Struggling with decision to continue therapy after involuntary commitment...

[Briellewannabe]

Quick background: things have been quite rough lately. I started taking medications for depression/anxiety in May or so, and my meds have been switched up constantly since, for numerous reasons. Every time something's changed (dosage/drug) I seem to plummet and my suicidal desires get more intense and it's harder to think rationally. A couple weeks ago it got particularly bad and I had enough--I stopped taking medication without informing my psychiatrist, though I told both of my therapists (one for talk-therapy and the other for EMDR... kinda... we never seem to get far). My sleep was bad before stopping the meds (like... 3 hours a night IF I got any sleep at all), and so after a month of almost no sleep, the last week has been crushingly difficult. I was barely hanging on, knowing that I definitely did not want to continue living but not being able to shake obligations to people I don't want to cause pain.

I knew a very dark day was coming up... I'll spare you the details, but it's the anniversary of the hardest day I've experienced. I knew that it would be difficult, and I figured it'd be bad enough that I part of my brain that always reminds me of others before making any rash decisions would be silenced. I didn't say any of this specifically to my therapist during my last session, a couple days before my "dark day," but I think it was evident that I was done. I didn't commit to another session, because I have to follow through with obligations usually and I didn't want one added thing to try and stop me, and I knew she was uncomfortable. She didn't want me to go, but I'd be careful not to express any intent. I didn't give her any basis to stop me. She checked in with me over the next couple of days, but I gave her robotic replies. Nothing she could use. I can't lie, but I don't have to supply anything either.

Then the dark day happened... and it was awful. I can't even describe, and I won't try, but it almost worked as planned. I drove to a building I knew had roof access and sat on top, but my stupid brain wasn't 100% into it, and I couldn't do it--I couldn't NOT think about the boys I nanny or my partner. It hurt... knowing all I wanted was to be gone but I couldn't shut off one tiny, tiny piece of me. I couldn't get that piece on board, and for some reason it had strength beyond the rest of the 99.9% of me that had already made up my mind.

It hurt so bad... has anyone experienced that? It felt like I was struggling to breathe and I was underwater and swimming towards the surface, but people were holding onto me, keeping me under the water, not letting me have the breath I needed. My whole body ached, but my head couldn't take much more. I drove to the ER, but that was pointless, because 99.9% of me wouldn't let me go in. I drove home and called my therapist... I'm not sure why. I was crying a lot, because it all hurt, and I told her about the roof, but that I was home now. I hung up after 30 minutes of nothing but crying and her trying to assure me and talk to me. I tried to sleep but couldn't. It wasn't getting any easier. I opened all my prescription medications and counted how many I had: 295. I took 5-10 without really realizing it, kinda in a trance, but made myself throw up when I realized it. I've done this before, and I've told my therapist about it, who didn't like it but understood. When my therapist texted about 5 minutes later, I stupidly told her again... I think I've gotten too comfortable with my therapist. She's been really good at trusting me, letting me say my dark thoughts without freaking out (too bad) and only calling a psych eval once (not 51/50, but they came to her office to evaluate me--they cleared me and let me go home with my partner). So I didn't think much of it, I just shared. I figured she knew I was okay, and that I'd let her know if it got worse. I already knew that I wasn't going to be able to do it, I assumed she knew too. Stupid, I know. She's not in my head, and I didn't convey that to her.

30 minutes later there was a knock at my door. Yep... the police and paramedics. There was no getting out of it. I resisted, trying to get them to understand I was okay, that I wasn't going to do anything, and tried to get them to compromise--that my partner would come home from work and be with me for the 72 hours if need be, but it was too late--they placed me in a 51/50 (involuntary commitment) and took me to the hospital. My therapist had called them.

The psych ward was awful. Apparently there are good ones, but this one wasn't. The paramedics told me it was my consequence, a ER nurse told me maybe I'd learn my lesson, and the psychiatrist told me that he was going to hold me 5-14 days and maybe I'd hate it so much that I wouldn't come back (like it was my choice). The staff was rude, treating me and the patients like we were incompetent (which some were, but still). They yelled, were rough. I had patients tough me inappropriately, one guy came into my room at night and stood over my bed, watching me sleep. I had a panic attack when I woke to him there and he left; I went to go tell the nurses, but I couldn't breathe or talk and kinda froze... they yelled at me, told me to get over it, to go to my room, but I couldn't move, so they dragged me to my room and left me on the floor. I still have bruises on my arms. ANYWAY, it was awful. It was scary. And it traumatized me in so many ways, making everything worse.

