose control over what happens next?
These are understandable concerns, and they can sometimes make it harder to say what is actually happening.
So what might happen if you tell your therapist?
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The first thing we do is talk about it
If you tell me that you're having thoughts about hurting yourself or ending your life, I'll want to understand more about what you're experiencing and what these thoughts mean for you.
We might talk about how often they're happening, how you're feeling in those moments, whether you've been thinking about acting on them and how safe you feel right now.
As your therapist, I'm responsible for taking what you tell me seriously, exploring your safety with you and considering what support or action may be needed.
Understanding your circumstances, your thoughts and feelings, and what might help you stay safe is central to deciding what support might be appropriate.
We think about safety together
If it would be helpful, we might create a safety plan together.
A safety plan isn't something I simply hand to you and ask you to follow. It's something we develop collaboratively, based on what you know about yourself and what might help when things become more difficult.
It might include recognising your own warning signs, identifying things that can help you get through a difficult moment, people you can contact, sources of professional support and what to do if you feel you can no longer keep yourself safe.
The aim isn't to pretend that difficult thoughts won't happen again. It's to have something you can turn to when they do.
Sometimes other people or services need to be involved
There may be times when talking together and creating a safety plan isn't enough.
Depending on what is happening, it may be appropriate to involve your GP, another mental health service, someone you trust or an urgent or crisis service.
Where possible, I'd want to talk this through with you and involve you in decisions about what happens next. You don't stop being part of the conversation simply because you're struggling.
There may, however, be circumstances where I have a professional or legal responsibility to share information because I believe you or someone else is at serious or immediate risk of harm.
What about confidentiality?
Confidentiality is an important part of counselling, and when you begin therapy I'll explain the circumstances in which it may have limits.
Having suicidal thoughts does not automatically mean that confidentiality will be broken. However, confidentiality isn't absolute. If I believe that sharing information is necessary to protect you or someone else from serious harm, there may be times when I need to involve other people or services.
Where possible, I would talk with you about this first.
Counselling isn't a crisis service
Counselling can provide a space where suicidal thoughts and thoughts of self-harm can be spoken about openly and without judgement. But counselling isn't a crisis service, and a private counselling appointment isn't a substitute for urgent help when someone is in immediate danger.
If you're in immediate danger or feel unable to keep yourself safe, please seek urgent help rather than waiting for your next counselling appointment.
You can contact NHS 111 and select the mental health option for urgent mental health support. If you or someone else is in danger, call 999 or go to A&E. You can also call Samaritans on 116 123 if you need someone to talk to.
You can talk about it
If you're experiencing thoughts of hurting yourself or ending your life and are able to keep yourself safe, talking to your therapist can be a good place to start. We can talk about what's happening, think together about your safety and consider what support might be helpful.
And if you need more immediate or urgent support, there are services specifically there for that too.
The important thing is not to be left carrying it on your own.
Disclaimer: This blog is intended to demystify what might happen if a client shares thoughts of self-harm or suicide. It aims to explain the possible journey, the limits of confidentiality, and the difference between therapy and crisis support. Please be aware that therapists and agencies may have different safeguarding procedures. This is a thought piece intended to explain my approach and is not a substitute for professional or crisis support.
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