Crossing The Line: S/i To Real Plans, When To Tell

[The Albatross]

Naoru - there was no ball to drop because you self censored in your session. I would have that conversation with her too - about the inability or unwillingness to discuss honestly because of fear of reporting requirements.

 

[Naoru]

Well, she knew that. She also knows, without knowing, what caused it. We recently discussed her reviewing policies so that we are able to speak more candidly in the future to chop away at some triggers and real-time issues, which I assumed was because she wants to really be able to safely make progress... and I assume she's trusting my judgement in the meantime to keep myself safe. But I know what they say about assuming ... We were supposed to address this last session but I successfully (unintentionally) derailed the conversation.

 

[recoveringfromptsd]

try opening your session with "I need to tell you something but don't act on it, I want to work through it with you", then tell your therapist about your SI, believe me if you frame it right you won't be carted off to the hospital, I was not, the whole month I was waiting to get into pratt. Mobile crisis followed me by phone daily, but that was my choice not my therapists. There are ways to be open about SI and not be sent to the hospital, but there is a line, and that line is imminent danger which is where you are in all likelihood about to harm yourself. You are the one in control always, and you are the one who has to be convincing that you have not crossed that line. But if you have a good relationship with your therapist that should be no problem, in fact therapist can often tell if your over that line without you saying anything at all, so if you not already carted off for being unsafe, you should not be for being honest about your SI. In fact being honest about helps your therapist and everyone else gain trust in you that you will be able tell them when you are across that line before you do something.

 

[recoveringfromptsd]

@Naoru I commend you on taking the steps to be open about you SI and plans and such. I think I said before when SI becomes plans with a likelihood of impulsively carrying the plans out, not only should you be telling your therapist, that's the line where you yourself need to get to the ER. In the end it all comes down to you being responsible for you. If have can do that, most professionals will let you take the responsibility to get yourself to the ER. That way your controlling the process.

 

[Naoru]

@recoveringfromptsd Thanks for the responses. I appreciate the support from everyone. I do not currently have an active death wish, but I will talk more with her as I know intellectually it's possible at any time, and perhaps she does not see how easily accessible the plan is or how quickly I could turn to carry it out. Maybe I don't know how quickly I could turn to carry it out. I also have a slew of things written to hand over next week. Y'all feel free to provide more input if you think something still isn't registering.
I think I see more now of what @The Albatross was trying to point out to me yesterday, but I was too out of sorts to get it.

 

[joeylittle]

I think I'm having a hard time, at the moment, understanding exactly what it is she could do when I tell her again that I have actionable plans and know at some point I will likely get into another headspace or position to utilize this plan. At this point, she knows, we talked about it, I couldn't discuss with her what triggered the episode because of reporting requirements, we backed off of our other work for a bit, and that was that. I mean, is she dropping the ball here by trusting my judgement? She's the one who told me my gauge was off?

I'm really hearing you. This entire issue is almost always more nuanced than can be conveyed in text.

If this helps you:

When you tell her the first sentence, above - you will actually already have diffused some of the potency of the plan. Plans hold more power over the individual when they are being guarded and kept secret. They are also able to retain their fantasy aspect, which is that dangerous wish-fulfillment pull of death as the answer.

In many ways, the trigger for these doesn't matter so much as the post-trigger safety precautions. I would recommend that you actually not dig too deep into that stuff just yet. Work on the present first, then deal with the past.

So in the present, let's say you lay your plan (such as you know it) out for your therapist, fully, and have a session where you honestly confront some of the realities of the act of suicide and it's consequences.

My therapist did a very effective thing with me, in my first real danger moment. We didn't have anything except an agreement to talk before I acted; but because we hadn't been talking about it fully quite yet, I always hesitated, and ended up calling him when I was very ready to go. I know now that had we opened up the line of communication even more, I may not have slipped that far.

Anyway - he gave me some realities about what would happen when I was found. How those people would be affected. He told me about what would happen to the people who were working with me at the time. I'm estranged from my family, but have no bitterness towards my sister or brother. He asked me to think about how this news would affect them.