When I got out I was required to see my therapist (the one who called, they wouldn't let me see the other one instead) the next morning. I was livid. This woman had betrayed my trust--she hurt me and made my situation worse. Yes, she was following procedure and I get that, I understand that, and she is not licensed yet and is working under someone else's license, so she had to be extra cautious, but I have such anger. Like... it feels so personal. Maybe it's because I started thinking of her as both a friend a therapist (we are the same age and have a lot of similar interests, attended the same school--at different times--etc.), but her calling, even though she knows how hard it is for me to be around people and in new places I don't know, to not be in control (my trauma stems from being kept in a space and having no control over what happened to me... repeatedly), and yet she called. I know rationally that I shouldn't be mad at her, but it hurts so bad. Because of that call things got worse... I didn't even know that was possible.

I know this is long, and perhaps no one will read it... maybe I just needed to type it out, but I'm struggling with knowing what to do. I care for my therapist, as she is the only person that I have found that I trusted, that was easy (in comparison to others) to talk to, and who I felt genuinely cared and wanted to help. She made therapy not torturous, which is hard to do. She always listened when I called (which in the last 2 months has been way more than I'd like to admit, though the previous year I called her 0 times, so, I recognize things have just been difficult), and she does check-ins when she knows things are difficult, which helps pull me out of my head a little bit. She's a good therapist. She remembers everything and connects dots like no one's business. I've been incredibly lucky to have her... until now. Now I'm just angry, hurt, and feeling betrayed. I don't know if it's even worth it to try and move on with her. If I don't, I don't think I want to start with another therapist. If I continue, I'll never be able to share like I used to. It'd be paranoid of her reacting like she was, and if I sensor myself too much, then I doubt therapy will be useful.

I'm at a loss of what to do.

 

[Rumors]

Go see your therapist. She did the right thing. The thing the law and code of ethics tells her to do. Go work it out... you might find it brings you to a new understanding of yourself.

 

[Deleted member 44579]

Hi @Briellewannabe... I agree with rumours.. She was worried about you and has a duty of care for you.. So in her way she thought she was stopping you from killing yourself.

Now she didn't know what the hospital would be like or how you would be treated..... I understand why you are pissed off at her... I would be too. Talk to her tell her how you feel.

I would not recommend stopping your medication... It's not the best for your mental health..
But I also understand that lack of sleep and make any person go crazy.... The body and mind needs rest.. Talk to your therapist about help sleeping....

You know it's better to communicate these feelings.. And we all support you here....things will get better..... But please open up to your therapist..... Take care

 

[Sideways]

Now I'm just angry, hurt, and feeling betrayed

These feelings are valid. If that’s how you feel? Then that’s okay.

But feeling betrayed isn’t the same as being betrayed. Your T made a call about your safety that you didn’t like, that landed you in a really awful place. But your T was trying to keep you alive. And you came pretty close to not being alive anymore, yeah?

Maybe the worst of it had passed, maybe you were safe by the time you called your T. But maybe you weren’t safe. Maybe in another few hours you would have decided to give the rooftop another try, or take too many pills, or....

Suicide is a real risk. Ts can’t afford to ignore the signs, because when they do? Sometimes people end up dead. And the real tragedy of that is if they can keep you alive long enough? Things get better. And life starts having meaning. And with time, and a bit of work, you not only stop wanting to kill yourself, you end up being glad that you’re alive. You end up looking forward to things, and loving people and being loved back.

I could’ve written your post. I’ve been made involuntary by Ts, in truly hellish psych wards, at times when I thought it was completely unnecessary. But hats off to my Ts, because they kept me alive and after 6 years of flat out just wanting to die? I’m really not so sure I want to die anymore. Things are getting better.

