Yeah ideation only usually kept in confidence unless it's so repetitive every session and person also has history of suicidal attempts then I think they might decide to break confidentiality and get the cops involved or something. I think it's case by case basis. When I was going for therapy I mentioned suicidal ideation but my therapist did not react...in fact I felt I was talking to a wall, as if such things were so common the therapist feels nothing about it. But in reality good therapists do listen to it and keep it in mind. They want the patient to feel better, so if expressing that pain in that way is helpful then it helps the therapy move along and pain to lessen.

But if someone is showing more and more that they see suicide as escape from problems and they say it more and more and seem also to kind of not participate in therapy, the therapist obviously becomes more concerned for the patient's safety. For me it was a way to express how much hurt there was. And usually I felt better, the week after. It's such a scary thing to say. In that moment I felt so afraid.