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When I ask someone if they’ve ever thought about suicide, I hold my breath as I wait for the answer. I know that they are likely to say yes. I know that as a therapist, who has heard suicidal ideation “endorsed” regularly, I also know that suicidal ideation is much more common than we may wish to believe.

The Centers for Disease Control (CDC) acknowledged an ongoing mental health and suicide crisis among adolescents and young adults. In a 2021 survey, 3.3 million adolescents had serious thoughts of suicide. In the same year, 12.3 million adults had serious thoughts of suicide.

Those thoughts don’t always show up in the ways we might think. Sometimes they show up like this:

• “Sometimes I just feel empty.”
• “I just want to disappear.”
• “I wish I could run away.”

As someone who spends time playing with words and metaphors as a writer, I am so moved by how people describe their suicidal ideation. Don’t get me wrong, it absolutely scares me.

But suicidal ideation is not suicidal intent. It is thinking about the idea of not being alive, thinking about the idea of disappearing, thinking about the idea that the people who love you might be better without you. Yes, it is painful to think those thoughts. Incredibly painful. And it is painful to hear and hold space for people to articulate those thoughts.

Yet to be effective as a suicide prevention professional, as a therapist willing to work with people who have experienced suicidal ideation, it also has to feel okay to hear those things.

So when a 15-year-old says that sometimes he feels empty, I listen. I make space for it. I make it okay to say it out loud.

What is much harder is thinking about what needs to be said to a teen’s parents.

Unlike just about everything else a young person shares with me, suicidal thinking is something I will need to share with a teen’s parents, if the young person tells me they are actively thinking about suicide right now. So, hearing what that teen has to say is a tremendous moment of living faith and fear.

In the New York Times Magazine issue on therapy, Maggie Jones goes in-depth on teenagers thinking about taking their own lives, beautifully weaving together the stories of professionals working at Services for Teens at Risk (STAR) at the University of Pittsburgh Medical Center.

Jones touches on the very real questions that parents wrestle with once they know their child is actively suicidal.

Suicidal children are caught in a vortex of pain, and those around them are often unsure how to respond.

At what point do you take your child to the hospital? What if they refuse to go? If they have attempted suicide, do you consider residential care in a facility? What else can you do to protect them? How do you know they won’t die the next time?

I can tell you it is different as a therapist and a parent. As a therapist, like Daniel Bender, a psychiatrist at the University of Pittsburgh Medical Center, my goal is to “understand how it feels to be them, not to tell them what they need to do.”

But, as a parent, it is much more complicated.

Bender shares about “the parents who are so anxious and desperate for someone to alleviate their child’s pain that they blame the therapist when she can’t pull it off.” This can happen when therapists recommend more treatment than just one-on-one therapy, something like hospitalization or an intensive outpatient program.

Bender’s new goal is not to “fix” young people. In the article, he shares that he “shifted his views about the work and his impulse to safeguard suicidal children at all costs. He began focusing on making them feel "‘seen and human’... If I can help a kid feel understood and help parents understand their kids… that is treatment.”

Sitting across from that 15-year-old and seeing him look right at me (not an easy thing for a teenager) as I saw him, made space for his pain, and let him know that I could handle his hard thoughts: This is why people become therapists, for these moments of connection, truth, and intimacy. To be able to help someone feel seen and human. That is treatment.

If you or someone you love is contemplating suicide, seek help immediately. For help 24/7 dial 988 for the National Suicide Prevention Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741.