And I know he was spinning scenarios, and he didn't have a way to predict the future any more than I did - but what he did do was introduce the possibility - just the possibility - that my action might cause someone else pain. He knew enough about me - because of what we had talked about - to know that I was very averse to that.

That's another piece of the puzzle - what is your therapist going to do right in that moment, when you and she are talking? She'll listen. She'll give you the space to talk. She will gather information about the nuance in how you think about your own death. She will be able to use that information, maybe in the room right then, maybe later. She needs the insight into how you think about it, basically.

So - trying to sum up - talking about it diminishes the potency of the secret and the shame - it makes it more real, which means it diminishes the fantasy aspect that usually colors all suicidal ideation - and it puts you in a better position to talk more about it when you need to talk about it more.

Your therapist gains insight, which she can use to provide better, more targeted therapy-based intervention.

And: your therapist gets an opportunity to back you away from the danger zone. It's as simple as, "what would it take to get rid of [your method]?" And, "you're most vulnerable at [x time of day] - how can you make it more difficult to start step one, during the vulnerable time?"

It's problem solving. And it doesn't have to end in you being hospitalized, if that's not necessary. It's going to put things in place for you to do more effective crisis management, when you are triggered again.

One of the fundamentals that you can do - and I know I said this before, sorry I'm a broken record - is remove the method. Remove access. Make access difficult. Make it time-consuming. Find your own stumbling blocks and use them. (I routinely kept a small balance on my credit card just so that I wasn't debt-free. Not leaving debt behind matters to me. So, I keep debt. One more thing to need to do, means one more time I'm going to be able to divert myself. Things like that)

I think I live where you are living (psychologically), and I was surprised how much became possible when I started revealing the information I had been witholding. So I believe it starts there.

 

[Naoru]

Thank you @joeylittle ... seriously. I believe your response and insight was exactly what I've been looking for, but didn't know how to get there or ask.

I'm sorry for being as dense as a brick with understanding this; I shouldn't have even been online responding the other night until I was prepared and clear-minded. Now that some of the storm has dissipated, I am beginning to see the gravity of the situation and just how bad off I really am. Looking back at this entire SI scenario elicits no feelings or urgency (seems logical), but after something happened this week causing me to prepare to take a razor blade to my face, I am ready to just put it all out on the table regardless of my understanding of how or why T can help me.

I have already told her - now what? How do I bring this up again? There's just so much. I'm overwhelmed.

I do have OCD related SI images and thoughts, but it's not quite the same as the experience I described originally. True SI is not a regular occurrence, and I trust my ability to keep myself safe by recognizing the difference and if by nothing else other than by relying on my situation/life to make carrying it out more difficult.

Removing the method entirely seems scary. I suppose it's always in the back of my mind as a safety net even when I'm not in crisis.
Stumbling blocks I can do.

Okay, hitting post reply before I delete it all again or think of anything else. :chicken::bag:

 

[joeylittle]

Removing the method entirely seems scary. I suppose it's always in the back of my mind as a safety net even when I'm not in crisis.
Stumbling blocks I can do.

That's fine. Stumbling blocks are a step towards removal, which often does require a step-wise progression. You're right - it's identifying with it as a safety net, an escape plan. The thing to make sure you are working on is getting your mind to turn, so you can see that there are other ways out of the overwhelming feelings/depression. Suicide plans are not, actually, a safety net - they are the holes in the safety net. But patching the net takes time.

You're doing good. I know it doesn't seem like it. But you are.

I am ready to just put it all out on the table regardless of my understanding of how or why T can help me.

I have already told her - now what? How do I bring this up again? There's just so much. I'm overwhelmed.

I would say, start with saying the first sentence I quoted, here. And then let yourself keep talking. I have told my therapist at times that it would be easier to answer questions than to sort it all out into a big statement for myself. You can ask her to keep prompting you to talk by asking you questions. She will probably know how to do this already, but sometimes, the act of asking for it is helpful too. You won't really know til you get in there. But laying it all out on the table is a good place to start, and it's an action. You can do it, really. Once you start, it will be easier to continue.