So, I get that you feel betrayed. Honestly I do. I’ve had those same thoughts: well if I can’t call you without being committed then I’m not gonna call at all. Been there, over and over. But actually, what happend was that you called your T and communicqted that you weren’t coping (which was the perfect thing to do and took a lot of guts), and your T listened. Your T heard what you were saying and for all that you think they over-reacted? At least they reacted. Your T wanted you to stay safe, your T wanted you get through that dark day to when things get better, and they did what they thought was prudent. Because not everyone survives suicidal ideation, and your T wants you to survive.

Have you got some appointments with one of your Ts booked for the coming weeks? Perhaps talk about developing a safety plan for how you would like this to be managed if it happens again (Ts will follow safety plans, and that gives you control over what will happen).

Be gentle with yourself. It gets better, it really does.

 

[EveHarrington]

I’d move on, because boundaries have been crossed into friend land. You know way too much about her. I know nothing about my therapists personal life except for once she told me about all the crime in Baltimore which was a big yawn cuz her professional profile states she used to work at Sheppard Pratt. She’s not my friend. Her life is none of my business, nor do I care.

IMHO her ability to help you has been compromised because she’s acting like a friend. You need a therapist, not a paid friend.

 

[Sideways]

because boundaries have been crossed into friend land. You know way too much about her.

This works for some people. Sharing info with Ts, chatting casually about things, is something a lot of people do with their T, and for some people it’s an important part of the connection and development of trust.

Boundaries become blurred when the T is sharing their problems, not just benign info about their life.

 

[EveHarrington]

This works for some people. Sharing info with Ts, chatting casually about things, is something...

I said what I did given that the OP even states that she feels her therapist is a friend.

I question if those betrayal feelings would even be there if the friendship never existed.

 

[Justmehere]

It’s really common for clients to be mad at a therapist after they have called for a welfare check.

It is her job to keep you alive. She gave you multiple opportunities to plan for safety, and even when she called for a welfare check before, you were able to plan for safety. This time, you were not able to do that planning and even you got close to admitting yourself to the ER.

She called for professionals to evaluate for risk to yourself when you are unable to plan for safety. When she became too concerned about a very real and legit risk to your life she called for others to check on you. That’s it.

The therapist, police, and the paramedics could not have admitted you. They could only get you to an ER doctor who made tbe decision that you were not safe to yourself. If you had been able to show anyone along the way that you were solidly able to keep yourself alive and had a solid plan for safety, it’s unlikely you would have been admitted.

You were not admitted because your therapist made a call. You were admitted because things got dark and PTSD sucks, and an ER doctor decided that the intervention needed was to be admitted to a hospital to keel you alive.

Acute inpatient psych units can be hellish. No doubt. Many are only good at keeping someone alive and they are well known to be re-traumatizing, which probably is why your therapist waited as long as she did.

Feeling angry and betrayed is understandable response to being shaken further by being in a shitty psych ward unit. Your feelings are very real and worth working through, but they are not an accurate reflection as to your therapist being untrustworthy.

Be angry. Be angry at her even, but don’t use this as cause to give up on therapy and cause to give up on her.

If you go back and look at any intake paperwork, it might state right at the get go that confidentiality is kept unless one is a danger to themselves.

You could choose to run from someone who is clearly on your side, and wants to help you and has shown a long track record of doing that. Things will likely stay the same and even possibly get worse.

Or you could choose to go back, and tell her exactly how you are feeling betrayed, and begin to find a plan for moving forward to rebuild trust and safety, and being able to recover from this and the past trauma that brought you into therapy. There is a huge chance things could get a lot better goong this route.

The choice is yours. I hope you go back at least one time and try to talk through how this impacted you.

 

[Muted]

Quick background: things have been quite rough lately. I started taking medications for depressi...

This is a tough situation. From her perspective I get the better to be safe than sorry, yet, calling it in can be more trauma (which you experienced).

I think it comes down to a liability thing and if she doesn’t have a clear grasp on your intention either way, she’s legally obligated to make the call. She either doesn’t know you well enough or was really concerned you would do it or trying to save her own ass. Maybe a combination.

I screwed up a while back and sent my t a text that she freaked about, without even realizing how she was going to take it. She will no longer associate with me outside of my appointments.

If you feel like the trust has been damaged beyond repair then find a new t. But, I would first consider if you’re blaming your t for how you were treated at the hospital or if your blaming her for making the decision to call and make sure you were ok?

