Every therapist remembers the first time they are touched by the death of a client by suicide.
It’s a moment that never really leaves you. She attended a group I facilitated, the news of her death devastated our clinic.. I still recall a nurse practitioner, who had worked with her for years, saying softly, “Sometimes the trauma is too deep, and it’s too hard to turn the ship around.” That sentence has stayed with me ever since.
The very first suicide training I attended was a state-run program. It felt clinical, procedural, and—if I’m honest—a bit disconnected from the reality of the pain people live with. We were taught to have clients sign “no-suicide contracts,” to give them worksheets where they listed distractions or people to call, and to ask a standard set of questions about intent, means, and plans. The message was clear: if the client didn’t have a specific, well-rehearsed plan, the risk was low. Over the years, I noticed that many of these protocols seemed designed less to save lives and more to shield clinicians from malpractice lawsuits.
But if you’ve ever loved someone who has struggled with suicidal thoughts, made attempts, or died by suicide, you know how inadequate these strategies can be.
Suicide is not rare, and it is not selective. Just this past year, two men in my own community—both in midlife—died by suicide. As a woman in my early 40s, these losses felt all too close. And the truth is sobering: despite decades of training, research, and intervention strategies, mental health professionals are about as effective at predicting suicide as chance alone. We simply aren’t very good at it.
It was in this context that I first came across the work of Dr. Stacey Freedenthal, a PhD, LCSW, and professor at the University of Denver. Her career has been dedicated to the study and treatment of suicidality. She has researched it, written about it, treated it in her own psychotherapy practice, and lived it—having once been suicidal herself. Some of her ideas run counter to traditional suicide prevention strategies, but they resonate deeply because they are rooted in compassion and authenticity.
One of the most profound shifts she offers is the practice of suicidal storytelling. Rather than bombarding clients with checklist-style questions like, “Do you have a plan?” or “Do you have the means?” she encourages therapists to step into curiosity and empathy with questions such as: “Can you tell me the story of how you got to this place?” or “What has brought you to the point of wanting to end your life?” These open-ended invitations give people the chance to share, in their own words, what feels unbearable. More importantly, they transform the therapeutic space into one of true connection. Research has shown that when people feel heard, validated, and understood—when they feel someone is sitting with them in their pain rather than analyzing it—the likelihood of dying by suicide decreases.
In my own practice, I’ve seen how hesitant people can be to speak about suicidal thoughts. There is often deep shame and fear: fear of being hospitalized against their will, fear of being judged, or fear of being misunderstood. Yet suicidal thoughts are far more common than most realize, extending beyond those with diagnosed mental illnesses. When I suspect a client is struggling with these thoughts, I often normalize the experience, letting them know they are not alone. As Dr. Freedenthal suggests, this normalizing can open the door to honesty.
When clients finally speak their truth, they almost always rush to soften it—“I would never actually do it,” or “It’s not that bad.” I listen, but I also know that research shows people tend to underreport the severity and frequency of their suicidal thoughts. That awareness keeps me attuned and reminds me to take even tentative disclosures seriously.
As therapists, we walk a narrow, often frightening line. Suicidal clients are the ones most in need of care, but they are also the ones who place clinicians at the greatest risk of legal liability if the unthinkable happens. This tension can leave therapists feeling paralyzed, torn between protecting themselves and fully showing up for their clients. And yet, this is exactly where we are needed most.
As we step into September—Suicide Awareness Month—I am reminded that suicide is not only a clinical issue; it is a human one.
Look around your own circles—your community, your friends, your family. Chances are, more people than you realize are quietly carrying suicidal thoughts. The most powerful thing you can do isn’t necessarily to have the perfect words or interventions. It’s to be willing to listen, to sit with someone in their pain, to validate their struggle, and to help them find professional support through therapy, medication, or inpatient care if needed.
