Weird therapy session regarding suicidal thoughts

[Ecdysis]

Without going into all the details/ background, I had a therapy session on Tuesday and the topic was suicidal thoughts and how that's played out over the years both during childhood trauma and since then.

This (relatively new for me) therapist is so weird... He's a specialised trauma therapist and he's good at his job.

But I don't really "gel" with him well on a personal level.

Anyway, so this session was completely about this topic of suicidal thoughts and feelings.

While I'm glad that he didn't make a drama out of it (nothing along the lines of "OMG you'll have to go inpatient")

His sort of weird response was along the lines of "Hmm, well, obviously you can kill yourself if you choose to. I guess it might be preferrable not to, tho."

Like, very low-key, very understated, a very bland response.

He's done the same thing with another topic before and with that topic I actually straight out asked him whether he was doing a "paradoxical intervention" or trying to get a rise out of me by being so bland and matter of fact and "whatever" about it. (That was an easier topic for me to talk about)

With the suicidal thoughts, it's a really difficult topic for me. And to have his response for 50 minutes be along the lines of "Hmm, oh well, whatever" is quite... disconcerting? weird? unhelpful?

I'm not sure what to make of it... Is it some kind of therapeutic technique? Is it his own helplessness about the topic of suicide? Is it some kind of misunderstanding (I was relatively calm when voicing it, as it's a constant 24/7 not-wanting-to-live thing, not some dramatic, acute suicidalness - so was he just mirroring my own "calmness" about the suicidal thoughts)?

Either way, I find it deeply unhelpful.

I told him that I'm planning to raise the subject again in our next session.

I wonder if he'll use the time to prepare some better, less lack-lustre response?

Sigh... I don't know whether to see it as yet another way in which this therapist and I don't connect well at all...?

 

[whiteraven]

His sort of weird response was along the lines of "Hmm, well, obviously you can kill yourself if you choose to. I guess it might be preferrable not to, tho."

This is exactly how my therapist is! In many ways, though, I'm grateful for it, because I know he cares about me, but he also is reminding me that this decision is completely mine. I can see where that could possibly backfire, but it's really been helpful to me.

(I was relatively calm when voicing it, as it's a constant 24/7 not-wanting-to-live thing, not some dramatic, acute suicidalness - so was he just mirroring my own "calmness" about the suicidal thoughts)?

Yeah...could be.

I'm wondering how you would have liked him to respond?

 

[Sideways]

obviously you can kill yourself if you choose to. I guess it might be preferrable not to, tho.

It’s a difficult conversation to negotiate and get right. It’s near impossible to say the ‘right’ thing. Certainly for me, there was never a ‘good’ response. And I’ve had a lot of conversations with a lot of different Ts about suicidality over the years.

Ultimately, what he’s said is an acknowledgment of the reality. And I’ve had a couple of Ts give me something similar as their response. “No one can actually stop you”. Which is the reality of the situation.

The one helpful thing about acknowledging that, which was my take-away (usually with the benefit of hindsight) is: okay, so it’s ultimately my call, and at the moment, I’m choosing to keep myself alive…so, there must be a reason I’m doing that.

I think it was also a helpful way of stopping the circulatory nature of those conversations. I could take about how much I wanted to end my life almost indefinitely. And that definitely wasn’t helpful.

If there’s a type of response you’re looking for, or something about your suicidality you want to talk about - tell him. Otherwise, yeah, reflecting back to you the reality of suicide (ultimately, it’s our choice, but there’s good reasons not to) is potentially what you’re left with.

 

[arfie]

in my own case, i think it helps to detach to clinical ho-hum in dealing with my own suicidal ideation. i almost phrased that in the past tense because it's been a goodly while since i have had direct suicide thoughts, but it still comes up from time to time in various forms. the therapists who were able to help me with that had pretty bland reactions to the discussions. do we ever really just get over ^it^?

for what it's worth
some of my most effective therapists have been people i wouldn't choose to have in my inner circle. they are professionals, not drinking buddies.

