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This study aims to explore the experience of psychotherapists when a client expresses suicidal ideation during treatment. A literature review concluded that although there is a wealth of data on suicide, suicide prevention and psychotherapy, there was little data that pertained specifically to the research question. This supported the employment of field research. Aim/Methodology: The study was underpinned by a radical constructivist epistemology, the theoretical perspective was interpretivist, and Constructivist Grounded Theory (CGT) was used as a qualitative methodology. The sample was achieved by purposive sampling, and six intensive interviews were conducted with senior psychotherapists of varying modalities. The interviews were transcribed and analysed under the CGT approach, using the constant comparison method, memoing and sorting. Findings: A significant number of initial and focused codes were generated, supporting axial coding, and further conceptualisation of five core conceptual categories: the relationship to responsibility (responsibility); external pressure to be accountable for risk (persecuting); need to be pragmatic about safety (McRisk®); working therapeutically with uncertainty (McRisking®); and assessing what is real ((in) congruency). Implications: An initial CGT theory was proposed: The McDonaldization of psychotherapy and the resolution of responsibility. The study indicated that the increased sense of persecution and surveillance, as a result of audit culture and regulation, is resulting in therapists being less prepared to take clinical risk, favouring safeguarding policy over clinical engagement. It is argued that this is potentially to the detriment of both the client and the therapist, and that it needs to be addressed at a training level.