When does the contract end?

[joeylittle]

You know, I kind of think most therapist would rather you contacted them ANY time than kill yourself. Just sayin'. If that contract is the only thing between you and something drastic, I'd say to check in.

I agree in principal - It would be interesting to know what problems exist, on the therapist’s side, when a client has left their practice. Ethical, liability...

OP, if you are saying you’re at risk for harming yourself, it’s worth reaching out to someone. If not that therapist, a crisis line, or GP, or nurse helpline even.

 

[Justmehere]

With this therapist, yes. I have another.

Have you contacted the other therapist and told them you are considering breaking the safety contract?

 

[anonymous]

I am a bit hesitant to respond to this because the original question is something I have thought about before but never was really sure about. I don't want to be in some kind of trouble for asking it or appearing misleading. I just wanted to know. I realize there might not be a single answer though. I will do my best to answer.

Is there a reason you can't speak to this t and are wanting to with the old one?

@Abstract, kind of. It sort of has to do with @scout86 's comment...

And it has been a long while (too long to be asking probably).

From what I've read here, there are a lot of therapists who don't do that kind of contract at all. I suspect the ones who do care more about keeping you alive than anything else.

@Abstract, because of this. My current therapist hasn't done this, and I honestly don't think I have given him reason to. As @scout86 suspects, I think the old one cares a bit more maybe too (even now). That particular therapist had a way of helping more than some others, and was not prone to sudden decisions.

I told him I wouldn't lie to him, he'd be the LAST person I'd call, if I was serious.

This is most likely the case for me as well. I never did call the old guy (or the new one) with any threats, and I do not think I ever would.

I'd say to check in.

It is more along the lines of this. Checking in... The old guy had a sixth sense. He would check in or ask me to if he suspected the world was off kilter. . Many times when he did this, it was a good thing. He always talked me down from whatever had spun me up.

I'm not sure why you really wanted to know this

It is a bit complicated. I think frequently there can be spontaneity involved in these types of decisions. They can be rash decisions with little forethought. When living on the edge and making unwise decisions, knowing full well what could happen, one needs to find a way to step back, assess, regroup, and move on. Maybe there is no deliberate attempt, but moving forward on the path could end the same way, deliberate or not. Sometimes, however, in those situations it can be hard for one to move forward. In those moments, it can be helpful to have some sense beat into you.

But should that moment arise, it seems way too late to ask the question, "Is it still okay to call?"

asking about it tells me it's not the right suicide contract for you

Perhaps my use of the term "contract" was erroneous. It was more of a verbal "please call me" statement. An "I would never forgive myself if something happened to you" guilt trip (yet seemed so incredibly sincere).

I agree in principal - It would be interesting to know what problems exist, on the therapist’s side, when a client has left their practice. Ethical, liability...

...hence the question...is it okay to call?

OP, if you are saying you’re at risk for harming yourself, it’s worth reaching out to someone. If not that therapist, a crisis line, or GP, or nurse helpline even.

At the moment, I am not in crisis mode to the point that I feel a call to a helpline or crisis line is warranted. Thank you for your concern.

Have you contacted the other therapist and told them you are considering breaking the safety contract?

Again, I think I should probably not have referred to it as a "contract" as apparently these are actually written down.

 

[EveHarrington]

I think there’s a huge issue if you want to contact an old therapist and not your current therapist.

Yes, I’m sure that your old therapist cares, but at the same time your old therapist is no longer part of your safety net so is it fair to put this on him? No, I’d argue it isn’t. Yes, therapists care but at the end of the day it’s a fee for service business. The extras outside of therapy end when therapy ends.

Point being, build your safety net. Your old therapist is no longer part of your safety net so it’s time to grieve this loss and move on.

I’m sorry if this sounds harsh, but it’s a practical matter.

 

[joeylittle]

Safety contracts aren’t always written down. Sometimes they include coping tools, or a series of steps to take in a crisis.

Sometimes they are just verbal. To ‘contract for safety’ is to agree that you (the client/patient) won’t put yourself in danger (can be defined lots of different ways), and will instead use some kind of intervention tool (could be calling the therapist/doctor, could be using emergency services, could be just stopping yourself, or any number of things).

Mine (with my T) is fairly short, and verbal. It’s separate from my own crisis management tools/strategies/steps.

 

[Suzetig]

An "I would never forgive myself if something happened to you" guilt trip (yet seemed so incredibly sincere).

Is it possible you're needing to know that you're new T cares enough to want you alive, or are missing your old T saying you matter to them (I'd never forgive myself sounds like you mattered to him). You don't sound actively suicidal but I can understand that the idea of a suicide contract would give you permission to contact him. Given you're saying you aren't in crisis, is there a way you could just drop him a note to say how you're doing generally (e.g. I started that class we spoke about, have taken up martial arts, whatever is happening). That way you have the comfort of contact that's relevant but without it crossing a boundary with the work you're doing with your new T.