 

[Briellewannabe]

I appreciate all your comments. There is a lot of good suggestions and comments I have to consider. I've touched on some specifics below, but I just wanted to thank you all for sharing. Perhaps I'm overthinking this, or maybe it's because I'm still not able to think rationally about this whole mess, but I haven't yet gotten over feeling incredibly defensive and still thinking that my therapist's actions, though correct in respect to procedures and policies she has to follow, was clearly the wrong decision for me. And she should have known that. I'm also having a hard time because I've done endless research on involuntary commitments now and realize there's little to no empirical data that indicates involuntary commitments work, in fact, there's a proven backfire effect that is often attributed to them. I don't understand how policies that violate someone's civil liberties and can make things worse is put into place, requiring therapists to possibly harm their clients even more. That upsets me too, and maybe I'm again putting more blame on my therapist than is deserved... I know she didn't write those policies.

I'm still not sure what to do, but after considering your replies, I haven't completely ruled out seeing my therapist again. I don't like it, and I worry that it'll be too difficult and that I'll never feel completely safe sharing again, but I also recognized she's been the only person who's helped at least a little, and who continually goes out of her way to try. But again... maybe that's why it hurts so much that she did what she did. It seems like the took the easy way out and just gave up.

But maybe you weren’t safe. Maybe in another few hours you would have decided to give the rooftop another try, or take too many pills, or....

Maybe that's part of the reason I'm still mad... I think a big part of me was still hoping things would get worse and I could decide to go to the roof or take pills or whatever.

Have you got some appointments with one of your Ts booked for the coming weeks? Perhaps talk about developing a safety plan for how you would like this to be managed if it happens again (Ts will follow safety plans, and that gives you control over what will happen).

I just had the one mandatory appointment with my therapist a couple days ago. I set nothing else up. That appointment basically went as well as it could, but it was me just being angry and having an incredibly hard time even talking to her. I couldn't look at her. I didn't confirm to ever see her again. I'm still not sure if it's even worth it.

You know way too much about her ... IMHO her ability to help you has been compromised because she’s acting like a friend. You need a therapist, not a paid friend

I appreciate your thoughts, but I should clarify--we are not "friends." What I meant is she's as easy as a friend to talk to, but I don't actually know a lot about her--just a thing here or there that she'll comment on, probably to try and build connection. It's nothing deep at all. Sometimes I'm really curious and wish I knew more... like she had a surgery and she gave no specifics, but I really wanted to know what was going on. So she'll mention things, but our relationship has never crossed any boundaries that it shouldn't. I just meant it's comfortable to talk to her and I got used to it, kinda forgetting that she is also someone who has to follow protocol. I dunno.

Boundaries become blurred when the T is sharing their problems, not just benign info about their life

Agreed... she definitely isn't one to share her problems, though sometimes I wish she did a bit more. I hate knowing some some detail and wish I understood it better.

The therapist, police, and the paramedics could not have admitted you. They could only get you to an ER doctor who made the decision that you were not safe to yourself. If you had been able to show anyone along the way that you were solidly able to keep yourself alive and had a solid plan for safety, it’s unlikely you would have been admitted.

I don't think that's right. When the paramedics came, they said it was too late to get out of it, that I was already placed in the 51/50 because I took medication. I never even talked to the ER doctor, it was only nurses checking my vitals and taking blood... it was already decided I was going to the psych ward. I never had a chance to be evaluated. I didn't have a chance to show them I was okay, or come up with a safety plan. Trust me, I would have absolutely have done that if it had been an option! The decision had already been made without any input or evaluation of a doctor.

If you feel like the trust has been damaged beyond repair then find a new t. But, I would first consider if you’re blaming your t for how you were treated at the hospital or if your blaming her for making the decision to call and make sure you were ok?

You make a good point. I probably am putting undeserved blame on my therapist for the treatment I endured, though she couldn't have possibly known... but I guess I feel like she SHOULD have known. Even if it wasn't that bad or that extreme, she should have known it would make things worse. We've talked about inpatient treatment before, and I've laid out my case against it very clearly (and I'd say convincingly, as she always seemed to agree with my assessment, as did the psych evals I had in the past, which is why they let me go).

