When a client tells you they are thinking about ending their life, something happens inside you.

It may be subtle. A tightening in the chest. A rush of urgency. A shift toward problem-solving. A sudden narrowing of focus around risk, liability, or documentation. Even the most seasoned clinicians can feel their internal system activate in these moments.

In our newest Clearly Clinical podcast episode and CE course, Beth Mullen-Houser, PhD, LPC, and Hanna Soumerai Rea, LICSW, explore therapist reactions to suicide talk through the lens of research and Internal Family Systems informed practice. The central question is not simply how to assess suicide risk, but how our own internal responses shape what happens next.

Therapist Reactivity Matters

Research consistently demonstrates that therapeutic alliance plays a significant role in treatment outcomes. When suicide is named, however, alliance can become strained. Therapists may feel fear, urgency, or heightened responsibility. These reactions are understandable. They are human.

The challenge is not that these reactions occur. The challenge is what happens if they drive the session.

When urgency escalates, treatment intensity can increase abruptly. Conversations may become more directive. Documentation and risk protocols may take center stage. In some cases, the relational field subtly shifts from collaborative exploration to risk containment.

Clients often notice this shift. Even when clinically appropriate actions are taken, a change in tone or presence can influence trust, safety, and openness.

This episode invites clinicians to consider a powerful idea: therapist reactivity does not just reflect risk — it can shape it.

An IFS-Informed Perspective

Internal Family Systems offers a framework for understanding therapist reactivity without shame. Rather than viewing fear or urgency as professional failure, IFS conceptualizes these responses as protective parts of the therapist attempting to ensure safety.

When suicide comes up, protective parts may activate quickly:

The part concerned about liability
The part that wants to fix or stabilize immediately
The part that fears making the wrong decision
The part that feels responsible for preventing harm

IFS does not ask therapists to eliminate these responses. Instead, it encourages awareness, unblending, and self-leadership. By noticing internal activation without being overtaken by it, clinicians can maintain steadiness in the room.

This grounded presence supports clearer decision-making and preserves the therapeutic alliance, even in high-stakes moments.

Slowing Down in High-Stakes Sessions

One of the core themes of the episode is slowing down.

In moments of perceived crisis, urgency often feels necessary. Yet research on alliance and regulation suggests that the therapist’s nervous system state meaningfully influences the session. A regulated clinician is more likely to convey steadiness, curiosity, and compassion. A reactive clinician may unintentionally transmit anxiety.

Slowing down does not mean minimizing risk. It means responding rather than reacting.

The conversation explores practical ways clinicians can:

Notice internal activation in real time
Maintain dual awareness of client risk and therapist response
Stay curious rather than collapsing into catastrophe
Protect the alliance while still addressing safety

These skills do not replace sound clinical judgment or appropriate risk assessment. They strengthen them.

Remaining Human in the Face of Suicide

Suicide work is among the most emotionally demanding aspects of clinical practice. It challenges our sense of responsibility, competence, and limits of control. It can activate fear and self-doubt even in experienced providers.

This course does not offer a checklist or a rigid protocol. Instead, it emphasizes presence.

Grounded in research and clinical wisdom, the episode highlights mindful awareness and compassion as essential anchors in high-stakes sessions. By cultivating self-awareness and regulating our own reactivity, we create space for clients to remain open, honest, and connected.

In the end, we cannot control every outcome. But we can influence the relational environment in which clients make meaning, seek support, and consider their options.

And when suicide comes up, that steady presence matters.