How Does Your Therapist Handle Self-harm?

[sun seeker]

@pixel, if you'd like to go into more detail on that, feel free. I'm okay with a tangent. Having said that, I would like to remind people of my original question: how does your therapist deal with self-harm and suicidal ideation? I'm looking for a variety of responses to get a sense of whether my therapist's response is normal.

 

[lostforgottensoul]

how does your therapist deal with self-harm and suicidal ideation? I'm looking for a variety of responses to get a sense of whether my therapist's response is normal.

Well, my therapist asks to see the cuts, if possible (likely to make sure they are ok) and then asks why i did it, if known or if not known, what feelings/thoughts/emotions I was having at the time or the earliest time I can remember prior.

Suicidal Ideation, we made a suicide contract together: No-Suicide Contracts - What They are and How to Use Them - No-Suicide Contracts - Suicide.org!

It has distraction techniques, self soothing techniques, affirmations, countering thoughts of a bunch of regular thoughts at the time of suicidal thoughts, imaginary mediphors, emergency plan, just a bunch of stuff.

He has a copy and I have a copy.

He'll break it out and ask me what i tried on it, what i didnt or where i stopped or where i got stuck. If i got stuck we'll figure out why and how to prevent it next time.

Or if im having them right then he'll ask why i feel like dying is the best way to handle things. He'll try to dig out why and work on it.

I learned, though, recently that therapists handle these things differently. Like self injury that for a lot of people its about full distraction and for me its about why. Im sure thats due to my trauma but all of this may be different for other people.

I hope that helped some?

 

[sun seeker]

Yes, there are certainly a lot of different reasons why people self-harm, and you have to get at the reason before you can strategize. I've tried a lot of strategies (or dismissed some of them outright) that don't work because they are assuming a lower level of activation than I have reached when the urge becomes irresistible.

What I am noticing in your response, @lostforgottensoul, is an ongoing dialogue about a serious issue. I am feeling that my therapist doesn't really want to address how serious the issue is and I have to be the one to push.

 

[pixel]

@pixel, if you'd like to go into more detail on that, feel free. I'm okay with a tangent

(I deliberately kept my post brief to avoid tangent-ing and you must have discerned that :tup:)

People dealing with the thought of suicide are not logical, they are emotional

Suicidal ideation often involves a coherent thought process which usually proceeds logically, resulting from purposeful reasoning.
I'm not commenting on whether it is right or wrong, or delving into the ethics of suicide.

 

[EmmaOwl]

I was dosed up with seroquel till sufficiently dazed and compliant then I was released. That was repeated many times and didn't help one bit

Well then "Blurred" is a very apt screen name for you! Goodness. I take 800 mgs of seroquel every night and it makes me feel ICKY. It is supposedly for two things, in my case - to force me into sleep, with the benefit of some "mood stabilizing" effects - or so they tell me.
But, say I take too much by accident, or too late at night... It will ruin my whole next day.
It's the sleep that makes me willing to take it. Nightly nightmares can make a person desperate.
Did you take it during the daytime? I know that it is sometimes given that way, but I cannot imagine I would be able to function. Do you mind telling me - if you even know - what doses of seroquel you were given and how often? I ask because.. well it seems to be one of those weird medications where it works but no one is sure why. So I am always curious when I see mention of it. Thanks for sharing your experience. It sounds like you've suffered some incredibly unpleasant memories, to say the least.
I hate medicine. I feel so damn dependent on everything, it is a crisis if I can't obtain it, so many things....

 

[lostforgottensoul]

What I am noticing in your response, @lostforgottensoul, is an ongoing dialogue about a serious issue. I am feeling that my therapist doesn't really want to address how serious the issue is and I have to be the one to push.

Yes, my therapist and I have created a save space and an open ongoing dialog. I think he also determines in his mind if Im ok to go home or if the suicidal ideations are more than an ideation and should be hospitalized. He has never hospitalized me but i think he determines that silently to himself.

So im hearing that your therapist doesnt see how serious of an issue self injury and suicidal ideations are and you are the one pushing about it. Am i reading that correctly?

Have you talked to your therapist about it. Something like "i feel my self injury and suicidal thoughts are much more serious then you are understanding they are and would like to do work around them" or something of that sort. Talked directly to your therapist about it, instead of just pushing. Basically saying "hey, this is serious and you arent getting how serious it is"?

 

[Blurred]

Hi Allie D, it was a number of years ago that I was on seroquel but I think they were giving me about 400mg three times a day but I'm not 100% on the dose - I was completely out of it. It did help me sleep but I was just so completely out of it the entire time. I'm guessing that lower doses might have helped me function better but I still have a feeling that I wouldn't have been "clear" even on lower doses. They pretty much gave it to me to calm me down (anxiety, SH, SI) and help with sleep. I guess it did its job at the time but I weaned myself off it when I realised I was dependant on it

 

[lostforgottensoul]

Did you take it during the daytime? I know that it is sometimes given that way, but I cannot imagine I would be able to function.

I know you arent asking me this but I take Seriquel XR (extended release) in the daytime as opposed to immediate release, generic quetiapine, usually given for sleep.

It (lower milligrams) makes you tired at first but you do get used to it and it builds up. Currently no generic for Seriquel XR in the US.

Im currently on 200mg seriquel XR and it does help me sleep a bit but mainly its helping daytime emotions/anxiety.

It sounds like you need it for sleep though.

 

[Blurred]

Well then "Blurred" is a very apt screen name for you! Goodness. I take 800 mgs of seroquel every night and it makes me feel ICKY. It is supposedly for two things, in my case - to force me into sleep, with the benefit of some "mood stabilizing" effects - or so they tell me.

I got off seroquel a while ago then got off antidepressants more recently and am glad I did. However i was only able to do that after finding my current therapist. I still have really rough times with everything but am slowly learning to manage without meds now. I know I can go back on them if I need to

 

[sun seeker]

Suicidal ideation often involves a coherent thought process which usually proceeds logically

Mine actually does stem from overwhelming emotion. The thought process that keeps me here, though, has a lot of logic in it.

 

[sun seeker]

Have you talked to your therapist about it. Something like "i feel my self injury and suicidal thoughts are much more serious then you are understanding they are and would like to do work around them" or something of that sort.

I answered. I deleted. I'll PM you.

 

[ShodokanJenn]

When I first started seeing my T, I was coming off of 11 weeks in the psych unit. I was actively suicidal, and still had 120 stitches from my latest self harm. Both the self harm and suicide attempts came in the midst of dissociation and flashbacks. So my T decided I would go through DBT training twice (the group therapy modules meant the whole course took six months). We would work on breaking free from dissociation without self harm or a suicide attempt. The deal we made is that if I felt myself starting to dissociate, I would use what I learned in DBT to try to stop it. If my efforts failed and I self-harmed, I am supposed to call and leave a message, email him a message detailing what happened, and seek treatment promptly (my sh almost always requires sutures. I thought his plan was stupid, but I have not self harmed or attempted suicide since we made that agreement.