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“It is never okay to talk about suicide”: Patients’ reasons for concealing suicidal ideation in psychotherapy
Abstract
Objective: To identify psychotherapy clients’ motives for concealing suicidal ideation from their therapist, and their perceptions of how their therapists could better elicit honest disclosure. Method: A sample of 66 psychotherapy clients who reported concealing suicidal ideation from their therapist provided short essay responses explaining their motives for doing so and what their therapist could do to help them be more honest. Content analysis was used to identify major motives and themes in these responses. Results: Seventy percent of suicidal ideation concealers cited fear of unwanted practical impacts outside therapy as the reason they did not disclose. Chief among these unwanted impacts was involuntary hospitalization, a perceived outcome of disclosing even mild suicidal thoughts. Less concrete motives for concealment, such as shame or embarrassment, were significant but secondary concerns. Nearly half of suicide-concealing clients said they would be more honest only if the threat of hospitalization was somehow reduced or controlled. Conclusion: Fostering disclosure of suicidal ideation in therapy may require renewed attention to providing transparent, comprehensive, and easy-to-understand psychoeducation about the triggers for hospitalization and other interventions. Clients make risk-benefit calculations about whether to disclose suicidal ideation, but may operate with exaggerated or inaccurate ideas about the consequences of disclosure.
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“Various issues surrounding the subjective reporting of suicidal states have recently generated concerns about the reliability and validity of such methods, particularly when used in isolation (Blanchard & Farber, 2020; Hom et al., 2017; Maple et al., 2020).”
From Toward objective characterizations of suicide risk: A narrative review of laboratory-based cognitive and behavioral tasks (2023) · cites this paper as Blanchard & Farber, 2020
In the citing paper
“One study found that almost half of patients who conceal STBs in therapy would have responded more honestly without the threat of hospitalization (Blanchard & Farber, 2020).”
From Toward objective characterizations of suicide risk: A narrative review of laboratory-based cognitive and behavioral tasks (2023) · cites this paper as Blanchard & Farber, 2020
In the citing paper
“as a key example, fear of involuntary hospitalization is among the most cited reasons for concealing or minimizing STBs (Blanchard & Farber, 2020; Hom et al., 2017; Ganzini et al., 2013).”
From Toward objective characterizations of suicide risk: A narrative review of laboratory-based cognitive and behavioral tasks (2023) · cites this paper as Blanchard & Farber, 2020
In the citing paper
“there is evidence that negative views of inpatient psychiatric care and fear of being hospitalized may compel suicidal patients to not be forthright with their clinical provider about their suicidal thoughts [18].”
From One Size Does Not Fit All: A Comprehensive Clinical Approach to Reducing Suicidal Ideation, Attempts, and Deaths (2019) · cites this paper as [18]
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Metadata
- Authors
- Blanchard, M., & Farber, B. A.
- Affiliations
- Columbia University (US)
- Corresponding author
- Blanchard, Matt
- ORCID
- Farber, Barry A.
- Venue
- Psychotherapy Research
- Publisher
- Informa UK Limited
- Published
- 2018-11-08
- Volume
- 30
- Issue
- 1
- Pages
- 124-136
- ISSN
- 1050-3307 (ISSN-L)
- 1468-4381
- OpenAlex
- W2900274605
- Cited by
- 155
- References
- 42
- Citations by year
- 2026: 16 · 2025: 36 · 2024: 25 · 2023: 24 · 2022: 20 · 2021: 20 · 2020: 10 · 2019: 3
- FWCI
- 9.71
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychotherapy Research (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Veterans Affairs
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Keywords
- suicidal ideation, concealment, disclosure, psychotherapy patients, involuntary admission, fear of consequences, shame, psychoeducation, patient-therapist communication
- MeSH terms
- Adult, Female, Humans, Health Knowledge, Attitudes, Practice, Deception, Male, Middle Aged, Patient Acceptance of Health Care, Professional-Patient Relations, Psychotherapy, Self Disclosure, Suicidal Ideation
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