 

[Justmehere]

I really get how awful acute inpatient psych units can be. The one you were taken to sounds awful. It makes sense to me that even if you agreeed you needed to be admitted, you would be distrusting of all mental health care professionals for awhile after such a horrible experience. They were totally shitty to you. You have grounds to be pissed at the hospital. I also know what it’s like to be on top of a building in so much pain and feeling like I was drowning. I remember that place really well. I’ve seen and had a traumatic acute inpatient experience. So I can relate to what you are feeling.

Not all therapists are shitty like this hospital was to you.You’ve trusted her before, for a long time, and she was in a tough spot, scared you would imminently die. You agree she had to do what she had to do because of the requirements on her.

I've laid out my case against it very clearly (and I'd say convincingly, as she always seemed to agree with my assessment, as did the psych evals I had in the past, which is why they let me go).

You’ve laid out your case before, and she listened. She frankly put her future licensing on the line to hold back. What would be her motivation, after so long of being by your side, to just go out and ignore all that and act with intent to make your life worse?

You had several chances with your therapist and your entire treatment team to take steps toward safety planning and getting less traumatic help long before the paramedics came. She was trying to give you all the space she could until she legally had no choice.

Pushing away help didn’t start with this hospitalization but long before it.

-I stopped taking medication without informing my psychiatrist,

I knew a very dark day was coming up...

I think it was evident that I was done.

She checked in with me over the next couple of days, but I gave her robotic replies. Nothing she could use. I can't lie, but I don't have to supply anything either.

Why were you pushing *all* of your treatment team away for so long? I think this is a very important question to consider.

What would you have liked her and your treatment to do instead? Are there other steps she could have taken along this process to help more effectively?

Are there other steps you could have taken? Is pushing everyone away and cutting them out from knowing what’s going on for you working out well for your recovery?

The decision had already been made without any input or evaluation of a doctor.

What type of license does she have and does that license come with admitting privileges?

I feel like she SHOULD have known. Even if it wasn't that bad or that extreme, she should have known it would make things worse.

She probably did know very well that you would be re-traumatized if they admitted you. Many therapists are taught in school that admissions can be retraumatizing. Yet they are still required to call for a welfare check by law when concerns reach a certain level. Why? To keep clients alive.

Many therapists would have called for a welfare check much sooner. Instead, she gave you space and time, probably hoping you’d be able to pull through. She eas probably so concerned you would die, she was willing to risk breaking your trust in her to keep you alive. That’s how concerned she was. She could have even been following the direction of a supervisor in handling the situation of a client who is refusing to schedule to see her and yet in clear life threatening distress.

Be mad. Direct it to the right folks: the hospital. Use that anger to seek solutions for the hospital failing so horribly. There are steps you can take to hold the hospital accountable. You can also take steps to make sure that ifanyone calls a welfare check on you again they have a plan to follow, like in a psych advance directive.

Be mad: direct it at the depression that is dragging you down and the abuser(s) who betrayed all safety to lead to PTSD in the first place.

Be mad enough to not give up on recovery.

How are your symptoms and the suicidal thinking now?

In all this effort to blame the therapist, I don’t want to lose sight of that. You’ve been in a place where your level of symptoms have concerned professionals for your safety several times lately, and even you have been concerned. You may need to add something like DBT skills group to get stabilized and not risk being hospitalized again.

You are trying to put all responsibilty on her for what happened when much of it falls on this apparently shitty hospital.

And some of it actually falls on you. No I don’t mean the crappy hospital treatment or for being depressed, but the responsibilty you had for your actions and choices to refuse help when smaller interventions other than hospitalization would have been sufficient. It was totally your choice and right to refuse help and stop meds, and it had this outcome.

Is running from help and shutting people out really working?

Your therapist recommending inpatient care in the past shows this has been an on-goong concern that you are a risk to die. There are other options other than inpatient care, like adding a DBT group, but what I think you and her are running up against is that something has to change to get out of this very severe distress you are in.

If therapy isn’t something you are willing to do, what is your plan to become stabilized over the long haul on your own?

 

[Muted]

I don't understand how policies that violate someone's civil liberties and can make things worse is put into place, requiring therapists to possibly harm their clients even more.

That’s an excellent point! Also, if you’ve had a bad experience in the past and she still called, I get why you feel like you can’t trust her anymore. I’m not sure if I could go back.