What Happens When You Share You’re Not Okay
I’ve not been doing very well
There’s a quiet moment that happens in therapy sometimes — when someone hesitates before saying, “I’ve not been doing very well.” You can almost feel the air change.
For many people, admitting they’re struggling feels risky. They worry their therapist will panic, overreact, or even call someone without warning. That fear is understandable — and it often comes from not knowing what risk actually means in a therapeutic context.
So let’s talk about it plainly.
At a glance
- Risk in therapy isn’t about judgement — it’s about understanding what feels heavy and why.
- You don’t need to be “in crisis” to say something is hard — we talk about things early, not at the breaking point.
- Safety is collaborative. We explore what helps you feel steady, grounded, and connected.
- You stay in the driver’s seat — guided by your needs, pace, and boundaries.
- The aim isn’t to control your feelings, but to help you move through them with support, clarity, and self-awareness.
What “Risk” Really Means
In therapy, risk isn’t a label. It’s a way of noticing when life has started to feel unsafe — either because of thoughts of suicide or self-harm, overwhelming distress, or situations where someone’s being harmed by others.
Sharing those thoughts doesn’t automatically trigger an emergency response. Therapists hear them often and know they can exist on a spectrum. Sometimes, they’re thoughts without plans or intent. Other times, they signal a need for more support. The difference is important.
The role of therapy is to help you talk about risk safely, not to make it taboo.
Why It’s Okay to Say You’re Struggling
People often downplay what’s happening because they fear losing control of what happens next. That makes sense — trust is fragile, especially when life already feels uncertain.
But therapy is one of the few places where you can be honest about suicidal thoughts without judgment. Naming them often reduces their power. Keeping them hidden tends to make them louder.
When you share, you’re not signing a contract for intervention; you’re opening a conversation about safety.
Not saying you’re struggling can sometimes make things heavier — especially when you’re trying to hold it on your own.
I understand how hard it can be to speak about this. You won’t have to force it. If it feels safer, I’ll help us approach the topic gently when the time is right.
How Therapists Work with Risk
Therapists use what’s called risk assessment, but it’s more human than it sounds. It’s simply a guided conversation about what’s happening, how intense things feel, and what keeps you safe. Together, you look for signs — shifts in mood, behaviour, or sleep — and create a plan for what helps in those moments.
If things feel overwhelming, you might agree to bring in extra support: a GP, a trusted friend, or a crisis helpline. The goal isn’t to take control away, but to share it safely until you’re steadier.
Risk management in therapy is built on partnership, not surveillance.
When Therapy Isn’t Enough
Sometimes, despite the best planning and care, things escalate.
That doesn’t mean you’ve failed, or that therapy hasn’t worked. It means your system — emotional, physical, practical — is under too much strain and needs more hands to help hold it.
At that point, your therapist might contact your GP, local crisis team, or — in rare cases — emergency services. The aim is always to protect life first, and return control to you as soon as possible.
Those situations are the exception, not the norm. But knowing what could happen removes the guesswork.
The Role of Support Networks
Safety rarely comes from one person or service. It’s built through connection — friends who check in, family who notice changes, therapists who listen, and sometimes professionals who step in.
If you’re supporting someone who’s struggling, you don’t need to diagnose or fix them. You can simply be there — offer time, listen, and remind them that being seen still matters.
If you’re the one struggling, you deserve the same compassion you’d give anyone else. The instinct to isolate is strong, but connection is what keeps us alive.
What Therapy Can Offer
Therapy can’t make every risk vanish, but it can help you understand what lies beneath it — the hopelessness, shame, fear, or exhaustion that makes life feel smaller.
It helps you name what helps, what harms, and what gives you even a small sense of agency when things are hard.
It also helps you prepare:
- Who can you reach if you start to spiral?
- What helps you ground yourself when things feel too much?
- What warning signs tell you that you might need extra support?
That’s the real meaning of a safety plan — not bureaucracy, but collaboration.
Where to Turn if You Need Help Now
If you’re reading this and feel unsafe, please reach out.
You can call Samaritans (116 123), contact your local NHS crisis team, or use the Hub of Hope to find immediate mental-health support in your area. If you or someone else is in danger, call 999.
Help isn’t only for those at the point of collapse — it’s for anyone feeling the ground give way.
A Note for Carers and Family
It’s frightening to watch someone you love edge toward crisis. You can encourage them to talk, offer practical support, and make sure you’re supported too. Organisations like Mind, Rethink Mental Illness, and Carers UK provide resources for family members navigating these situations.
You can’t always stop a crisis, but your presence can make it survivable.
Risk is part of being human
Risk is part of being human. It’s the moment when pain outweighs perspective.
Therapy doesn’t make that pain disappear — it makes it bearable by helping you face it with company, compassion, and plan.
Safety isn’t the absence of risk; it’s the presence of connection.
For me, awareness and openness are part of that. When we can talk about what’s happening, we can face it together — and that’s where safety grows.
If you ever find yourself thinking, I can’t keep myself safe, that’s not a reason for shame. It’s a reason to reach out. Therapy exists for exactly that — to meet you there, and help you find your way back to steady ground.