 

[PamelaS]

in my own case, i think it helps to detach to clinical ho-hum in dealing with my own suicidal ideation. i almost phrased that in the past tense because it's been a goodly while since i have had direct suicide thoughts, but it still comes up from time to time in various forms. the therapists who were able to help me with that had pretty bland reactions to the discussions. do we ever really just get over ^it^?

for what it's worth
some of my most effective therapists have been people i wouldn't choose to have in my inner circle. they are professionals, not drinking buddies.

I appreciate all of these responses here for you Ecdysis. I think this is all very good input. I am very familiar with suicidal ideation and suicide attempts and actual suicide. It’s been a part of my life nearly all of my life. That’s just to give you my backstory to share my take on it. In any relationship, and a patient/therapist relationship is a relationship, communication is key. So I agree that the first step could be sharing your concerns and confusion about their method and their response to you and see if your T is willing to listen to you and consider your concerns. You said that you have seen benefits working with this person, so maybe you could consider continuing to work on PTSD with this person while seeking other resources for the suicidal ideation. There are many suicide hot lines, and resources available. Hope you find all of the feedback you get from this thread helpful for you to make your next move. Wishing you well and reach out again. This is a great site with people who get it. Staying connected to people you can trust to help guide your next step is a really smart move. Best wishes.

 

[Chris-duck]

His sort of weird response was along the lines of "Hmm, well, obviously you can kill yourself if you choose to. I guess it might be preferrable not to, tho."

I mean I guess it's a weird line to tread, but I've had quite a lot of SI in the past and it *is* an option, not a good option! But still an option. And he might have misjudged it, but for me feeling trapped and outta options would make me more likely to act on it.

trying to get a rise out of me

I don't think it's about "getting a rise" out of you, but it would clarify your thoughts on it. Like someone says you can kill yourself if you want, how did you feel about it? Was it "well I don't actually want to ffs, I just feel really f*cking bad" which is valid. Or "oh cool, it's an option, but no rush hey".

"Hmm, oh well, whatever"

I think it's worth discussing with him that you think he was dismissive about it.

I told him that I'm planning to raise the subject again in our next session.

I wonder if he'll use the time to prepare some better, less lack-lustre response?

It doesn't read, to me, that he responded badly overall, just maybe badly for you. Do you know how you wanted him to respond? It's okay if not obv. But something worth having a wee think about before next session.

Sigh... I don't know whether to see it as yet another way in which this therapist and I don't connect well at all...?

You looking for reasons cos you liked your previous T of 20 years or you think it's a legit bad fit? Either is fine obv, just worth having thoughts on before moving on.

 

[Movingforward10]

I think this is something T's do: when something holds enormous emotion for us (even if we deliver it matter of fact, and even especially because we are despite the level of weight it carries), they meet it by the opposite. The underwhelm. And it is so jarring. It has created ruptures for me with my T, so I understand how you feel.

So I think it is a technique.
And, thinking about it objectively, I can kind of understand it. If they met us with the same type of "this is big", then we're all stuck in it together. So whilst the "this is big" response gives validation, it might not necessarily help with the "and how do we get past it" process. If that makes any sense.

 

[Applecore]

Without going into all the details/ background, I had a therapy session on Tuesday and the topic was suicidal thoughts and how that's played out over the years both during childhood trauma and since then.

This (relatively new for me) therapist is so weird... He's a specialised trauma therapist and he's good at his job.

But I don't really "gel" with him well on a personal level.

Anyway, so this session was completely about this topic of suicidal thoughts and feelings.

While I'm glad that he didn't make a drama out of it (nothing along the lines of "OMG you'll have to go inpatient")

His sort of weird response was along the lines of "Hmm, well, obviously you can kill yourself if you choose to. I guess it might be preferrable not to, tho."

Like, very low-key, very understated, a very bland response.

