Safety contract

[joeylittle]

It's nothing to do with legally protecting the therapist. It's more to do with chronic ideation being a factor that makes you high risk for a suicidal action - even if you are certain right now that such an action is not possible for you.

It's not that he doesn't trust you. It's that these thoughts can flip over on people without much warning. Safety contracts can be controversial, but they are very common and are really there to help. I also understand your reaction; talking about suicidal thinking is very hard, and one can feel like they are on thin ice.

Are you content with your therapists level of experience, when it comes to crisis management and assessment? Or are you concerned now that he will over-react on your behalf?

 

[Deleted member 42783]

It's nothing to do with legally protecting the therapist. It's more to do with chronic ideation bein...

Ya know, I have dealt with SI off and on my entire adult life. It wasn't until I was almost thirty that I realized that it wasn't normal. To me, it's like a running gag chronically in the back of my mind. I can't take it as seriously as he does. Not that I blame him.

There is a real sense of being misunderstood and not believed that comes with all this. Yes, I feel he doesn't trust me and now I question my trust of him. Do I think he's doing what he thinks he should do? Yes. Does it come across as ham fisted and awkward? Yes. Especially after he has explained to me over and over that not being believed or being given the benefit of the doubt has been detrimental to my health. Eh, I see him again in a couple days and I will no doubt be honest when he asks me about it again. I can't lie to him. I can't look him in the eye either. He is young. A young guy who I think got more than he bargained for with me. I think he knows what he's talking about but he is not experienced enough to make autonomous decisions apart from the agency. I have no idea what he will do if the SI continues.

 

[joeylittle]

To me, it's like a running gag chronically in the back of my mind. I can't take it as seriously as he does. Not that I blame him.

I'm only talking from personal experience here. I've had chronic suicidal ideation since I was pretty young. I had it well under control for almost 30 years. And then, one day, I didn't.

Now, my depression was worsening - but I didn't know I was depressed, because so much of it was just what I always lived with, plus maybe a little worse due to some big life changes. I was not at all aware that I was going to totally lose control of myself as suddenly as I did.

And honestly - I had, up til that point, never lost my ability to regulate those suicidal thoughts.

You might be right - of course - because only you can know how pervasive your thoughts are, and how low you can get. But believing you have complete control over them is a potentially dangerous assumption.

Before my attempt, I never would have believed that could ever happen to me. It took me quite awhile to even accept it as an attempt.

That's just my experience - but it's not an uncommon one.

 

[Deleted member 42783]

But believing you have complete control over them is a potentially dangerous assumption.

I don't believe I have control over them otherwise I would've gotten rid of them a long time ago. I appreciate you sharing your experience though. I guess that I think that I will be able to reach out for help if things get worse. Maybe that's wishful thinking. I'm usually good at noticing when I'm slipping into a worse depression but, like you, I am frequently in a state of mild depression. It has become more consistent the older I get. I used to be able to go a couple years between bouts. I'll admit, I didn't realize that I needed medication again last summer until things had gotten pretty bad. I was acting out sexually instead of with SI so I didn't catch it. Had to have bipolar 2 ruled out before I go the PTSD diagnosis.

 

[Deleted member 42783]

@joeylittle
Thank you for sharing. I mean it. I needed to read it. I become too self reliant sometimes which is I guess why I need other perspectives.

 

[joeylittle]

Hey, that's what we are here for :). I resonate with much of what you are describing - and I empathize with how hard it is to talk about this stuff. Just posting about it here really is something you can recognize as a step forward. Thinking of you.

 

[recoveringfromptsd]

A safety contract does not really have any effect when it comes to protecting a T because as they have no control over what you do on your own, it sounds like while you have a good relationship with your T, that it is not as good as it could be. If your T knew you and trusted you with your safety he/she would address the S/I issue with you on a 1 to 1 basis, and would reach an understanding.

I have such in my case, all the clinicians who work with me trust my word, if they ask about my state of mind they know I won't lie even if the answer has consequences I don't like (like hospitalization, psych hold, etc). And I don't lie in such cases because I used to, and people took control from me because they could not trust my word on my state of mind so they went with caution instead. This has helped me a lot, because some months back I was very suicidal and when I saw my med prescriber and he asked about safety from his script I answered and he started to respond with the option of EPing (Emergency Petition) me (invol psych hold), but my T stepped in, and got me into PHP instead. She knew me well enough to know I was just having thoughts. I have never done a safety contract in the last 2 years with my current care team. All my interventions have the element of trust in them.

I sort of have an agreement with them, "I will be open and honest with them on safety" if they don't run off half cocked based on what I say.

Seems to me there is room for your T to understand you better by knowing the difference between passive S/I and active S/I as it relates to you.

 

[Sideways]

One of the difficulties with SI is that from a T's perspective, it always has to be taken seriously: single most common factor in completed suicides is that they talked about it beforehand with someone, often just in a general sense.

Living with SI is a risk factor with suicide, and your T has an obligation to pay attention to that.

Say you visit your GP and tell them your family has a history of breast cancer. It's a significant risk factor, and your GP wouldn't be doing their job unless they took reasonable steps in response to that.

In this case, it sounds like the "reasonable steps" that your T has to take have been agreed with the Boss beforehand - a contract isn't something he's just whipped up for your case, it's more likely a standard thing they do when they're presented with risk factors. When we examine completed suicide cases to try and figure out what we could possibly do different to prevent anyone else losing their life? This is one of those things.

I have a long history of SI, and like others have mentioned, I had it in hand for years. The time it took, after years and years, for it to not be under control and me to make a serious attempt? I didn't really get much warning. And I'd genuinely had no intent for years. Like you, SI was my norm.

My current pdoc takes it painfully seriously. Despite my awesome progress, I'm still not allowed more than a week of meds at a time. So yeah, where's the trust? If I tell her I'm ok, it's offensive that she refuses to let me take control of my own medication, especially since me having control of my life is something that helps me recover. Pfft!

But I don't hold it against her - she's just doing her job. SI is serious: passive or otherwise. The day she doesn't take it seriously, the day she doesn't do what she reasonably can to keep me safe (even if I find her safety precautions a but offensive), is the day she is no longer acting professionally. So when she continually refuses to let me have control of my own meds, I do my best not to get offended. She's doing it because that's her job. Taking my word for it is great, but going one or two steps further? Is better.

 

[Muttly]

I think you have gotten a lot of good advice already. What I would add is, that as hard as it may be, talking to your t about this will really help. What you take as a lack of trust, he may take as an obligation to the boss. He may have realized you didn't like the paper trail but not realize how invalidated you might feel. Also, most relationships have bumps, where trust becomes harder. It's the talking that through, in healthy ways that strengthens that trust. If you have been invalidated a lot in the past, that's super hard to do. It's also incredibly healing when you can do it.

 

[Deleted member 42783]

Well, I've returned to this thread eating crow.
I have been invalidated many times and SI had become my norm but, you guys were right, I became suicidal for the first time at the end of last week. It happened very fast and I came very close. I'm kind of blown away by how fast that happened. Thank you for your words and wisdom. I came here that night to chat and the words of some of the members here really kept me from carrying it out. NEVER has the desire been so intense and seemingly insurmountable before.
My husband and I thank you all!

 

[Tinyflame]

Yes I understand.

I'm glad you're ok @valkeasisu . :hug:

 

[joeylittle]

@valkeasisu - I'm really glad you worked through it. And yes - it can be mind-blowingly quick. I truly never understood it until it happened to me - sounds like you had a similar experience. I hate that you went through that, but am also glad you understand it now (if that makes sense).

Good job with getting help when you needed it. That's not an easy thing to do.