Suicide is not just an act; it is a process. A slow sinking into despair, a progressive isolation, a feeling that life has lost its meaning. It does not appear out of nowhere; it is not an impulsive decision without history. It is a silent cry that often goes unnoticed.
For those of us working in mental health, addressing suicidal behavior is one of the most delicate challenges. Not only because each case is unique but because the margin for error is minimal. We are not talking about reducing anxiety symptoms or improving social skills: here, intervention makes the difference between continuing or not. And in the digital era, where online therapy has become an increasingly used alternative, a key question arises: can we really support someone in crisis through a screen?
The Distance That Brings Us Closer: Myths and Realities of Online Therapy in Suicidal Crisis
For many people, the idea of psychological treatment through a screen generates skepticism. It is believed that physical closeness is indispensable, that the therapist's body in the same room is what provides security. And while it is true that physical presence has an impact, reducing online therapy to an impoverished version of face-to-face work is a mistake.
The reality is that digital distance has unexpected advantages:
- Reduces barriers to access. Not everyone can or wants to attend a physical consultation. Those living in rural areas, with reduced mobility, or simply feeling ashamed to seek help may find in online therapy an access they would not otherwise have.
- Provides a safe space. For someone in crisis, speaking from the privacy of their room can feel less threatening than doing so in an office. There is no need to face the gaze of others in a waiting room, no need to travel. Just one click is enough.
- Allows for more flexible intervention. In crisis situations, the possibility of having shorter and more frequent sessions, or even intermittent contact throughout the day, can make a difference.
The Art of Listening to What Is Not Said
If listening is a fundamental pillar in face-to-face therapy, in online therapy it becomes an act of surgical precision. Here, it is not only important what the person says but also how they say it and what they leave unsaid.
Response times in a chat, the tone of voice in a video call, the way someone averts their gaze or keeps the camera off... Everything communicates. And when we are facing someone at risk of suicide, every detail matters.
Crisis Intervention: Holding Without Touching
Crisis intervention in suicidal behavior has three fundamental axes:
- Assessing the risk. Differentiating between passive ideation ("sometimes I wish I wasn't here") and active ideation with a plan ("I've thought about doing it this way and at this time") is essential.
- Creating a safety framework. In online therapy, this translates into establishing a clear safety contract. Where is the person at this moment? Do they have access to lethal means? Can we contact someone in their environment if the risk increases?
- Providing real-time emotional regulation. Grounding techniques, breathing exercises, stabilization strategies. Because when the mind spirals into suicidal thoughts, sometimes all that is needed is a pause, an anchor to regain some control.
The Therapeutic Bond: The True Key
But if there is one thing that truly makes a difference, it is the bond. Because no matter how many strategies we have if the person does not feel that there is someone there.
The question many ask is whether it is possible to create a deep bond through a screen. And the answer, for those of us who have worked in online therapy with people in crisis, is a resounding yes.
The bond is not created by physical closeness but by emotional presence. By the quality of listening, by the feeling that the therapist is there, even if only on the other side of the screen.
An Invitation to Stay
Suicide is not a free choice because hopelessness distorts the perception of what is possible. Because when someone reaches that point, they are not seeing all the options, only the one closest to immediate relief. And that is where online therapy can be a bridge. A space to explore other possibilities, to remember that pain is not eternal, to find reasons, even small ones, to stay a little longer.
If technology allows us to reach those we could not reach before, if it gives us the possibility to provide support at the moment when someone needs it most, if with just a video call or a message we can hold onto life… doesn't it deserve to be embraced with all its possibilities?