What happens if you tell your therapist you're suicidal?

I keep rehearsing the line in my head, like it is a script, but my mouth stays closed when I sit on her couch. I am very polite. I say “yes ma’am” and “thank you.” I talk about sleep hygiene and stressors and coping skills, like I am trying to sound clinical for the session notes. The real sentence is that I have suicidal thoughts. No plan. No date. Just the thoughts, like pop ups, and it scares me. I do not say it because I picture her switching from calm therapist mode to risk assessment mode, and then confidentiality turns into a rule book. She knows my parents. They pay. My brain keeps yelling she will call them and say I am unsafe. I know there is duty to protect, imminent risk, mandated reporting, all that stuff, but it feels like a trap door under the carpet. I imagine a cascade: she documents it, asks about means, does a lethality screen, makes a safety plan, asks for consent to involve family, and if I freeze she escalates to crisis protocol. Then my mom crying, my dad going quiet, and me getting treated like a problem to be managed. I keep thinking, what if I say it wrong, what if “I don’t want to be here” sounds like “I will do it tonight.” What if I get sent to a hospital because I used the wrong words. I try to stay objective, like I am reporting symptoms, but my hands sweat and I talk about homework instead. Do you also do that thing where you translate your pain into acceptable bullet points so nobody panics;

Last session she asked what I am avoiding, very gently, and I gave the most boring answer possible. Later at home I tried to be logical. Therapists do not want drama, they want risk management and client stability, and they usually follow a decision tree. If there is no plan, no intent, and you can agree to a safety plan, the standard of care is often outpatient. That is what I repeat to myself because it helps. I can picture a version where I say, “I have suicidal ideation, passive and recurring,” and she nods like it is a normal data point. She might do a brief suicide risk formulation, ask about protective factors, and build a coping toolbox with me. She might suggest a psychiatric consult. She might ask me to reduce access to anything risky, and ask if I have one trusted adult, and that part could be my choice. If someone is in immediate danger, calling local emergency services is the right move. I still fear the parent phone call, yes, but I also notice hiding it is its own risk. When I keep it secret, the thoughts get louder, like they win by default. Also, I do want a future, even if it is small, like just finishing a week and eating breakfast. When I imagine saying it out loud, it feels like turning a light on in a messy room. Not clean, just visible. And visibility is kind of the first intervention. I am not saying it becomes easy. I am saying it can become more manageable, and a treatment plan is a real thing, not a moral failing. Next time I think I will ask her, politely, what her confidentiality limits are with parents, in plain words, before I disclose details. If you were in my chair, would you rather keep guessing, or would you rather know the protocol and build a plan that keeps you here for the next day, and the next?

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