Therapy for Suicidal Ideation
Compassionate and collaborative therapy for people experiencing suicidal thoughts, emotional pain, or periods of crisis.
You Can Talk About Suicidal Thoughts
Suicidal thoughts can be frightening, exhausting, isolating, or difficult to explain. Some people want to die. Others want emotional or physical pain to stop. You may feel trapped, disconnected, hopeless, burdensome, or unsure whether life can become different.
You may also be afraid to tell someone what you are experiencing. You might worry that you will be judged, misunderstood, or immediately hospitalized. These concerns can make it harder to seek support.
Therapy offers a place to talk honestly about suicidal thoughts. We can work together to understand what is happening, assess your current safety, reduce immediate risk, and address the experiences contributing to your distress.
If You Need Immediate Help
Therapy with Z does not provide emergency or immediate crisis response.
Call 911 or go to the nearest emergency department if you are in immediate danger or unable to remain safe. You may also call or text 988 to reach the 988 Suicide & Crisis Lifeline in the United States.
What Is Suicidal Ideation?
Suicidal ideation is a clinical term for thoughts about death, dying, or ending your life. These thoughts can take different forms.
Passive suicidal thoughts may involve wishing you could disappear, go to sleep and not wake up, or no longer exist. Active suicidal thoughts may involve thinking about ending your life. The level of intent, planning, preparation, and immediate danger can vary significantly.
Thoughts may appear briefly during a difficult situation. They may return during periods of stress. Some people experience chronic or recurring suicidal ideation over a longer period.
Every experience requires individual assessment. The presence of suicidal thoughts does not tell us everything about your level of risk or the type of support you need.
Why Suicidal Thoughts May Develop
There is no single cause of suicidal ideation. Thoughts may develop through an interaction of emotional pain, physical suffering, relationships, life circumstances, mental health symptoms, and environmental stress.
Suicidal thoughts may occur alongside:
anxiety, depression, or emotional numbness
trauma, PTSD, or painful past experiences
chronic illness, chronic pain, or disability
grief, loss, or major life transitions
relationship conflict, rejection, or isolation
discrimination, minority stress, or lack of belonging
financial, housing, employment, or academic stress
shame, guilt, or feeling like a burden
exhaustion from caregiving or ongoing responsibilities
substance use or changes in judgment
a recent crisis, hospitalization, or suicide attempt
difficulty imagining that circumstances can improve
The thoughts may serve different functions for different people. They may represent a desire to escape, communicate the severity of distress, regain a sense of control, or imagine an end to suffering.
Understanding what the thoughts mean for you is an important part of therapy.
What Happens When You Tell Me
Talking about suicidal thoughts does not automatically result in hospitalization.
I will listen carefully when you disclose suicidal thoughts. I will also ask clear questions about your experience. Assessment may include the frequency, intensity, and duration of the thoughts. We may discuss intent, planning, access to lethal means, past suicidal behavior, substance use, protective factors, available support, and your ability to remain safe.
These questions are not intended to punish or frighten you. They help us understand your current level of risk and determine what support may be appropriate.
Many people experiencing suicidal thoughts can participate in outpatient therapy through collaborative safety planning, ongoing assessment, additional support, and appropriate follow-up. Emergency evaluation or a higher level of care may become necessary when immediate danger is present or outpatient support is not sufficient.
I will be honest about concerns that arise. I will also involve you in decisions whenever circumstances allow.
Therapy That Addresses More Than the Crisis
Reducing immediate danger is important. Therapy should also address the conditions that make life feel unbearable.
Our work may explore what intensifies the thoughts, what helps them recede, and what has allowed you to survive difficult periods before. We may examine patterns involving emotions, relationships, physical health, self-criticism, isolation, avoidance, or overwhelming responsibilities.
Therapy may include:
identifying warning signs and changes in risk
developing practical coping strategies
strengthening distress-tolerance and emotion-regulation skills
working with hopelessness, shame, or feeling burdensome
addressing anxiety, depression, trauma, grief, or chronic pain
reducing isolation and identifying meaningful support
improving communication about your needs
creating distance from immediate urges
solving practical problems that contribute to distress
exploring values, identity, connection, and reasons for living
developing ways to respond when suicidal thoughts return
The goal is not to force optimism or demand that you feel differently. The work begins with understanding your experience. From there we can look for changes that make life more manageable and create room for something beyond the current pain.
Collaborative Safety Planning
A safety plan is a personalized set of steps for responding when suicidal thoughts intensify. I use a collaborative safety-planning approach informed by the Stanley-Brown Safety Planning Intervention.
A safety plan may include:
personal warning signs
coping strategies you can use independently
people or places that provide distraction
trusted people you can contact for support
professionals and crisis services you can contact
steps for reducing access to lethal means
personal reasons for living
A safety plan is not a promise or contract. It is a practical resource developed before or during a crisis. The plan should be accessible when thinking becomes more difficult.
Safety plans are reviewed over time. They may need to change as circumstances, relationships, resources, or risks change.
Reducing Access to Lethal Means
Suicidal crises can intensify quickly. Creating time and distance between a person and potentially lethal means can reduce immediate danger.
Means safety may involve temporarily changing access to firearms, medications, or other items that could be used during a suicidal crisis. A trusted person may sometimes help secure or manage access.
These conversations are approached collaboratively. The goal is to make the environment safer during periods of increased risk. Specific steps depend on your circumstances and current level of danger.
