Parsing a few things because this is not a good sentiment to be bouncing around the internet unchallenged. As a PhD student in counseling psychology, I am also, for all intents and purposes, a practicing therapist with a caseload of 10-12 clients a week and up to 20 total depending on whoās coming in weekly/bi-weekly, while also seeing a handful of walk-in crisis appointments who donāt end up on my caseload. In my setting (college counseling centers) an overwhelming majority have expressed past suicidality and a pretty high percentage (maybe 30-40%?) express current suicidality at some point in their work with me. I have sent precisely zero people for involuntary hospitalization. That is my (and any other therapist who is following ethical practiceās) absolute last resort. If you express suicidality in session, your therapist will do a lethality assessment that will vary in brevity according to the severity of your suicidality and will generally assess plan (do you have a specific plan for how you would kill yourself? how detailed and specific is this plan?), access (do you have access to the substances/location/other means that are needed to follow said plan? How hard or easy is it for you to gain access?), and intent (do you actually plan on making an attempt). The assessment will also include risk factors like substance use, impulsivity, previous attempts, recent losses, hopelessness, etc etc andĀ āprotective factorsā like social support, spirituality, positive coping skills, sense of responsibility to significant others etc etc. Before any counseling relationship begins, the therapist will let the client know about confidentiality and the limits thereof, one of which is that a therapists duty is to protect the health of the client above all else, so if a client provides information that they are an imminent (time is an important criteria. I could not, for instance, hospitalize a client with a very specific plan, access to said plan, and intent to follow through on the plan if the plan is for some time off in the future) risk to their own health, confidentiality no longer applies, and the therapist has a legal and ethical duty to take action to reduce that risk. However, 99 times out of 100, that action is making the lethality assessment, coming up with a safety plan and letting the client leave! Institutional settings are generally not positive places, so we donāt want to send people there when itās possible to keep them healthy in their own homes. Iāve had a client who would sit in my office every week and tell me that they wished their family was not around so that they could commit suicide. That they desperately wanted to kill themselves but that their family would be devastated so they wouldnāt try. Thatās significant, strong suicidality, and I never once even waffled on whether or not I should consider trying for an involuntary hospitalization.Ā
TL;DR - Expressing suicidal ideation in therapy is very common, therapists do *not* want to institutionalize you and, in fact, legally cannot unless a lot of conditions are met, and we donāt trap people into institutionalization - limits of confidentiality are enumerated at the beginning of therapy, and if a conversation is moving in a direction that would risk a client crossing those boundaries, I (and other therapists) will remind the client about where the boundary is, and institutionalization is rare, especially in college counseling centers. In the 2015-2016 school year at the university i worked at (~5,000 students, 4 full-time counseling staff), there was one involuntary, therapist-initiated hospitalization. One. Yes itās a risk, but not a lot of other settings are going to include someone who can process that with you in a healthy way and give you access to the skills and resources that will help.Ā