Post when you need - sometimes, we need to write things out when we are feeling raw. It's what this board is for.

 

[recoveringfromptsd]

I agree with @joeylittle, if your actively overwhelmed by flashbacks now is not the time start digging into the past, while its important for integration eventually, not learning how to manage the flashbacks and such beforehand is a recipe for chaos, and I also agree having an agreement with your therapist and even others that you will tell them first if you feel you can't insure your own safety is absolutely essential. Doing DBT would be a good thing to do right now, getting the help you need to learn how to manage your PTSD is something you need to do right now.

There is little difference between us @Naoru as we both struggle with PTSD flashbacks and such, what is different between us is I got the help I needed to know and be able to manage the flashbacks by staying grounded. I still have them flashbacks no different than before, I just an now able to stop them by using grounding techniques I learned in the hospital.

I had an agreement to tell someone if I could not be safe before I went into the hospital, and even had one in the hospital. So they allowed me to have a BO level instead of an initial SO level (BO = behavioral observation, SO = Suicide Observation), the difference with SO is you have to be in view of staff at all times, and you have to wear safety sweats, and cannot have certain items to use.

 

[Naoru]

@joeylittle It has taken me a while to admit I even have depression (or anything else for that matter). As mentioned on another thread, my body has acted depressed for quite a while, but I figured since I didn't feel anything and I'm always functional that I can't be ... but that's part of it, isn't it? My t has mentioned it a few times but never pressed the issue. I always feel a little bit of shock when she names it, just as I do when she names everything else.

Anyway, I will plan to do just as you suggested and also ask her to prompt me with questions. She does this regularly, but I agree - putting it out there will be good for me to express ... Thank you.

and I'll consider posting more, but that's really out of my element and comfort zone. There's nothing I can say that hasn't been heard before. I do love the search function. ;)

@recoveringfromptsd While I obviously struggle with flashbacks and managing the other PTSD symptoms, what caused the recent SI episode was something bad that actually happened. My failure to manage symptoms doesn't usually provoke such a strong response ...

... but I will admit this week was a kicker - minor events spawning the full gamut of symptoms flared up in all of their glory - and I really had a difficult time coping and not beating myself up about it (both having PTSD and being unable to manage it at all for even just a day over something minor) ... a reality check. Now I don't have a job and I've been sleeping ever since. Living on avoidance again. Definitely need to go back to the basics and deal with the present.

I'm not sure if I have been clear explaining or if it is still denial talking or I'm still missing the point.

But it doesn't matter

I'm admitting I am weak and do not understand what the hell is going on with me [again] and that is okay. Back to T I go.

 

[joeylittle]

It has taken me a while to admit I even have depression (or anything else for that matter). As mentioned on another thread, my body has acted Depressed for quite a while, but I figured since I didn't feel anything and I'm always functional that I can't be ... but that's part of it, isn't it?

It took me 25 or so years. I really understand. You might want to read about Dysthemia (persistent depressive disorder). It's characterized by a strong belief that you aren't depressed, this is just the way you are. This is a helpful link: Symptoms and causes - Persistent depressive disorder (dysthymia) - Mayo Clinic

Once I started considering that I had depression, and realized that this diagnosis was describing my whole life, it still took about a year to get used to it.

I'm not sure if I have been clear explaining or if it is still denial talking or I'm still missing the point.

You're clear. And I love the search function as well. You do what you need.

 

[Naoru]

a strong belief that you aren't depressed, this is just the way you are

Well if that isn't me, then I don't know what is! Wow. Thank you for the link ... definitely seems to fit the bill. Another long battle to fight, I presume.

FTR I spoke with T about all of this today. I laid my cards out on the table and told her The Method and my crisis this past week. You're right ... it did something to have it out there. I cannot even begin to write it out here. We walked through most of it, and we touched on many of the things you mentioned before ... along with something called emotion ... and things like self-love and compassion. :sour::cautious::sick:

In all seriousness, thank you again for providing the answers I didn't know I was looking for. :notworthy: