How Do I Find A Psychiatrist I Feel Safe With, Without Revealing The Issues That Make Me Feel Unsafe

[Sunset]

I've had a lot of bad experiences in mental health. One, I'm a goth, and I've had a lot of practitioners who seem to have negative views of that and see me as disturbed or even potentially suicidal because of how I dress. Two, I've had practitioners disbelieve or mishandle the fact that I was abused by a previous boyfriend.

My fear is that I'll get stuck with a psychiatrist once I see them. I've had a psychiatrist (in college) basically tell me I had to be dealing with them, or else I'd get reported for being a danger to myself - even though I was not at the time, and many of my actions were either simply me being different, or logical responses to avoiding an abuser (he ignored my reports of physical and sexual abuse). I was seeing an outside professional but he basically made it so I had to deal with him.

At this point every time I pick a new practitioner I'm terrified that I'll get hurt again. I don't feel like I can be honest with them without hiding anything that might remotely possibly be misinterpreted that I'm suicidal - because if they ever think that, no matter how mistaken or based on their own biases, I'm afraid I won't be able to leave the relationship and find another doctor without being reported for being a danger to myself.

I also feel like bringing up the questions I have is dangerous. I feel like, say, asking outright how they handle thinking someone is suicidal, or what are the criteria, is itself something that makes people think you're suicidal. I feel like there's such a huge presumption that if a psychiatrist intervened it must have been for cause, that expressing doubt or caution itself makes people think there's a problem.

How do I find someone I can actually trust without risking the abuse I had in college happening again?

I know this sounds a little paranoid, but I've seen things happen that people (including other mental health practitioners) swear up and down should never happen, or aren't issues to be worried about. Even when really bad things were happening I had people swearing everything was fine. So I'm a bit wary of other people telling me not to worry about the concerns I have.

 

[Casey_03]

To be honest, this does sound a bit paranoid and you seem really fixated on the suicidal thing, but at the same time, I can understand why, especially if you've had bad experiences in the past. I used to be really paranoid about this too, and afraid to admit when I was depressed for fear of the therapist thinking I was suicidal. It sounds like you've had a ton of really bad therapists ... but I don't think you should feel like you have to stick with one just out of fear they might have you committed. I think you should read up on the laws that allow them to commit people who they deem suicidal and at least have that knowledge as a weapon in case some douchebag therapist tries to manipulate you again. In my experience, they will shut right up if they realize you are actually familiar with the laws that govern their work and their industry (I had a lot of disagreements with therapists in my day and this always helped). But also keep looking for a decent therapist who will not treat you in such a crappy way -- there are some good ones out there, not many, but some. And if you fear they might think you are suicidal, keep in mind that they are only supposed to act on this concern if you are really behaving dangerously/erratically, harming yourself or talking about harming yourself. If you just tell them you are experiencing suicidal ideation, or having thoughts you know you won't act on, they aren't supposed to take any action other than talking to you like normal.

 

[Sunset]

It's not just that I've had bad experiences, but that, when I reported my bad experiences, the response I got by and large was they're only trying to help and you must be misinterpreting something and that doesn't happen. So I'm a bit wary of being told I'm being paranoid, because I was being told I was being paranoid and there was no abuse going on, even when I was actively experiencing abuse.

 

[Casey_03]

Yeah, I understand and didn't mean it as a criticism at all. Could it be a sexism thing? I'm not usually one to toss around the sexism card, but I know most of the male therapists I saw in my day did dismiss all of my concerns, much like you are describing (yes, even when I was in an abusive relationship)

 

[EveHarrington]

Can you not dress goth for your appointments? I'm not shaming you, rather I am all too aware how much society judges us by our appearance.

 

[Sunset]

Can you not dress goth for your appointments? I'm not shaming you, rather I am all too aware how m...

It's not just the goth thing. It's that I don't feel safe that I'm not being judged on superficialities to determine whether or not I'm suicidal, which makes me not feel safe with psychiatrists. And that I often feel disbelieved when I report my own history, which again makes me feel very unsafe.

 

[EveHarrington]

I'm sorry, I didn't mean to imply it was just a goth thing. However, if you are mentioning you are goth I have a feeling that you also realize how people judge harshly based on appearances. I was suggesting that dressing un goth could help, not solve the problem.

 

[joeylittle]

I also feel like bringing up the questions I have is dangerous. I feel like, say, asking outright how they handle thinking someone is suicidal, or what are the criteria, is itself something that makes people think you're suicidal. I feel like there's such a huge presumption that if a psychiatrist intervened it must have been for cause, that expressing doubt or caution itself makes people think there's a problem.

I understand this fear.

My advice would be to look for a therapist, first, and not a psychiatrist. Why? Because a therapist will nearly always do a no-strings-attached short (20 minute) phone session where you can ask them questions about how they work, what their expertise is in, etc. Often, this phone consultation is free. In the US, you'd probably never have that opportunity with a psychiatrist.

When searching for a therapist, look for one with a strong background in crisis work. As far as I was concerned, if they hadn't spent a lot of quality time working for crisis lines and being the therapist on-call for an ER (more than just the hours required for licensure), they weren't going to be able to work with my chronic suicidality very well - and that is a major symptom for me. I cannot speak openly with someone who is not willing to build trust with me where suicidal ideology is concerned.

Finally, I'd recommend looking for a LCSW - just because they've had to log more and more varied types of clinical hours. They've seen more, and can be less likely to jump to an aggressive 'must be hospitalized' stance. Just my experience.

Once you've got a relationship building with a therapist, they can probably make suggestions of psychiatrists they are familiar with who would handle your case well.

Oh - also: know how to talk the talk. When a clinician says, "are you thinking about killing yourself?", stay calm and say something along the lines of "I ruminate on ending my life as a way to escape the emotional pain I'm in, but I do not have a plan, I don't have a method, and I don't have any sense of a date or the pressure of time." - these are typical measures used to determine how much a danger to themselves someone is.

Also, it helps to share the thing that keeps you from becoming suicidal. For many, this is that they don't want to hurt the people they would leave behind. For others, it's a fear of having a failed attempt, and the shame and possible medical complications that go with that. For others, they know that they want to live, just not how they are living right now. And sometimes, it's an actual fear of death.

Although it may seem backwards, the more coherently you can explain yourself using the language they use to determine whether or not someone is a danger to themselves, the more likely that they will believe you - because, frankly, you aren't in immediate danger when you can identify it as ideology.

This goes both ways, though. When you find someone you trust, there will come the time when you are feeling worse than you've ever felt, and you'll need to engage in some kind of safety contract with your therapist. But by then, hopefully, you'll have a shared understanding of what your personal danger threshold is.

 

[Biz]

@Sunset , I don't think what you're saying sounds paranoid. I had a provider jump too quickly to assuming my suicidality in the past too and it was a really negative, sticking experience. I think your concern seems right on having been in that kind of situation.

In my search for a great provider, I found it surprisingly helpful to ask them about how comfortable they feel with suicidal ideation. You're right about their concern with this and usually it takes a follow up statement like, I'm not asking because today's the day or nothing has been this extreme recently. Sometimes, this discussion came up in my initial, once it was a conversation had when they were going over their policies, and with my current provider I had an initial early question and then a deeper discussion when my SI really came up.

The T I worked with before my current provider was really open and asked me to come up with an indicator that meant I was serious. I decided spending money on my plan is serious. I experience SI enough that I have a solid plan, but I'm only to the level of purchasing materials if sh*t could go down.

One T I almost worked with had a delineated policy in her paperwork that said, "If you report a plan" she would hospitalize. I refused to sign it until we talked that over. That was a difficult but good conversation and it helped me trust her a bit and illuminated her style more. Ultimately, I didn't stay with her in part because I wasn't so sure how she'd handle me.

 

[Biz]

@joeylittle , that's interesting your thought on LPC vs. LCSW on the hospitalization. Most of my negative experiences with this were with LPC's.

 

[joeylittle]

Most of my negative experiences with this were with LPC's.

Yeah, me too. They just haven't logged as many flight miles, so to speak. And I do understand why they are careful: you're dealing with keeping someone alive. But hospitalization isn't the right answer each and every time, and I think it takes experience - and a real personal interest in managing mental health crises - to be a good judge of where someone's at. An LPC is generally not going to have that experience, or that interest.

 

[Suzetig]

I think @joeylittle is right in this one. Look for a therapist who has a bit of experience under their belt, they'll be less jumpy about suicide and happier to hold the risk.

Good experience in working with trauma helps with that too. Don't be afraid to ask directly about when they would need to break confidentiality - they should be happy to give a clear answer and if they say something like "when I think you're a risk to yourself and/or other people" get them to break it down for you. So, at what point do I become a risk to myself, how comfortable are they in openly talking about suicide, have they worked with suicidal clients before, how often have they breached confidentiality.

I can understand the suggestion about changing your appearance but therapy is the one place you should be able to be yourself completely, so go as you are and if they can't manage that, find someone else. It's not easy finding someone to work with so try not to be disheartened. When you find the right person it'll be worth the search.