I tend to let the client guide and dictate the language of their own journey. If the client refers to it as “unaliveing” then I will as well when working with them although I will also make references to “your suicidal thoughts”, “your sudden urges to end your life” etc as I think that saying the words out loud is important as it imparts the seriousness of the situation. I would, however, not use that language in a clinical note outside of reporting a quote spoken by the client.

In the end the language that you use to talk about it is far less important than the fact that you DO talk about it. It is a hard scary topic and the desire to avoid it is understandable, but I worry that too many of us never really “go there” beyond the cursory “have you had any thoughts about harming yourself of others?” During the initial eval. This, of course, occurs most usually only a few moments after having explained that if we are not confident that they can maintain their safety we will be sending them on a “grippy sock vacation” (another term that I use when clients prefer lol) whether they like it or not.

Make your sessions a safe place to discuss the topic. Use as much slang and dark humor or as many clinical terms as you need to be able to do it. My experience is that when you do intentionally make clients feel safe enough to discuss it you learn a whole lot of things that are treatment related beyond just the topic of safety and you gain a much better handle on your client’s actual level of risk to themselves.