Beyond Safety Plans: How to Sit with Suicidal Ideation and Honor Its Function
Suicidal Ideation Isn’t Just a Symptom. It’s a Strategy.
Suicidal ideation (SI) is not simply an indicator of pathology. It is a coping strategy. It’s a way to manage unbearable emotional pain, find a sense of control, escape, or imagine relief when life feels impossible. For some people, SI is not a temporary crisis but a lifelong presence: a nagging thought that surfaces in times of stress or a familiar old coping strategy that has helped them survive.
In my own work, when a client discloses suicidal thoughts, I don’t feel alarmed or afraid. In fact, I rarely feel like it is an emergency. That stance alone is a therapeutic intervention.
Clients are exquisitely attuned to our reactions. If I flinch, rush to safety planning, or treat their disclosure like a crisis, I reinforce the message that their thoughts are dangerous, shameful, or unmanageable. But if I stay grounded and curious, the client immediately sees: “My therapist isn’t afraid of this. Maybe I don’t have to be either.”
That calm stance communicates safety, reduces shame, and models affect tolerance in real time. It shows that suicidal thoughts can be spoken aloud, examined, and survived in the room without escalation. Clients recognize that suicide is something that can be talked about without catastrophe.
When clinicians work too hard to eliminate suicidal ideation, they risk misattunement and inaccurate treatment. Treating SI as purely a problem misses its paradoxical purpose: it has been helping the client feel better.
The purpose of this article is to encourage clinicians to sit with suicidal ideation rather than rushing to fix it.
Understanding Common Functions of Suicidal Ideation
When you discuss the details of suicidal ideation (SI) with a client, aim to understand the role the thoughts play rather than immediately categorizing them as risk. Ask questions like:
When do these thoughts show up?
What do they provide in that moment?
How do you feel just before they come up?
How do you feel just after?
Teasing out these details validates the client’s lived experience and models that suicidal thoughts are not inherently untouchable or dangerous to talk about. In fact, when SI is explored calmly and without fear, its intensity often decreases. The thoughts can become less like an emergency and more like any other passing thought. As we know, all thoughts and urges are something that can be noticed, tolerated, and allowed to move on without action. This shift in attitude in the therapy session can lower risk and reduce shame.
In my practice, I see clients with labels like “treatment resistant.” These clients can tell you all about their upbringing and trauma, they’re overly familiar with safety plans, and they’ve had multiple therapists try to eliminate their SI. But what’s actually happening is that no one has slowed down to ask what SI does for them.
Below are several common themes around the function of suicidal thoughts, with examples to illustrate the concept.
Control: Imagining suicide can restore a sense of choice when everything else feels chaotic or dictated by others. This is particularly prominent in children and teens who lack a lot of control in their lives. SI restores the possibility of self-determination in circumstances that feel oppressive or inescapable. Understanding this function allows clinicians to honor the client’s need for agency.
Example: A college student trapped in a demanding major chosen by their family may quietly imagine suicide to feel some power over a life that doesn’t feel like their own.
Unbearable emotions: When emotional pain feels intolerable, people often clamour in desperation to make it stop immediately. For some clients, suicidal ideation becomes one way to imagine stopping the pain right now. It’s less about wanting to die and more about wanting the suffering to end. Many of these clients have little to no affect tolerance. They haven’t learned or have never experienced that intense emotions rise, peak, and subside on their own. In their lived experience, distress feels endless and lethal. They genuinely don’t know that feelings won’t kill them or last forever.
Example: This commonly shows up as thoughts like “I can’t do it.”, “I can’t feel this another second.”, and “It’s always going to be like this so I can’t keep living.”
Escape: Suicidal ideation can offer a mental break from unresolvable circumstances or feeling stuck. Often, the “stuckness” isn’t just about an external situation, but about fear of change or not knowing how to take the next step. In those moments, imagining suicide can feel like the only exit door.
Example: A client in a painful relationship may think, “I can’t bear to leave, but I can’t stay like this. At least I could end it.” Suicide becomes the imagined escape from a breakup they don’t yet know how to navigate.
Communication: For some, suicidal ideation is a way to signal unbearable distress when other methods have failed. It’s a desperate attempt to be heard. This signaling is often unconscious. A person might not deliberately think, “I’ll use suicidal thoughts to get attention.” Instead, they may find that only when they hint at self-harm or suicide does anyone stop, listen, or respond with urgency. Over time, the mind learns that expressing suicidality reliably produces validation, care, or intervention, which everyday expressions of sadness or despair did not accomplish.
Example: A client might notice that nobody responds to their depression until they hint at self-harm or suicide, at which point family or friends finally listen.
Safety Plans Are Not Enough
“When I tell you I think about suicide, it’s not because I want attention or because I’m about to act on it. Those thoughts help me find relief. Like there’s a way out if things never get better.
So when you ask me to remove my suicidal thoughts it feels like you’re asking me to give up the one thing that has been helping me survive. I hear that my coping is unacceptable and that I can’t talk about what actually gets me through. It makes me feel ashamed for having these thoughts. Like there is something wrong with me.
If you want to help, I need you to understand what those thoughts do for me. Ask me about them. Honor the role they’ve played. Then, if we’re going to work on change, let’s figure out together how I can get the relief and control I need in ways that don’t leave me at risk.”
When treating suicidality, we’re not treating a monolith. We’re not just “treating suicide.” We’re treating a complex, individualized coping strategy that gives each client something different. A generic safety plan doesn’t address this complexity. Without taking the time to determine what suicidal ideation does for the person in front of us, we risk making things worse.
The mental health struggles continue because the underlying function of SI was never addressed. Without that step, a safety plan becomes just another piece of paper and the client ends up feeling like the problem, rather than realizing their suicidal thoughts are serving a purpose that deserves to be understood and honored before being replaced. Sometimes, we have to stop intervening and just listen. Most clinicians are too afraid to risk that.
Understanding Risk Levels
The first step is recognizing that not all suicidal ideation carries the same urgency. Some clients experience chronic, background SI that serves as a coping strategy without immediate intent. Others present with active planning and imminent danger. These two situations require very different responses. Of course safety is always primary, but when there are no immediate threats, you can and should slow down. Slowing down creates room to explore what the thoughts are doing for the client, rather than moving straight into crisis mode.
Honoring Suicidality
When SI is not acute, take time to validate the role it has played in survival. These thoughts may have carried the client through unbearable moments. Letting go of this coping strategy might be met with resistance, grief, or anger. Holding and naming these emotions strengthens trust. It shows clients that you are not frightened of their experience and that their thoughts are safe to discuss openly.
I’ve worked with clients whose lives have dramatically improved. They have stable jobs, supportive partners, reduced symptoms, and yet SI still lingers. Self-hatred, shame, and old coping patterns don’t vanish overnight. Honoring SI means acknowledging that even in healing, the thoughts may still come, and that’s not failure. That’s part of the work.
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About our practice: At Sagebrush Psychotherapy, we specialize in working with chronic suicidal ideation and the complex struggles that come with it. If you or someone you know is ready for therapy that treats suicidal thoughts with nuance, compassion, and expertise, we invite you to explore our offerings and see how our team can support you.