Discussing Suicidal Thoughts in Therapy

[piratelady]

I've been a little on the depressed side over the last couple weeks. I've started having suicidal thoughts as well. I also haven't had therapy in nearly 3 weeks. I'm scheduled to go back on Monday. I've never been in therapy when I've had suicidal thoughts before. I've been going back and forth in my mind about whether or not to say anything.

Reasons to keep it to myself: He'll think badly of me, either that I'm being an attention seeker because I've had to take a therapy break (like I'm being manipulative). Or he'll worry about me and feel compelled to break confidentiality.

On the other hand, I haven't been able to snap myself out of this so far. But I don't have a plan or anything, I just don't see any hope in continuing on. I mean, the only pro I see for living is that it would devastate my husband. I know, I won't always feel this way, but ultimately the depression the PTSD will never go away long term. I'm just going to have to go through this again and again and again.

Anyway, to help me make my decision about how to approach this in therapy, I'm wondering if anyone can share their experiences with discussing suicidal thoughts in therapy. How did you bring it up? Just blurt it out? How did they react? Did they try to have you hospitalized or tell your family? What sorts of questions did they ask you or how did that conversation go?

Maybe if I know what to expect I'll be more willing to have the conversation. Thank you.

 

[Tinyflame]

Idk @piratelady , talking about it, especially with no plan (genuinely), can come about. I'm not a good one to advise: I guess like you said it's potentially not easy or quick to solve, the discussion isn't meant to effect anyone else or imply anything other than how to manage, but feels like it could be construed otherwise and therefore hard to bridge and lots of motivation to avoid, and I agree ultimately our own choice, and battle.

That being said, seeking help is always advised, though I was advised to sort of keep it to myself.

Ugh, that is surely not helpful. :( Ideally it's just a conversation.

Good luck, xox.

 

[EveHarrington]

Hospitalization is only if you are a danger to yourself or others. Merely having thoughts but no plans means you’re not a danger to yourself, especially if you have a safety plan and can contract for safety.

 

[bellbird]

I've been going back and forth in my mind about whether or not to say anything.

Please say something :hug:

Just blurt it out?

Oftentimes, yep. But that tends to be my strategy with things I find difficult to say :D I have to let my mouth run with it before my brain has a chance to stop it.

How did they react?

Concerned, but calm. Not angry or disappointed.

Did they try to have you hospitalized or tell your family?

We had many conversations about my suicidal ideation over the last 4 years with my T.
There was only one time (earlier this year) where she had me hospitalised. But that was because I had spoken about my suicidal thoughts and could not guarantee that I was not going to act on them when I went home following the therapy session.
She told me afterwards that she felt really bad, but that it was something she had to do; a) from a legal point of view, and b) because she cared about me and my safety.

What sorts of questions did they ask you or how did that conversation go?

The key question they'll ask is if you are safe, i.e. you won't act on your thoughts.

it would devastate my husband.

They'll also probably ask what protective measures you have in place. You can tell them things like this.
My T also made sure I had the number of the crisis line in my phone. And we made a safety plan for what I would do when I felt suicidal.

It's only if your T believes that you or someone else's safety is at risk that they can break confidentiality.

Otherwise, therapy needs to be a place where suicidal thoughts can be discussed without the fear of T telling someone getting in the way. There's nothing wrong or bad or melodramatic in you having them; they're a "normal" and often very frequent occurrence for many of us going through this.

 

[piratelady]

no plans means you’re not a danger to yourself, especially if you have a safety plan and can contract for safety.

Thank you, this is really helpful.

It's only if your T believes that you or someone else's safety is at risk that they can break confidentiality.

Thank you. The internet told me they will try to enlist your family in therapy, which I really don't want. It's good to know I can say no to this if I want.

There's nothing wrong or bad or melodramatic in you having them; they're a "normal" and often very frequent occurrence for many of us going through this.

This is hard for me. to understand. Thank you for the information on your experiences.

Please say something

I am going to try. I'm going to see my GP on Monday as well. I do worry that they will ask for permission to talk to my therapist. Which also scares me. I wonder what they would talk about.

I just don't want people to make a big deal out of this. It's fine, really. I feel like it's going to get blown out of proportion.

Thank you all for the information, it's really helpful.

 

[bellbird]

The internet told me they will try to enlist your family in therapy, which I really don't want. It's good to know I can say no to this if I want.

I understand that completely. My family don't know about my mental health issues, and I have been very adamant through my treatment that I don't want them to know, or be involved.
Having a safety 'agreement' with my T helped a lot with this.
Do you think you'd be able to talk to your T about not wanting the involvement of your family? It could help to start the conversation around making a safety agreement/contract so that you feel comfortable about disclosing SI-without-intent to your T, without the fear of your family finding out?

My safety agreement involved having people who I was ok for T to contact if a crisis situation arose (like that one time where she had me sent to hospital). My people are two of my close friends, who are willing to care for me in those situations. Sort of like a family role, but not officially family.

I do worry that they will ask for permission to talk to my therapist.

They may do; mine did. But again, if you are not a danger to yourself or someone else, then it would breach confidentiality for them to do so without your permission. You have the option of saying no.

I wonder what they would talk about.

In my case, I did give my GP and therapist my permission to discuss me/my treatment. And I'm glad that I did.
I don't know what exactly they talk about, but I suppose the idea behind it is to make your treatment 'better'.
Say I showed up to therapy several weeks in a row more symptomatic than usual, after starting a new med, but I wasn't aware of that fact/didn't feel comfortable enough talking to my GP about it, my T could do that for me.
But in saying that, there have also been instances where I haven't felt comfortable for T to tell GP about a particular thing I disclosed in therapy, and so she hasn't.

I just don't want people to make a big deal out of this. It's fine, really. I feel like it's going to get blown out of proportion.

I know, I hear you. It's a very real and valid concern. But your safety is important too :hug:

 

[hopefully optimistic]

O have very little experience with this, but a couple of weekends ago I had a really rough evening. I don’t tend to offer I formation with my T or my dietician. But I saw my T on Tuesday and she asked about the weekend and I told her the truth-I has a really hard night. She asked about self harm, which I told her didn’t work and it freaked me out. She then asked about suicide ideation or if I hadn’t gone that far. My response was -maybe nearly there ....(I wasn’t expecting the conversation and was attempting to be as honest as possible, but things got better after that night and I wanted to be sure they weren’t blown out of proportion). She did ask if I had a plan. I did not. She then went on to tell me how she gets how scary it is when a coping mechanism doesn’t work, etc. That was it. She was completely calm and didn’t take it much further. Two days later I see my dietician, who I have seen longer than my T (by like 2 months). Similar questions, similar answers. Except my dietician says she is going to recommend a higher level of care. Afterwards I email my T (since I am freaking out) and my T says she will contact the dietician and let her know that’s completely unnecessary.

All of this to say-would I be that honest with my dietician again? Probably not. I get her covering her own ass. I get it. But I felt so ashamed and guilty. This week my dietician did explain that my safety and her concern for me is paramount, but that she felt better after talking to my T.
So....it’s so hard. But I think it should be discussed at some level.

 

[StellaBlue]

I lived with constant suicide ideation for years - we're talking constant from age 14 to 54 - it's not been an issue for almost 2 years now (and I feel - blessed). My current therapist, who I've seen for 5-6 years (on and off) has been a rock throughout all of it. After about a year of seeing him, I finally told him about it. He would check in but never threaten (or even suggest hospitalization) - even though I was "sectioned" twice after that (not by him).

Interestingly, one of the most helpful things he did regarding this was to ask "what if you decide that this is not going to go away, that you have to live with it, and just stop fighting it?" - that was the beginning of the end of my ideation - just radical acceptance - when I stopped fighting it, it stopped fighting me.

But that's my story - for you, if you trust this therapist, tell him - tell him you have no plan, tell him you're afraid of being seen as manipulative, tell him how badly it sucks to have these intrusive thoughts. If he is worth his salt, he can handle it.

 

[piratelady]

I did wind up telling him about the suicidal thoughts. He seemed a little caught off guard by it, but handled it well. He asked me if I had a plan, which I said I didn't. I actually spent a fair amount of time googling suicide assessments to see what they ask and what they look for in regards to body language. Then he didn't ask any of those questions, lol. All in all, it was fine I think. I am glad I told him, I'm a little sad that I wasn't entirely honest with him about how bad it was. But I feel like I'm finally getting out of it, so it probably doesn't matter that he doesn't know.

just radical acceptance

For some reason, this thought really scares me. Like, if I accept it, it seems like it would be easier for me to follow through with a plan. Or maybe I'm just a worrier. We're all different.

 

[Ronin]

Like, if I accept it, it seems like it would be easier for me to follow through with a plan.

Acceptance does not mean resigning, though?

You can well accept it... and then get proactive about it, toward changing the state of things.
Just taking basic reality as it is instead of extra pressure about it, denial, minimizing, and so forth.