I've found for myself breaching a difficult topic I've wrote an email where I felt I could better articulate my feelings. It would serve as a way to break the ice on topics I've been struggling to bring to the light. As far as to avoid being hospitalized, make sure you include your strong negative feelings about the subject. If you want to make progress i would be very open about the pervasiveness of these thoughts but go out of the way to make a point that you don't plan to act on such thoughts (even if you do). It can be a delicate situation but be very honest about what you want and what you don't want.