If you’re reading this, it might be because you’re feeling suicidal and you’re afraid to say something to your therapist because you’re worried about how they will respond. Let me preface this blog post with this—how your therapist will respond depends on a lot of factors—everyone is different, every situation is different. With that in mind, I will give a brief overview of what you can expect to happen when you work with a DBT-adherent therapist.
In DBT, we try very hard to not have our clients hospitalized, and there are many reasons for this. There is no research demonstrating that hospitalization reduces the chance that someone will complete suicide in the future. In fact, hospitalizing certain individuals who are suicidal might actually be reinforcing, making it more likely that they will attempt suicide in the future. Plus, hospitalizations do little to actually solve suicidality. If you’re hospitalized, you are removed from your environment for a period of time. You may learn some skills in the hospital, you may not. Then you are discharged right back into the same stressful environment. So your environment hasn’t changed at all and you’ve spent several days away from the problem, which likely creates more problems such as losing your job because you had to call off, or not resolving conflict with a significant other because you went to the hospital. Now, there are some situations where hospitalization is necessary (e.g., manic behaviors, psychosis), so that could happen, even if you’re in DBT therapy, but outside of those limited circumstances, most of the time we try to not hospitalize our clients for suicidal thoughts or intentions.
So, what do we do instead?
To get back to the question at hand, what will my DBT therapist do if I tell them I’m suicidal? Most likely your therapist is going to ask you several questions to assess the situation. They will more than likely be supportive and validating as much as they can while ascertaining information concerning the stressor that’s causing suicidal thoughts, intentions, and behaviors. They will ask about your intention and whether you have the means to complete suicide, and they will work toward determining your level of risk.
Once the assessment is complete, your therapist is going to work with you to mitigate this risk. Basically, they will help you problem solve ways to decrease your risk factors—making a plan to give medications to a trusted friend or family member, for instance. Or they might have you call someone in session and make plans with them to spend the night with them. It’s usually helpful to involve a supportive person in your environment to help you when you’re noticing suicidal urges. Your therapist is going to help you use DBT skills (e.g., tipping the temperature, paced breathing, self-soothing) to decrease your level of distress and remember your Life Worth Living goals. If you’re in comprehensive DBT, they’ll set up a plan to help you to remember to use phone coaching so that you can call them any time of the day to help with skills if you’re so distressed that you are struggling to use DBT skills. When the two of you have come up with a solid plan, your therapist may reassess you’re current state to determine the likelihood that you will use your safety plan versus harming yourself. They may set up a plan for them to check-in on you or have you reach out to them at some point. Many clients will note that having a game plan usually helps them decrease their suicidal urges, or at least manage them more effectively.
Being willing to discuss suicidal thoughts, intentions, and actions, can be incredibly difficult. It is especially challenging if you don’t know what to expect from your therapist or if you’re worried about how they’ll respond. If you feel this way, you are not alone. Instead of focusing on “staying alive,” DBT focuses on building a life worth living—learning how to build your life to be a life where you genuinely are excited to live day by day. DBT therapists directly teach people how to build a life worth living by helping people to solve the problems that are leading to suicidal urges. Hopefully this gives you more insight into how DBT therapists manage suicidal thoughts and behaviors!
About the Author
Maria Mangione (she/her), M.A., LPCC is a licensed clinical counselor that specializes in dialectical behavior therapy. Maria works to help people develop the tools they need to develop trust in themselves and build their life worth living. Maria believes in having meaningful connections with her clients and believes that therapy and healing can be fun. Click Here to learn more about Maria’s experience and therapeutic style.
If you are feeling suicidal, or you are in crisis, please call 988 (the suicide prevention hotline) for assistance.
Suicide Prevention by the American Psychological Association: Click Here
DBT’s Approach to Treating People at High Risk for Suicide: Click Here