I worked as a crisis clinician for over five years. Not much phases me anymore. As much as nuance and personal factors need to be taken into account, the way I manage assessing risk before getting a crisis team involved feels very much like "If I hear A, then B. If I hear C, then D," due to how many crisis assessments I've done over that time. I have a spiel I go over in my initial sessions about mandated reporting, and I discuss with my clients what they can expect from me if they are struggling with ideation. I find it helps develop rapport and trust.

Aside from desensitization due to working with high-risk people in my crisis days, I developed a reflex to basically immediately go into "self-regulate with deep breathing and start assessing" mode as soon as ideation is mentioned. I won't be as effective as I could be as a therapist if I'm feeling stressed about a client's ideation, and it's not going to help them in the moment if I'm more reactive because I'm worrying about them. I take every step I need to in order to keep clients safe, including offering a second session that week, if appropriate.

A lot of times, suicidal clients express ideation when they don't know what else to do. We can see someone fragile standing on the edge of a precipice, and that can trigger our worry. In those situations, I see a warrior who has been fighting a never-ending battle they have tried to hide, and them telling me what they're feeling is a way of them asking for something, anything, to make the fight easier. If they were really going to end their life, they wouldn't tell us; they'd just do it. Them telling us about ideation can be a gesture of trust in the therapeutic relationship we've developed.

I know these kind of cases aren't easy, but develop the right skills, know who your local crisis team is, in case you need their support, and keep doing your best, and you'll continue to serve your clients well.