Treating Suicidality: What Clinicians Need to Know

⚠️ Content Warning: This article discusses suicide and loss. If you or someone you know is struggling, call or text the Suicide & Crisis Lifeline at 988 for immediate support.

March 30, 2026

Pia Khandekar, Author and Founder/CEO of PsychPro Consulting 

Tom O'Connor, Publisher

 Suicidality Is A Unique and Separate Construct 

Clinicians are taught how to work with trauma, anxiety, depression, and a host of other conditions during their training programs, yet training on the treatment of suicidality is still surprisingly limited. A decade of working in acute psychiatry, while also training psychology and psychiatry residents in treating suicidality, has highlighted the need for additional education on this important subject. As part of my consulting work, I provide specialized training for clinicians on best practices for assessing and treating suicidality. While most of us are aware of how to assess it, few are familiar with theoretical models or specific treatments of this condition.  

During these training sessions, we initially spend time on the clinical conceptualization of suicidality. While the condition can arise in the context of other diagnoses (e.g., post- traumatic stress disorder, bipolar disorder, and depression), suicidality is in fact a unique and separate construct. 

Clinically, this distinction matters. A persistent misconception in mental health care is that suicide risk will resolve once depression, trauma, or anxiety symptoms improve. While those conditions are often related, suicidality follows its own course and requires specific interventions. Treating it indirectly can leave specific risks insufficiently addressed, even when other areas of functioning appear to improve. When suicidality is appropriately recognized as a transdiagnostic clinical construct, providers gain the power to treat it directly and effectively.

Managing Countertransference

When suicidality is expressed, there is often an unspoken pressure to fix it–immediately. Clinicians may feel an urgency to say the right thing, offer reassurance, or move quickly toward hospitalization. At times, these reactions may stem from the clinician's own discomfort with the topic, fears about liability, or a sense of helplessness in the client. These reactions overshadow a fundamental tenet in these situations: the need for presence.

Presence, in this context, is not a vague or abstract quality. It is the ability to stay engaged without rushing, to listen without trying to reframe or resolve in that exact moment, and to tolerate the discomfort that often accompanies conversations about suicide. 

Understanding suicidality as a distinct and treatable phenomenon allows us to slow down. Instead of reacting from urgency or fear, clinicians can remain curious about what suicidal thoughts and behaviors are communicating, what sustains them, and how they function within a person's broader psychological landscape. This shift often leads to greater clarity in assessment and more grounded intervention. 

Clients who are suicidal are frequently carrying a profound sense of shame and isolation. Being met by someone who remains steady, curious, and attentive can be regulating, even before any specific behavioral intervention is introduced.

One of the clearer findings in suicide prevention research is that asking directly about suicidal thoughts does not increase risk. In fact, direct, clear, and calm conversation often reduces isolation and opens the door to more honest assessment. When I speak about suicidality plainly and without alarm, clients are less likely to view it as something that must remain hidden. 

This does not mean minimizing the risk that individuals will experience these thoughts or avoiding necessary action. It does mean recognizing that how clinicians show up emotionally is integral to effectively treating suicidality. In training, I help providers identify their own emotional responses, including fear, urgency, and uncertainty, and consider how those responses influence decision-making. By becoming more aware of these reactions, providers can choose intentional, theory-based responses rather than reflexive reactions.

Read: Dr. Ashley Smith's article: What I Wish Everyone Knew About Suicide

Moving Beyond One-Size-Fits-All Assessment

Another challenge in working with suicidality is the tendency to over-rely on standardized risk assessments. These measures are important tools, but are not necessarily inclusive of factors known to elevate risk. Relying solely on these measures can lead providers to interact impersonally, particularly when they are introduced too quickly or without adequate context. This, in turn, can leave clients feeling like the questions are simply a "check in the box" rather than an important aspect of their care.  

Importantly, suicide risk is not static. It shifts in response to life events, sleep disruption, new losses, and transitions in care. Distinguishing between chronic vulnerability and periods of acute escalation allows clinicians to respond proportionately, rather than treating all disclosures as emergencies or, conversely, overlooking significant risk escalations.

Effective assessment requires more than a self-report checklist of symptoms or risk factors. It involves a deeper discussion of recent life events, dynamic risk factors, or variables that fluctuate on short timescales, such as agitation, sleep disruption, or intense hopelessness. Assessment expands cognitive style and constructs known to contribute to suicidality, such as perceptions of burdensomeness, entrapment, and absence of rescue.

Similarly, while most clinicians are trained to help their patients identify social supports and reach out to crisis resources, the most effective treatment for suicidality is highly individualized. Crisis Response Planning is a broadly researched and highly effective form of safety planning that emphasizes a collaborative effort to not only help clients identify unique warning signs and triggers but also teach coping skills that effectively target their specific combination of stressors. 

Towards Theoretically Grounded Interventions

When clinicians are provided with a theoretical framework for conceptualizing suicidality, life-saving interventions become possible. The pace shifts because there is less pressure to move at lightning speed toward reassurance or certainty. What often emerges instead is a fuller picture of how suicidal thoughts and behaviors function for a particular person: how they surface, how they recede, and how they operate alongside other aspects of that person's inner life. This allows the clinicians to effectively address the mechanisms that precipitate the suicide mode and implement treatments grounded in research, like Cognitive Behavioral Therapy for Suicide Prevention (CBT-SP), Crisis Response Planning (CRP), and lethal means safety counseling.

Over time, having a clearer and more nuanced way of thinking about suicidality alters how clinicians relate to uncertainty itself. The need to resolve everything gives way to a steadier form of engagement, one that allows questions to remain open long enough for something more impactful to emerge. The work does not become easier in any simplistic sense, but it becomes more intentional, and therefore more effective.

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Dr. Pia Khandekar earned her PsyD in Clinical Psychology from the University of Denver and completed her APA-approved doctoral internship at Sharp Mesa Vista Hospital in San Diego. She has 19 years of clinical experience, the last six of which focused on research on the treatment of suicidality. For clinicians or organizations seeking further training or consultation on implementing evidence-based interventions for those with elevated suicide risk, visit https://psychproconsulting.com/  or contact her practice at (619) 693-8327.

Remember, if you or someone you know is experiencing a suicidal crisis, immediate help is just a call away. Dial 988 or go to your nearest emergency department. 

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