I used to suffer from horrible ideation. I know you're not looking for a solution, but what helped me was meds. I feel such a relief now and am able to cope better.
I am very open and honest about my SI and thoughts of SH with T and L. Every session, L does a safety check-in. She trust me to know when I need a hospital and when I just need to be heard.
After seeing my dad's dog being put to sleep, it really triggered me. The next session, L and I discussed death and SUI the whole session. It was such a relief to not have to bottle up the thoughts and feelings.