How Do You Talk To Your T About Suicidal Ideation?

[Fadeaway]

This could have gone under Therapy as well, but I choose to put it here due to suicidal ideation being at the center of the issue.

Every therapist I have ever been to says they have to report suicidal statements. So how do you address ideation without crossing the line that makes them feel the need to report it? Obviously this isn't a question I can just ask my therapist.

I have multiple "plans" for various situation on how I would do it given my location and resources. But that what they are plans for if I ever get to that point. I have put dates out of the future. Meaning I have told myself when I was feeling suicidal that if things don't improve by such and such date I will do the deed. Those dates always pass and I am still here.

I do think a lot on topics such as the consequences of a failed attempt, and what lies after death. I don't believe in the Christian version of heaven and hell, but I acknowledge that there is know way to know what comes next. I think about the things that it would take for me to make the plunge. "How bad? Whats my personal limit before I am done with this life."

I have the feeling that if I ever did do it, it would be a completely impulsive move. I am not an impulsive person at all. I like to plan the heck out of every thing I do. but on the rare occasion I do get the itch to be impulsive.and it has had catastrophic consequences every time.

The thing is, while I know part of it is the PTSD, a huge part of it comes from the fact that my mom committed suicide. It's a blessing and a curse that what drives me in life is to be everything she was not. It tends to keep me on the straight and narrow and away from committing the actual act so that I am not like her. But when I see patterns of my life mimicking hers despite my avoidance of anything that could be like her (It seems my best efforts are often in vain) I worry about my genetic tendency towards suicide. My mothers aunt struggled with suicidal ideation as well.

I want to talk to my therapist about theses things. I just just don't know how much to share and what would be too much.

 

[Truthful_Whispers]

I just flat out tell them that I think about suicide on almost a daily basis, but I haven't formed a plan. Death is often a pleasant thought for me, and I do not fear it like many people do. When people form a detailed plan on how to do it, then it is getting serious.

 

[joeylittle]

Every therapist I have ever been to says they have to report suicidal statements. So how do you address ideation without crossing the line that makes them feel the need to report it? Obviously this isn't a question I can just ask my therapist.

Actually, I asked mine something just like this. It's really OK to ask them to tell you what they consider to be specific examples of suicidal ideation vs. suicidal threat. They might try and re-direct the question back to you, but you can hold firm to: it's important to me to know how you (therapist) respond to different types of disclosure, because it's not always black and white, it involves interpretation. And then, they should start talking.

Ask them their view on hospitalization; say, hypothetically, 'what would happen if you had a client come in and start talking about killing themselves later today - what would your steps be?'

As long as you are keeping yourself neutral, clear, and direct - you really don't run the risk of them thinking that you are secretly talking about yourself, beyond the fact that you want to know how they react in different circumstances.

I needed to be very clear that my therapist was not going to be reactive - some therapists are very push-button about this topic, if you say anything resembling suicidal ideation, they err on the side of safety vs. confidentiality. I do understand why that happens - just, those kinds of therapists aren't good for people who need to be able to talk about their suicidal thinking without fear of hospitalization.

Also, asking your therapist how much crisis work they have done, generally - that's a good way to get information on how comfortable they are with suicidal thinking. If they've actually spent more than just the required amount of time (for licensure), it tells you something about both their ability and their experience.

When you do open up about it, you should choose to do it on a day you are feeling pretty grounded. And from the way you described it, I would suggest doing things in reverse order from your post. Remind them about your familiy history with suicide, and how that is a major unresolved issue for you. Then communicate that your ideation has sometimes gotten very detailed, but it has always been rooted in hypotheticals - as in, 'if I'm here, I could do it like x', or 'if things are this bad x months from now, I can stop trying' - and you've never been concerned about your safety.

Then, be specific about what you want to work on. Do you want help changing these thought patterns? Do you want reassurance that it's normal? Are you worried that you will lose your impulse control? Or are you just looking to establish a foundational understanding with your therapist about these things, so they can get rolled into your therapy overall...

When a person can discuss their ideation relatively calmly (there may be sadness, but not agitation), and can articulate their awareness that it is something to be addressed, not an actual coping skill, it's highly unlikely that the therapist will misinterpret the situation.

However, if they say 'any talk of suicide is extremely dangerous', 'I don't hesitate to immediately recommend hospitalization', 'my focus was never crisis intervention'....things like that - you should consider another therapist. Maybe not right now, but soon - because you need to be able to talk about these things in therapy.

