You Can Tell Me Anything: Disclosure of Suicidal Thoughts and Behaviors in Psychotherapy

• Published in: Psychotherapy (Chicago, Ill.) Ill.), 2021-12, Vol.58 (4), p.533-543
• Main Authors: Love, Heather A., Morgan, Preston C.
• Format: Article
• Language: English
• Subjects: Adjustment; Behavior; Clients; Disclosure; Female; Health Care Seeking Behavior; Human; Humans; Male; Motivation; Psychotherapists; Psychotherapy; Suicidal Ideation; Surveys and Questionnaires
• ISSN: 0033-3204; 1939-1536
• DOI: 10.1037/pst0000335

Only half of clients disclose suicidal thoughts or behaviors in psychotherapy. Qualitatively, we sought to understand the experience of disclosing suicidal thoughts and behaviors (STBs) to clinicians and applied the disclosure processes model (Chaudoir & Fisher, 2010) to frame our findings. Participants (N = 68) responded to an anonymous, open-ended survey about their experience of disclosing or withholding recent STBs in therapy. Half of our sample (n = 34) withheld their STBs from their psychotherapist, whereas the other half (n = 34) disclosed. We coded primary themes of the disclosure process and framed these processes using the disclosure processes model framework. Motivations for nondisclosure primarily included fear of negative outcomes, particularly involuntary hospitalization. Motivations for disclosure included help-seeking intentions to address STBs and a positive therapist-client relationship. Clients' perceptions of psychotherapists' responses to the disclosure were described as supportive, the level of care was adjusted, or a lack of appropriate care was displayed. The findings of this study reveal common motivations for disclosing or withholding STBs and how psychotherapist responses to disclosures impact clients. Implications for promoting STBs disclosure in psychotherapy and responses to clients are included. Clinical Impact Statement Question: What motivates or prevents clients from disclosing suicidal thoughts or behaviors in psychotherapy? Findings: Motivation for disclosure was related to positive therapist-client relationships and help-seeking goals, whereas fear of involuntary hospitalization was the primary motivation for nondisclosure of suicidal thoughts and behaviors. Meaning: Psychotherapists' familiarity with common motivations for disclosing or withholding suicidal thoughts and behaviors has potential to improve care of suicidal clients. Next Steps: Long-term outcomes of the disclosure of suicidal thoughts and behaviors in psychotherapy need to be examined.