Tell Or Keep My Mouth Shut?

[Mammo]

Hello...

Came onto a touchy subject with my T today...suicide.

By way of context, I've made 3 attempts, the last one was involuntarily hospitalised for 3 weeks.
Hospital for me - was the opposite of therapeutic - in fact it was outright traumatising.

I sent my T a book I had written that outlined my history. Naturally today, he said he wanted to discuss SI, to gauge level and severity of depression and "risk" - which I totally understand.

For me - SI is normal. Macabre as it sounds, thinking about it makes me "feel better". Literally gets me through the week. But whilst I understand why he wants to discuss this topic, I am frightened. I want to be able to trust him that he will tell the difference between "thinking" and "doing" - but the risk to me is extremely great - I can't go through hospitalisation again.

With my previous T I never discussed this. Too frightened. I don't have a problem discussing things per se, but the risk of someone freaking out and panicking, is overwhelming.

Thoughts? Are there likely "red flags" he will be looking for as to where to draw the line?

Appreciate your help
M

 

[moonbeam]

Tell.

And tell him that while you have a history of it, and its in your mind its just thoughts you aren't feeling driven to act on it.

Its like the difference between suicide and ideation. Only this is SI and ideation. Same idea. Anyone who has done SI in the past will have the thoughts come up. At one point it was a coping mechanism and nobody can deny or change that. Part of recovery is that people stop SI even if the thoughts sometimes remain. So logically they wouldn't lock you up for thinking about it. Of they did anyone who has done SI would always be locked up.

That's part of gageing risk. Yes the risk is increased by having done it in the past. But if its primarily thoughts and you are able to counter and not act on those thoughts it decreases that risk. Your T may want to rediscuss it down the road just to check in and/or ask that you keep him updated and let him know if the urges become more difficult to stop or become actions. But I doubt you would be hospitalised just based on your post. I think it would be better to tell so you can try to work on the emotions behind the thoughts.

*I am not a doctor though.

 

[digger]

he said he wanted to discuss SI

Can you clarify if you are using the abbreviation SI for Suicidal Ideation, or for Self Injury. Both get used on this forum and it can get a bit confusing - I was reading it as Suicidal Ideation, please correct me if I'm wrong.

It is something I've discussed with my T. She is aware of past attempts. Obviously I don't know your T so can't predict his response, but my T didn't panic or overreact and seems to understand the difference between ideation and intention. It did take me a long time to talk about any of the ideation stuff with her and some of my thoughts and views around suicide and feelings about past attempts, but it was a useful conversation to have.

I think voicing your concerns to him about your fears about the possibility of him overreacting is important and being clear that you need to know he understands the difference between 'thinking' and 'doing'. I think it's also important that he understands how hospitalisation has effected you in the past.

I was very clear with my T about my not currently being a risk of acting on ideation and the reasons why I'm not and how I deal with that. I think she's trusts that I know myself well enough.

 

[Mammo]

Hi Moonbeam,

thanks for responding, I appreciate it.
Do you think it may freak him out if i know how I would do it? sorry, i know that's morbid.

 

[anonymous]

Suicidal Ideation.....

A good therapist will only hospitalized you if you are at risk of hurting yourself. A good therapist knows that thoughts are only thoughts and many of us have thoughts that we never act on. It's ludicrous to enprison someone for their THOUGHTS and rings of more primitive times. It's up to you to gauge the kind of therapist you have.

 

[Mammo]

hi digger,
sorry, new to the acronyms - yes suicidal ideation. Would also appreciate your feedback on my follow-up question to moonbeam.
M

 

[GWhizz]

My T brought this up with me at one of our initial meetings. She simply wanted to assess my level of risk and history. The reason for it, which I imagine is similar for your situation too, was to get an idea of a) what might trigger me to do so (so to prevent her doing something in therapy that may trigger it), b) to see how serious the risk was, and c) to put in place an action plan for in the event of it happening again (she asked that I try to tell her if it happens again and what we may need to do such as interventions etc).

Ask your T exactly the focus and aims of this assessment. Find out the rationale and implications from your disclosure before you part with any important details. This way you can control it and protect yourself.

Of course it is best to be completely upfront and honest about something like this. But I get it. Hospitalization was traumatic for me too and with my last T, we put in place strategies to try to prevent SI, or if it did occur, ways to minimize the risk of hospitalization being required (dealing with it between her and my GP - it can be lot for a therapist to manage alone if they are not working with a team).

I hope you can find a level of safety and trust in your T needed to move forward with them on this.

Best of luck

 

[digger]

Do you think it may freak him out if i know how I would do it?

Personally I think I'd check out his reaction and responses to the subject generally first before getting more specific. You need to be confident I think that he understands that you're not going to act on it. Again though, not knowing your T it's hard to assess or predict how he will react, you are best places to do that if you've been seeing him a while (?). From your relationship with him so far, what do you feel about his reactions - is overreacting something you've seen in him before or have his response generally been more measured? Has he been consistent in the way he reacts generally to things?

 

[Go Hungry]

Yeah, you should tell him about it. I often get the question "any suicidal thoughts?" during sessions. My usual answer is "no more than normal", because it's such a daily part of my life. But thinking about it isn't the same as taking actions toward that end. Your therapist should understand the difference.

 

[moonbeam]

Hmmm thanks for clarifying. That doesn't actually change my answer.

I still think a good T will know the difference between ideation and actively suicidal. Its still important to discuss it with him so you can work on the emotions behind the thoughts. Besides if you can't trust him with this how can you trust him with trauma?

Actually GoHungry has hit the nail on the head. That's exactly it.

 

[joeylittle]

It's up to you to gauge the kind of therapist you have.

In combination with you asking the right questions.

You need to ask your therapist where they draw the line. How they make this particular call, and what their beliefs are around it. For anyone with suicidal ideation - you need to be able to talk about it with your therapist (I believe), and freely. Which means you need one who can handle that.

Were your previous attempts accidents or purposeful? I'm asking because there is a difference between something called parasuicidal behavior (doing something very dangerous with the knowledge that you might be heading towards killing yourself) and suicidal behavior (doing something with the clear intent of death). There are therapists that can work with the former, and separate the two, and there are therapists who are not comfortable making the distinction.

 

[Spiderallis]

Oh, I know exactly what you mean- we've probably got similar tales of what makes the risk of hospitals so very scary. @Go Hungry totally nailed it, establish that there's a baseline level of the ideas and it does not indicate plans or intent. I know it's a comforting thought, I think of it as checking all the exits and making sure the escape hatch is still there- I don't want to open it, I just want to see it. Maybe even go over your reasons for wanting to avoid inpatient hospitalization before that's something that needs to be discussed- there might be a partial day hospital program or something that's more suitable, in case you ever need that kind of support.