 

[PTSDbegone]

Thank you for asking this question. It is something I have been wondering myself.

 

[Chava]

I've told my therapist I feel like dying (this is different for me than I feel like "killing myself"...I have attempted suicide several times in the past but not struggling at that level currently). I'm so glad she doesn't abandon me with those feelings but also doesn't over-react and get me committed. I think there is also an understanding that I will go to ER if I'm really in danger, because I have done that before.

Do you think you could bring up that you've thought about suicide but don't have a plan...and see how your therapist responds? Or @joeylittle 's ideas. ? You should be able to talk about this. For me, the suicidal ideation is just a way of feeling like I have some kind of power when I'm feeling hopeless or like I don't have any control...it's been helpful to have the chance to recognize that. The feelings of wanting to die lift when I look for a new route, a way to feel like I have some kind of control or power (not really suicidal these days...more wishes for passive death, but that's dangerous enough if I toss alcohol into it). Sometimes it's something so bizarrely simple that just gives me back the feeling that I have control over my body and my life, even if not perfectly. The suicidal feelings are related to vacating myself and feeling immobilized or totally lacking for power in my life.

Not sure if any of this stuff is helpful...just saying it has helped me to feel like I can talk about how horrible I feel, including my passive death wishes, because I can look at where that's coming from vs be afraid to even acknowledge it.

 

[KwanYingirl]

I didn't know therapists have to reportsuicidal ideation. Once I had to go to the ER because I had called my doctor to get permission to take extra dose of Xanax-I was having a bad day. He shocked me when he demanded that I go to the ER or he would call the police.they drew my blood and as it turned out, I had taken many Xanax and sleeping pills while dissociative. I remember the feeling of drifting away, but they purged my stomach and I guess I owe that doc a thank you.
I talk to my therapist and Psychoatrist about my self harm and suicidality. It's just talk though. It was different when I spoke of taking more meds. I've also taken myself to the ER a few times when it was after hours and I was perilously on the verge of acting on it.
I think they understand that my cutting is not an intent to leave, but actually a major action to keep me from experiencing feelings I couldn't tolerate. I need relief from the pain of losing hope. That is a lonely dark place. No guardian angels in that realm.

I think I'll find out under what conditions my therapist would report me.

 

[NoWhereKnowWhere]

You'll notice when talking about suicide they usually ask if you have plans. The reason for this us to gauge whether or not your going to do it or are just feeling like you'd rather not be here. I personally don't think it's a good gauge because like you said and I personally find it's usually quite impulsive.

This is why it's a good idea to have a crisis plan. You may feel one way in the heat of the moment and another the next day.
I would also recommend a rainy day letter (a letter you write to yourself when you feel well and read when struggling).

I hope this helps.

 

[theshadowoftheliving]

One of my past therapists was so understanding of ideation. He knew that I was actually safer when I could speak about it - and the process of revealing how I felt to a sympathetic and understanding person made me feel less alone, and therefore less of an urge to act on what I thought. But I also had a therapist who overreacted to everything and even saw my self injury as suicidal (it was quite the opposite - a desperate attempt it remain alive). I don't have an answer for you, except that you need the sort of therapist that will listen to this and not judgemental. You might only know if your therapist is his sort of person by starting conversations.

 

[Fadeaway]

I saw my T today and tried to get a feel for whether I could talk to her about it or not. She is great and I am fortunate to have found her, don't get me wrong, but I do think she would be quick to report if I didn't tread very lightly. At least right now. As @joeylittle said, I should be grounded when I do, given that I tend to panic every time on the drive there, I probably should get through that first.

 

[Changing4Best]

I told my pshrink recently that I have thought of it, but that I would do it only if such and so would happen in the future. I make it know that I am not planning to do it now. He said, "Oh Sheila..." I doubt he reported it, but I don't know. He did not place me under observation or anything, that I do know.

 

[Gadgie]

When I was in the emergency services, we were called out to quite a few suicide attempts. Most of them were really a cry for help, but a small percentage were not, and were successful?

They were the worst ones to attend, some stayed with me and will never leave me.

A few months ago, I was there myself, and was actually just about to take some pills, when the phone rang, that was the call that saved me. I've previously written about that in another thread.

 

[Changing4Best]

I made a serious attempt once. I took 4 months of medicines. I was unconscious for something like 10 days. I didn't tell anyone what I was planning to do, I planned it for 4 months. My therapist was so disappointed in me. Also, the nurse who was in the room when I came to was a real bitch.