Recurring or Chronic Suicidal Thoughts
Some people experience suicidal thoughts repeatedly. The thoughts may become familiar even when there is no immediate intent to act.
Chronic suicidal ideation still deserves attention. Therapy can help identify changes from your usual baseline, recognize signs of increasing danger, and distinguish recurring thoughts from a developing emergency.
We may examine the function of the thoughts and the conditions that make them more intense. We can also strengthen your ability to respond without allowing the thoughts to control every decision.
Recurring thoughts do not remove the need for safety assessment. Risk can change over time. Ongoing honesty helps us notice those changes.
Support After a Crisis or Hospitalization
Returning to everyday life after a mental health crisis can feel overwhelming. You may be processing fear, shame, anger, relief, confusion, or concern about how other people now view you.
Outpatient therapy may support the transition after emergency evaluation, hospitalization, a suicide attempt, or another crisis. Work may include reviewing the events leading to the crisis, updating a safety plan, rebuilding routines, strengthening support, and coordinating with other professionals when authorized.
Some people need more support than weekly outpatient therapy can provide. Intensive outpatient programs, partial hospitalization programs, residential treatment, in-person services, or other levels of care may be appropriate. Recommendations depend on current needs and safety.
Suicidal Thoughts and Self-Harm
Self-harm and suicidal behavior can overlap but are not identical. Some people engage in self-harm without intending to die. Others may experience self-harm urges and suicidal thoughts at the same time.
Both experiences should be discussed openly and assessed individually. Therapy may explore what happens before the urge, what function the behavior serves, and what alternatives could help you survive intense emotional states.
My Approach to Therapy
My approach is person-centered, strengths-based, trauma-informed, and grounded in harm reduction. I will not reduce you to a risk level or assume that suicidal thoughts define who you are.
Therapy may draw from approaches that support acceptance, emotional regulation, distress tolerance, self-compassion, problem-solving, and behavioral change. We may use structured skills when practical tools are needed. We may also slow down and make room for experiences that need to be understood.
You are encouraged to ask questions, express disagreement, and participate actively in decisions about your care. Visit the Approach to Therapy page to learn more about how I work.
Who I Work With
I provide individual therapy for:
adolescents and teens ages 13 through 17
emerging and young adults
adults in midlife
older adults
Suicidal thoughts can occur during any stage of life. Therapy is adapted to each person’s developmental needs, circumstances, identities, health, relationships, and available support.
Caregiver involvement for adolescents is considered according to age, clinical needs, safety, privacy, legal requirements, and individual circumstances. Limits of confidentiality are reviewed at the beginning of therapy.
Online Therapy and Safety
Appointments are provided through secure video. You must be physically located in a state where I am authorized to provide therapy at the time of the appointment.
Your current physical location and emergency contact information are confirmed as part of telehealth safety planning. We will also discuss what to do if the video connection stops working during a difficult moment.
Sessions require a private location and reliable internet access. You cannot participate while driving.
Visit the Online Therapy and Telehealth page for current availability and more information about virtual sessions.
Frequently Asked Questions
Will I automatically be hospitalized if I mention suicidal thoughts?
No. Disclosure does not automatically result in hospitalization. I will assess your current risk and ability to remain safe. The response depends on the intensity of the thoughts, intent, planning, access to lethal means, recent behavior, available support, and other relevant factors.
Emergency intervention may be necessary when immediate danger is present. I will involve you in the process whenever circumstances allow.
Is everything I say confidential?
Therapy is generally confidential. There are legal and ethical limits to confidentiality. Action may be required when there is a serious and immediate concern about safety or when another reporting requirement applies.
We will review confidentiality and its limits before treatment begins. You are encouraged to ask questions about how information may be handled.
Do I need a diagnosis to receive therapy?
You do not need to identify a diagnosis before contacting me. We can begin by discussing what you are experiencing.
A formal diagnosis may be required when insurance is used. Any diagnosis will be discussed as part of your care.
Can I begin therapy if I am not currently in crisis?
Yes. You do not need to wait until the thoughts become urgent. Therapy may help you understand recurring thoughts, strengthen coping strategies, update a safety plan, and address the experiences contributing to distress.
Can you help me create a safety plan?
Yes. Safety planning can be part of therapy when clinically appropriate. We will create the plan collaboratively and review it as your needs change.
Do you provide emergency or on-call services?
No. Therapy with Z is an outpatient practice. It does not provide continuous monitoring, emergency response, or between-session crisis coverage.
Call or text 988 when you need immediate crisis support in the United States. Call 911 or go to the nearest emergency department when there is immediate danger.
Is online therapy appropriate when someone has suicidal thoughts?
Online outpatient therapy may be appropriate for some people experiencing suicidal ideation. Suitability depends on current risk, available support, privacy, location, treatment needs, and the ability to participate in safety planning.
Some situations require in-person treatment or a higher level of care. Appropriateness is assessed individually and may change over time.
How do I begin?
You may request an appointment through the secure scheduling system. Current rates, insurance information, and payment options are available on the Rates and Insurance page.
Submitting an appointment request is not a method of obtaining emergency help.
Begin Therapy for Suicidal Ideation
You do not need to hide suicidal thoughts or wait until they become unbearable before seeking support. If you believe outpatient therapy may be appropriate, you are welcome to request an appointment or contact me with questions.
Immediate Support
Therapy with Z does not provide emergency or immediate crisis response.
Call 911 or go to the nearest emergency department if you are in immediate danger or unable to remain safe. Call or text 988 to reach the 988 Suicide & Crisis Lifeline in the United States.