Chronic Suicidality and How Therapy Can Help
What Is Chronic Suicidality?
I would first like to clarify what I mean by chronic suicidality.
Acute suicidality often arises during a state of crisis typically following a drastic life change like a breakup, job loss, or a traumatic event. It’s intense and short-lived. Acute suicidality requires immediate crisis intervention.
Chronic suicidality, on the other hand, is much more enduring. It can begin in childhood or adolescence. Sometimes people have made multiple suicide attempts. For these individuals, suicidal thoughts aren’t tied to a specific crisis—they become a pervasive part of their mental health struggles.
Potential Origins of Chronic Suicidality
Unmet Childhood Needs
One way that I have seen clients develop suicidal ideation is growing up in a painful childhood environment, particularly ones where you have unmet needs from your parents or direct caregivers. As children the reality is we don’t have the means to heavily influence our environment. For example we don’t choose where we live or what we eat for dinner. We are dependent on our direct caregivers for our day to day functioning. When attempts to influence our caregivers to meet our need, for instance through becoming a “perfect child”, don’t change our environment there can be profound hopelessness. Of course this is not black and white and children do have means of coping and for example can receive support outside of their home. But largely the individuals I work with feel stuck, trapped, and helpless in their childhood due to unmet needs and to resolve this the concept of suicide develops as an option.
The Myth of the Inherently Flawed Self
Another potential origin of suicidal ideation is what I call “the myth of the inherently flawed self.” This can manifest in patterns like, “If I could just fix this about myself, everything would be okay.” However, the target for self-improvement often moves, leaving a perpetual sense of failure. Alternatively, irresolvable issues may persist despite therapy or self-help efforts. No matter what therapy or techniques you try you can’t seem to make the changes you want to change. Similar to the other mentioned potential origin, these patterns foster hopelessness, as the individual feels incapable of achieving the change they desire. Over time, suicide may seem like the only solution.
Why Does Suicidality Become Chronic?
The two potential origins I described are important in the development of chronic suicidality because of their enduring nature. In both circumstances you feel like you can’t impact your environment or change your circumstances. Over time, these deeply ingrained belief systems take root in their psychology, driving behaviors and ultimately leading to a persistent sense of hopelessness.
Another important factor in the development of chronic suicidality is the temporary relief that suicidal ideation provides. This relief acts as a powerful reinforcer for these thought patterns and any accompanying behaviors. Imagining death or suicide can feel like a form of problem-solving and act as a way to escape or avoid overwhelming difficulties. The mere thought of an end often reduces emotional distress, creating a sense of relief. This cycle reinforces suicidal ideation as a coping mechanism.
Suicidal ideation can also function as a mental “get-out-of-jail-free card,” offering a fallback option: “If things get too hard, I can always kill myself.” In this way, it becomes a maladaptive strategy for coping with the challenges of life.
How Therapy Can Help
So, how do we interrupt this cycle? How do we decrease suicidal ideation?
I start with what I call “taking suicide off the table”. This doesn’t mean denying or suppressing suicidal thoughts, but rather removing suicide as a viable option. By doing so, you can focus on solving life’s challenges and building a life worth living.
As Marsha M. Linehan, the founder of Dialectical Behavior Therapy (DBT), said:
“The desire to commit suicide, however, has at its base a belief that life cannot or will not improve. Although that may be the case in some instances, it is not true in all instances. Death, however, rules out hope in all instances. We do not have any data indicating that people who are dead lead better lives.”
Dialectical Behavior Therapy (DBT)
One of the most effective and well-researched treatments for suicidality is Dialectical Behavior Therapy (DBT). This approach is specifically designed to help individuals manage intense emotions, reduce suicidal behaviors, and build a life they feel is worth living.
In therapy, you’ll learn techniques to navigate painful emotions and challenges in a way that feels empowering. Over time, this work builds confidence—confidence that you can handle what life throws at you without needing an escape plan. As one of my clients put it:
“I know I have DBT. I don’t have to be scared anymore.”
A therapist can also help you untangle your self-concept and beliefs about the world and others. Together, you can break down persistent patterns of thought and behavior, replacing them with healthier, more compassionate views of yourself and your environment.
The core dialectic in DBT is the simultaneous complete acceptance of yourself while holding a desire for change. One starting point for this is the reminder. You are doing the best that you can—and you can also do better. Therapy is about developing self compassion and making changes.
A Life Worth Living
It’s important to acknowledge that removing suicide as an option doesn’t invalidate the pain or struggle behind those thoughts. It makes sense that in times of intense distress someone might have thoughts of suicide or wish there was a way to make it all go away.
However, when suicide is no longer on the table, it opens up new possibilities. Instead of focusing on “not being suicidal,” the focus shifts to “how to live.”
Facing life without a fallback plan can be scary, but I’ve seen so many people make this transformation. I’ve witnessed their strength, resilience, and ability to rebuild their life worth living.
Final Thoughts
If you’re living with chronic suicidal thoughts, know that I believe in your courage and resilience. I’ve witnessed clients take this journey and resolve this ineffective pattern. Therapy can help you learn to tolerate painful emotions, rebuild your self-concept, and create a life that feels worth living.
Disclosures and Resources:
This content is for educational purposes only. This content is not intended to provide medical advice, diagnosis, or treatment. It does not establish a therapist-patient relationship with the reader or user.
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