He's done the same thing with another topic before and with that topic I actually straight out asked him whether he was doing a "paradoxical intervention" or trying to get a rise out of me by being so bland and matter of fact and "whatever" about it. (That was an easier topic for me to talk about)

With the suicidal thoughts, it's a really difficult topic for me. And to have his response for 50 minutes be along the lines of "Hmm, oh well, whatever" is quite... disconcerting? weird? unhelpful?

I'm not sure what to make of it... Is it some kind of therapeutic technique? Is it his own helplessness about the topic of suicide? Is it some kind of misunderstanding (I was relatively calm when voicing it, as it's a constant 24/7 not-wanting-to-live thing, not some dramatic, acute suicidalness - so was he just mirroring my own "calmness" about the suicidal thoughts)?

Either way, I find it deeply unhelpful.

I told him that I'm planning to raise the subject again in our next session.

I wonder if he'll use the time to prepare some better, less lack-lustre response?

Sigh... I don't know whether to see it as yet another way in which this therapist and I don't connect well at all...?

Full disclosure, had lurid suicidal thoughts from age 12 through to about 42 and am pretty much clear of it for a few years now. It was an escapist voodoo or masturbatory fantasy that I never would have carried out: exactly because there have been two actual suicides in my immediate family.

So there's eyewitness knowledge here about how suicide destroys the lives of those left behind. When I told trial therapists the gory details of these suicides, the ones I fired were the ones who freaked out - because I could handle it better than they could.

How did I get over it? Gave myself an audit for narcissism. Because no matter what pain relief we are seeking through the prospect of suicide, the act itself is extremely selfish and destructive to those around us. Suicidals are indeed emotional suicide bombers.

My penny's worth, take it or leave it. This therapist might be running the scenario of your possible narcissism. If your pain is all about you, instead of feeding your possible narcissism, he is starving it of oxygen. I don't like his tactics, because they are a little unkind, but they might be one of several ways of reaching effective recovery.

If you confided in me as a stranger, say if we met me at a bar, on a hike, or on public transportation, I would say something else. I would say I totally get your pain and your fantasy of relief from it, because I was there for decades. So let's try to unravel your pain and without even having to talk about your relief scenario, it will become less appealing. Our pain is all about us, and it naturally does make us self-orientated. There are different ways to get through that, only one of which is suicide.

Couple of other matters. First, sympathy can prompt complaining, chronic complaining has a world of health risks (Google them), so sympathy can be counter-productive.

Second. My suicidal ideation became an addiction (also know as rumination and intrusive thoughts in PTSD), and I treated it as such. So, nipping those thoughts in the bud by swamping my mind with other thoughts, such as practicing gratitude and immersing myself in the joy of nature and light humour.

If you run all this past him during your next session, I'd be curious what he says. He might even have some jokes.

 

[Ecdysis]

Sent an email to T today, asking to try other techniques for this issue for the next session.

Hoping something will help to shift it.

I can't really relate to the issues you posted @Applecore . I'm not sure that everyone who struggles with suicide is narcissistic? That seems like a weird logic to me.

I think part of the problem is that I don't have a good rapport with this T, so we don't intuitively "gel" well together. Sometimes therapy with him works, sometimes it flops.

Another part of the problem is my autism diagnosis. This T is specialised in trauma but knows basically zero about autism. I think the autism makes me talk/ present particularly "flat" and "emotionless" in therapy, when talking about topics that are very difficult or triggering for me. I'd have assumed he's used to that from his other trauma clients tho, who dissociate or go emotionless on hyper-emotional topics.

Anyway, I think given that he and I don't have a very good rapport, the issue of suicide/ not wanting to live is probably "too big" for him to deal with spontaneously. I probably should have told him in advance I needed to talk about it.

So, now he knows and I'm (very) vaguely hopeful, that maybe something slightly more useful may result in the next session, tho I'm not getting my hopes up very high either (just allowing it to rise marginally above baseline).

