How much do you tell your therapist about suicidal thoughts? I tell T everything! This includes ways, how exactly I'm planing, what exactly will happen to my family, how I imagine it would feel like, everything. I can't verbalize it so I write it. He only has to break confidentiality if he has to involuntarily commit you. Which is when it's immediate life threat behavior and you refuse to sign yourself in. I tend to also comment about my vanity, complain about not being able to use xyz method (and vividly describe how I would) because I'm an organ donor, and the statistical failure rate. Which I'm always convinced I'd fall into and become a vegetable which doesn't help with my vanity. I always have a safety plan and to call if I'm not going to make it to my next appointment. As long as she feels I will get to my next appointment then she wont mention hospitalization. She does always check my next appointment with my Pdoc is. We have gone over the involuntary process and my rights as involuntary patient but she doesn't think It'll ever get that far.