September is my favorite month of the year. Not only is it my birthday month, but it’s also  a time for reflection and renewal, and the month offers an opportunity to delve deeper into the complexities of mental health, including ideation. September is Suicide Awareness Month.  While therapy  focuses on the well-being of clients,  what many people don’t know is that therapists also experience emotional challenges.

As a therapist who has experienced suicidal ideation before, I think it’s time we bring context and nuance to the conversation:

1. Therapists can also experience  suicide ideation

• Breaking the Stigma: We therapists, like anyone else, can struggle with mental health, including ideation. By openly discussing this, we can dismantle the stigma surrounding mental health within the therapy profession.

• Self-Care and Support: Therapists need access to self-care resources and support networks to manage their own well-being. This can include peer support groups, supervision, and personal therapy.

2. Therapists can also be on the receiving end of psychiatric care

• Seeking Help: It's essential for therapists to recognize when we need professional help and seek appropriate care, such as therapy, medication, or hospitalization.

• Confidentiality and Ethics: In therapy, Therapists are also deserving of privacy and confidentiality. We deserve to be treated just like any other client, without assumptions that we should “know better” because of our profession.

3. Many workplaces do not look out for therapist well-being (nor do they pay well) but expect therapists to self-sacrifice.

• Systemic Issues: The therapy profession often faces systemic challenges, like low pay, long hours, and limited resources. These factors can contribute to therapist burnout and mental health issues.

• Advocacy for Change: It's important to advocate for changes within the therapy profession, such as fair compensation, adequate support systems, and ethical workplace practices.

  
  

4. Being a therapist comes with a lot of costs, both literal and figurative.

• Financial Strain: Therapists often face financial challenges, including student loan debt, low pay, and limited opportunities for advancement. I go into depth about this with Michael Fulwiller at the Heard Business School podcast. While therapy can be a lucrative field for some, it’s often not the case for many, and comes with a lot of marketing and entrepreneurial skills many therapists don’t have. 

• Emotional Toll: The emotional demands of the job can take a toll on therapists' mental health, leading to burnout and stress. We don’t just “talk to people all day” or “profit off people’s trauma”. A good therapist profits off a client’s healing, and we are supposed to work ourselves out of a job. This means that we need to pinpoint people’s pain and treat the wound with understanding, sensitivity, and intervention. This requires a lot of training, skill, attention to detail, and our ability to hold people’s pain for hours on end. 

  
  

5. Coercing someone into “voluntary hospitalization” is actually involuntary and harmful.

• Informed Consent: Individuals experiencing ideation should have the opportunity to make informed decisions about their treatment. Coercing someone into hospitalization can undermine their autonomy and trust in the therapeutic relationship.

• Alternative Options: There are often alternative options to hospitalization, such as outpatient therapy, crisis hotlines, and support groups. Exploring these options can help individuals find the most appropriate care.

  
  

6. Hospitalization can be incarceration.

• The Experience of Hospitalization: For some individuals, hospitalization can feel like incarceration, with limited privacy, restrictions on movement, and forced medication.

• Law enforcement: Many emergency medical services and mobile crisis teams in the U.S. rely on the presence of law enforcement for hospitalizaiton. For many people of color experiencing mental health crises, the presence of law enforcement can be dangerous and unsafe. 

  
  

7. This is not a world worth living in, for many people.

• Addressing Systemic Issues: To create a more livable world, it's essential to address systemic issues such as inequality, injustice, and environmental degradation. Institutionalized racism, caste and colorism,  sexism, homophobia, and classism can create or intensify feelings of depression and anxiety that are not imaginary. These are very real experiences. 

• Collective Action: Individuals can work together to advocate for change and create a more equitable and sustainable future. Collective action does not mean you have to take everything one yourself! Many caring therapists fall into the trap of believing that they have to save the world. It’s important to know that this responsibility is a group effort, and you don’t have to carry the weight of the world on your shoulders alone. 

  
  

8. It is actually unfair to expect therapy to be a solution to world problems because therapists should not be expected to self-sacrifice for world problems. Therapists are human too.

• The Limits of Therapy: While therapy can provide valuable support and coping mechanisms, it cannot solve all of the world's problems. While it’s important to destigmatize therapy, it’s also important to recognize its limitations. Therapy can be helpful, but it is not the solution, and therapists don’t have all the answers either. 

• Humanizing therapists and therapy seekers : Addressing societal issues requires collective action and systemic change, rather than relying solely on individual therapists. Therapists are also surviving this world too, and we are subject to the same systemic issues as our clients. 

Many therapy seekers are not honest about suicidal ideation because they don’t want a “fuzzy sock vacation”, a popular Instagram and TikTok term for psychiatric hospitalization. Talking to a therapist about  suicide ideation can result in punishment. Therapy seekers deserve to feel safe enough with their therapist to discuss ideation without fear of hospitalization;

Of course, there are valid reasons to send someone to the hospital, especially if they want to go and you have a strong suspicion that nothing and no one will stop them from taking the next steps. As therapists, we are obligated by law to document that we took the proper precautions for client safety, and in many states, this requires safety planning and hospitalization, if needed. But as a therapist,  I often find that most of the time we do this to cover ourselves legally,  and not because the client is at actual risk. For many therapists, we make the call out of fear of losing our license, or potential legal retaliation.

If a client tells you they’re experiencing ideation, they might be looking to you to talk about their options and get them to safety. Safety for them may or may not be  psychiatric hospitalization. 

Talking about ideation can actually make someone feel less alone. Talking through what a safety plan looks like for them can also help. Venting about the crappy state of the world can help them feel less “crazy”.

Personally,  I think there’s something really refreshing about being honest about our mental health with clients, if it’s beneficial to the client’s well-being Many people expect therapists to be perfect and for us to have all the answers. This perception may elicit shame in therapy seekers who see themselves as a “work in progress”. But when we therapists are honest about our mental health, we humanize ourselves, and we humanize our clients. There is no such thing as an emotionally perfect person, therapist or otherwise.

So much about our profession is rooted in perfectionism in order to assert our validity as a field. But when we humanize therapists, we humanize ourselves. This is why I call myself The Bad Indian Therapist.

Did you find this refreshing and honest?

Read more about depression, YOU ARE NOT ALONE.

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