On a positive note: I started a specialised autism therapy about 2 months ago. Where I live, autism therapy isn't covered by insurance, you have to apply to specialised autism centres for therapy there. This therapy seems to be helping, where the trauma therapy had hit a wall. So maybe the suicidalness may actually get more effective treatment from that quarter, who knows.

Also, the Ketamine therapy is helping with it. It certainly alleviates the suicidal ideation symptoms well, which is a huge relief. It hasn't (at least until now) changed the underlying issues that drive the ideation, so that's still there, in the background, fuelling it. The Ketamine is surprisingly helpful in helping to shift and change deeper issues too tho, so it still may, in time. Also, the combination of Ketamine plus talk therapy seems to be very fruitful and so maybe it'll just take time of alternate Ketamine and talk therapy sessions to whittle away at this issue over time.

Oh, and I've been reading up on suicide amongst people with Autism and both the risk of suicidal ideation and committing suicide is up to 10 times as high for people with autism as for the general population.

The same is true for people wiht PTSD.

Not sure how to "combine" those two risk factors for me... Not sure on the maths of it... Does it make me 20 times more likely?

Anyway, PTSD and Autism as suicide risks are enough of an explanation for me, without needing to throw an assumption into the mix that suicidalness may be narcissistic. I'm sure it is in some people and yeah, literally EVERYONE has some narcissistic traits. I don't think my suicidal ideation is linked to that tho.

 

[Ecdysis]

Therapist replied and said yes we can try other modalities like EMDR.

I replied saying that I'd also like to look at the spiritual level. I think at midlife I'm going through that long dark night of the soul thing... And maybe the intense feelings of not wanting to be alive anymore are in part a metaphor for "part of me" needing/ wanting to die? Some kind of spiritual ego-death thing, of stuff that I need to leave behind. Things that belong in the first half of life but are utterly a burden in the second half of life, and that I need to let go, even if it's really painful?

 

[Charbella]

I think the autism makes me talk/ present particularly "flat" and "emotionless" in therapy, when talking about topics that are very difficult or triggering for me. I'd have assumed he's used to that from his other trauma clients tho, who dissociate or go emotionless on hyper-emotional topics.

I wonder if you’re giving the autistic part of you too much credit here. 4 years into therapy I still talk about the hard stuff emotionless. I don’t have autism but with ADHD there are some overlapping traits. I think trauma therapists are used to their clients talking about it that way. In order to survive the trauma most of us walled off our emotions too. Getting in touch with them means I now can name it and feel it but it certainly doesn’t mean I bring them to the big stuff conversations. Because for me I can either talk about it or feel it but I can’t do both. As soon as emotions start to creep in I’m out.

My therapist is pretty chill about suicide. He could’ve made that exact comment. It’s his time to become emotionless and now that he knows I won’t talk about the subject when he brings it up to talk about he might make a joke to ease the tension and maybe get a few words out of me. I think he gauges just how bad it is by what is coming up in EMDR and how bad I don’t want to talk about it. Which for me, I’ll make a sarcastic comment if I’m on the verge. Even when I’ve brought it up to talk about, he’s pretty chill about it, because the subject doesn’t go far before I’m ducking out of it. I believe it’s because there’s no wrestling with this part of me, I don’t see a future so it’s always there.

As to the narcissistic traits comment, I totally agree with you and I too have had family die from it and watched its impact. Do I think ultimately it’s a selfish choice? Yes, and yet if someone told me I could hit a button and be guaranteed to be gone I’d take the selfish choice. Because knowing how it impacts others and being sad for them doesn’t lessen my pain. It doesn’t make me want to live my life for them.

I think EMDR is a great way for those of us who are emotionless to touch those feelings in a very powerful way, so I hope you give that a try.

 

[Applecore]

Sent an email to T today, asking to try other techniques for this issue for the next session.

Hoping something will help to shift it.

I can't really relate to the issues you posted @Applecore . I'm not sure that everyone who struggles with suicide is narcissistic? That seems like a weird logic to me.

