is it something they can handle? Yes
does it concern them? She mostly tries to normalize it, but it does seem to concern her. I think the concern is more the physical and emotional toll it takes on me rather than the actual act itself
do they suggest medication is the only solution? No. My T knew that medication was off the table right from the start, so she's suggested other ways to handle it.
do they want to find out what causes the thoughts? Yes, and for me to be more aware of the thoughts and emotions that trigger the si, so that I can find other ways to cope with them
do they show understanding? Absolutely. I would never have told her if I didn't think she'd be understanding.
have they helped at all? Surprisingly, yes. My si has decreased significantly in the past 6 months or so.
if so, what have they done to help? I think it's a lot of things. Helping me to see that it's not something I have to be terribly ashamed of. Listening and allowing me to talk about it without judging me. Teaching me other ways to deal with my emotions and thoughts. Helping me to be more aware of the triggering thoughts and emotions. Helping me to see that it's okay to have and express emotions and that I dont' have to keep everything so self-contained.
do they want you to tell them if you have si thoughts? Yes, so that we can work through what is triggering those thoughts and come up with other options.
do they want you to tell them if you have si'd? Yes, again, so that we can discuss what triggered it and talk about other ways I might have handled things.
do they suggest hospital for si'ing? No. It's never entered the conversation in 3 years.
does it make them uncomfortable to talk about this? It does not seem to make her uncomfortable at all. It makes ME incredibly uncomfortable, but my T is just calm and listens.
do you feel safe sharing with them? It took me a while (like a year and a half) before I felt safe enough to share, but, yes, I do now.
do you tell them the truth if they are able to hear it? Yup
do they criticise you for it? Never. My T usually says that she feels honored that I've chosen to share this with her.

ETA: My si is actually an OCD behavior, so we talk about it often. For me, not talking about it makes it worse. Talking about it has actually been the thing that's helped the most in trying to overcome it. So, my situation may be a bit different than others.