How I define a crisis: when I am not sure I am able to keep myself from harm, and the risk or threat of harm is imminent and immediate.
So again, suicidal and/or self harming? I don't want to put words in your mouth, and not sure what you or your therapist would call harm.
It can be other situations other than suicidal or self harm. For example, there was a dangerous person threatening me. When the threat became something greater than I alone could handle, I was in crisis. Another time, I was in a car accident but too scared to get medical care. Harm was there, and I couldn't keep myself safe.
But as for internal threats or states, yes, generally when self harm or suicide, or when I'm about to do something that could put me in danger in some other way or act out in a way that could bring harm on myself.
How my therapist defines something as being enough to reach out to her for crisis support: three steps before I end up in the above situation.
Does that work for you? Do you know when that point is?
This is a long and wordy explanation, but I'm not sure how else to better say it. You can skip over it if you want.
I used to not be able to identify that point. I used to felt like every crisis came on quickly and suddenly. I still experience it that way sometimes. It seems like things hit quickly, and bam. I'm toast.
However, through a lot of journaling and a couple of worksheets, I have been able to map out what are red flags that I'm vulnerable for a crisis to hit. Vulnerable means higher risk for things to suddenly go from 0-60 and end up in a crisis, and this sort of helps me know when things are going downhill.
For example, if I sleep less than 4 hours every night for more than 4 nights in a row, I am at higher risk for a mental health crisis to hit. If clients send me a lot of complaints, I am at higher risk for a crisis to hit. I don't actually generally feel bothered by a few nights of little sleep or crabby clients at work, and people say I'm so patient and calm when others are stressed, but I have noticed this stuff still starts to fill up my stress cup even though I don't feel it. Then if a crisis hits, my crisis may not be about my clients or about my sleep, but those things still exhausted my capacity to cope with other more serious things. It is a sign I'm going to be less resilient if something else happens. Even more so, it becomes something I need to be aware of and take action about long before the crisis hits.
I actually have worked out a chart with my therapist that goes from 1-10, 1 being things are great, 10 being I need to be emergently hospitalized. There are categories for each level for things I experience when at that level: types of emotions, intensity of emotions, body sensations, types of thoughts I might have, amount of sleep, amount of dissociation or numbness, etc. In every category is things I can do to regulate my emotions. What works when I'm at a 3 may not work when I'm at a 7. What works at a 7, might be too much for when I'm at a 3. If I hit 8 or above, then it's time to get crisis help.
I started working on this when I was an inpatient on a specialized PTSD treatment unit and they wanted all patients to fill this out. They called it a "relapse prevention plan." The word relapse annoys me, but the model fits. It's a very CBT/DBT type of thing to do, and it's been helpful.
I don't really refer to this chart much, or follow it closely, but it does keep me mindful of what could build up to suddenly being overwhelmed later on. It even helps when I reach that crisis point. It tends to not run away with me as much, and I feel like I know a little more what I need to do and when.
I used to only have this filled out in categories 1-3 and 7-10. Everything seemed to go from 3 to 7+ in 0 seconds flat. I was either ok or very not ok. It has taken some time to figure it out what was happening for the middle of the chart. It took journaling about past crisis, and even journaling through a crisis, ad then going back later and looking through what I wrote down, to figure out what the red flags were in the months, weeks, and days before things spill over.
Now, I generally have a better sense when it's time to call my therapist. I still think I overreact to my own crisis, and my therapist still thinks I underreact and don't call her soon enough. But I do have a sense of when she thinks I should call. Just having a plan helps me get through the crisis sometimes without outside help. It's almost like I've trained myself to on what to do to intervene in my own crisis more automatically.
It's also changed over time. 3 years ago, there was a certain set of circumstances and on-going trauma that was triggering me quite a bit. I was fighting sucidial thoughts a lot. Now, it's only every now and then. It can still get intensely and suddenly triggered, but it doesn't pull me as far. Just this weekend someone gave me a very triggering gift. I also got a weird threat emailed to me. I was aware of some of my vulnerabilities were already high: lack of sleep and ect. The gift and weird threat situation felt so bad. I quickly spiraled and I wanted to self harm. However, because I knew in my mind already I was already extra vulnerable piror to the gift and threat, it was easier to not give in to the thoughts, urges, despair and anxiety. It was easier to recognize, ok, xyz red flags are happening. I need to do xyz and if those things fail, then call my therapist. Just having that plan was claming. Thankfully, the things I did to deal with it all worked, and I didn't need any crisis help. I never got into the 7+ zone and I was able to be effective in handling the gift and the threatening email. Even today, I'm still in a place where I'm extra vulnerable for another thing to spike me into a crisis, but I am preemptively doing things to reduce that risk. If something else hits, I will know more about why, and what to do.
It's a really hard thing for me to figure out. As a kid, I could have been in a life or death situation and no one would have responded. It screwed up my idea of what a crisis is. It's taken work and time, and I still get it wrong. I try to error on the side of reaching out for help, if only to learn and try a new skill. I had to figure out so much on my own as a kid. Trying to learn I don't have to do it all on my own anymore.