I entirely respect your point of view. Also, I didn't say that everyone who struggles with suicide is narcissistic. I said that your therapist might be taking the position that an aspect of narcissism might be relevant here, whether he is wrong or right. In fact I was talking about your therapist, not about you - and I said if these are the tactics he was using then I would find them unkind.

My point would rather be that suicide is by definition a self-orientated act, just as pain is a self-orientated feeling. I think it's helpful to think about that when looking for recovery. I no longer visualise shooting myself in the brain with a Colt .44, and I think that learning to be less self-oriented helped. If my experience can help others, then great - if not, no problem.

I think part of the problem is that I don't have a good rapport with this T, so we don't intuitively "gel" well together. Sometimes therapy with him works, sometimes it flops.

Good fit and compatibility is a well-known issue in therapy. You have every right not to gel, for whatever reason.

Another part of the problem is my autism diagnosis. This T is specialised in trauma but knows basically zero about autism. I think the autism makes me talk/ present particularly "flat" and "emotionless" in therapy, when talking about topics that are very difficult or triggering for me. I'd have assumed he's used to that from his other trauma clients tho, who dissociate or go emotionless on hyper-emotional topics.

This right here is hugely important. I have a close family member who self-diagnosed as being on the spectrum, and heavily masking. Taking your issue up with an autism expert would be a very good idea IMHO.

Anyway, I think given that he and I don't have a very good rapport, the issue of suicide/ not wanting to live is probably "too big" for him to deal with spontaneously. I probably should have told him in advance I needed to talk about it.

I very much doubt suicide is too big a subject for a therapist. That's pretty much one of the main things that they're there for. I am no expert, but my father was a psychotherapist and both his mother and his brother (so yes, my grandma and uncle) committed suicide. I lived in an apartment where her blood was on still on the floorboards, which certainly contributed to my own suicidal ideation, no matter the extent to which it could be viewed in the frame of narcissism as a self-help exercise.

So, now he knows and I'm (very) vaguely hopeful, that maybe something slightly more useful may result in the next session, tho I'm not getting my hopes up very high either (just allowing it to rise marginally above baseline).

On a positive note: I started a specialised autism therapy about 2 months ago. Where I live, autism therapy isn't covered by insurance, you have to apply to specialised autism centres for therapy there. This therapy seems to be helping, where the trauma therapy had hit a wall. So maybe the suicidalness may actually get more effective treatment from that quarter, who knows.

Excellent.

Also, the Ketamine therapy is helping with it. It certainly alleviates the suicidal ideation symptoms well, which is a huge relief. It hasn't (at least until now) changed the underlying issues that drive the ideation, so that's still there, in the background, fuelling it. The Ketamine is surprisingly helpful in helping to shift and change deeper issues too tho, so it still may, in time. Also, the combination of Ketamine plus talk therapy seems to be very fruitful and so maybe it'll just take time of alternate Ketamine and talk therapy sessions to whittle away at this issue over time.

Excellent.

Oh, and I've been reading up on suicide amongst people with Autism and both the risk of suicidal ideation and committing suicide is up to 10 times as high for people with autism as for the general population.

The same is true for people wiht PTSD.

Not sure how to "combine" those two risk factors for me... Not sure on the maths of it... Does it make me 20 times more likely?

Anyway, PTSD and Autism as suicide risks are enough of an explanation for me, without needing to throw an assumption into the mix that suicidalness may be narcissistic. I'm sure it is in some people and yeah, literally EVERYONE has some narcissistic traits. I don't think my suicidal ideation is linked to that tho.

Yes exactly, literally EVERYONE has some narcissistic traits. Very few people admit that they might be one of them. You have your own journey, and it looks like you have clarity of direction, which is an excellent start.

I can recommend taking a look at or listen of the quite short, rather funny and very wise The Subtle Art of Not Giving a F*ck by Mark Manson. If it makes you laugh out loud even once, it will have been worth it. It's also about this.

Keep going buddy, I believe in you.

Applecore