It's not that unusual either for people to want to split themselves in therapy, so someone might think "really hard suicidal feelings stay with the old T while I bed in with my new T (I don't want new T thinking I'm hard work, and I don't even know where to begin the conversation anyway)". For that reason if you presented to your new T under the suicide contract he may well do the absolute minimum necessary to make sure you are safe and then refer you back to your new T, your old T doesn't have clinical responsibility for you now and the support they can offer you is very limited. On a purely practical level, their liability insurance may only cover existing clients which you aren't any more, the payment we make for therapy in part creates a duty of care for you which changes when you aren't a client any more. So, on a very human level your former T may care very much that you are safe, but professionally I'd expect they would be very limited in what they could do in terms of support.

If you're missing him, drop him an update email, don't make it about risk because you tie his hands in how he can respond. Do however talk to your T about suicide contracting and the significance it holds for you (i.e. It means they care about you?).

For what it's worth, I don't have an explicit suicide contract with my T, I know she cares and we talk about how I keep myself safe, strategies and supports. I also know she would get immediate help to me if I needed it but we don't have anything written down.

 

[anonymous]

@joeylittle and @Suzetig, thank you for your responses.

Mine (with my T) is fairly short, and verbal. It’s separate from my own crisis management tools/strategies/steps.

Thanks. I'm not sure what we actually had. I assumed from the previous response that it needed to be written. It was just one of those deals where he called once to check in and got a bit scared. He would ask me to promise him I would be okay until next time, etc. I'm not sure, besides distraction, what my management strategies are.

Is it possible you're needing to know that you're new T cares enough to want you alive, or are missing your old T saying you matter to them (I'd never forgive myself sounds like you mattered to him). You don't sound actively suicidal but I can understand that the idea of a suicide contract would give you permission to contact him.

Kind of, but not exactly this....
I don't know if the new therapist gives a rats ass, true....
BUT, I also know that I can contact the old therapist on occasion.
AND...while not exactly active, something did jump start these thoughts again for the umpteenth time.

Given you're saying you aren't in crisis, is there a way you could just drop him a note to say how you're doing generally (e.g. I started that class we spoke about, have taken up martial arts, whatever is happening). That way you have the comfort of contact that's relevant but without it crossing a boundary with the work you're doing with your new T.

I have contact with the old therapist, but not really on a therapeutic level, as you suggested. It isn't often, and it isn't what I would consider "boundary crossing" although some on this site clearly would. Maybe once a year or so we will talk for a little while. I'll let him know what's up, but more about me being okay than not okay. On occasion, I will ask him a therapy related question, but not really ask for therapy per se. It's more like, "What type of therapy do you think is best for....." or "Have you read about this recent research on xxxx and what are your thoughts?' It's not, "OMG, I was so triggered and I wanted to run and hide" type of conversations.

He has welcomed the contact and told me he thinks it is cool that I am still hanging in there and likes to know how things are going. He likes having the occasional update. So, I do think he cares, but I really try not to put him into awkward situations where he is crossing a boundary or violating some sort of rule. I also don't make a habit of contacting him on a very regular basis.

This is just to say that I don't think I need the contract as permission to contact him and I realize that there is a real limit on what we should and should not discuss.

If you're missing him, drop him an update email,

...and yes, I do miss him.

For that reason if you presented to your new T under the suicide contract he may well do the absolute minimum necessary to Mage sure you are safe and then refer you back to your new T,

Returning to the old therapist is not an option. I have moved several times since seeing him and he lives far far away.

For what it's worth, I don't have an explicit suicide contract with my T, I know she cares and would get immediate help to me if I needed it but we don't have anything written down.

I believe that the old therapist would have done that. I don't have that kind of faith in the new one. I believe the old one would have been able to talk me down.

So, you may wonder why the question then if I know I can contact him????
I think it is a question of what is appropriate and how do I not overstep my boundaries, etc. I also wonder if he even remembers our agreement. Something did trigger my question. I REALLY wanted to tell him what was up. But it sounds like it is a good thing I didn't????

 

[Friday]

I tend to think of therapists as any other professional relationship.

Whilst actually seeing them, they’re like colleagues, I can hit them up pretty much any time, within reason.

After I’ve moved on I may reach out to them, but I understand we’re no longer working together. It’s a favor, or consult. So, ideally, I reach out to the people I’m currently working with. But any contact I’ve ever made in my entire life I consider fair game, tbh. If I have your number, and think you’re the best person for situation X? I’ll give you a ring. I just won’t expect you to be available. You may be, you may also be on vacation or up to your eyeballs in work, or in any other way not able to take my call.

 

[Suzetig]

believe that the old therapist would have done that. I don't have that kind of faith in the new one. I believe the old one would have been able to talk me down.

Maybe this is the crux of it, you trusted your old T to keep you safe in the work that you're doing. It could be that you're subconsciously planning to go into a new part of the work, go deeper, whatever and aren't sure your new T can keep you safe and hekp you cope with the feelings that come up for you?

I have a very established relationship with my T but every so often find myself thinking "can she handle this, what if I feel overwhelmed, will she be able to deal with it?" and so I start testing out the relationship all over again.

It's worth taking to your new T about safety, what she would do if she was concerned (or indeed if you were concerned enough to talk to her about not feeling safe). You can do it in very general terms if that's easier than raising a specific worry or scenario. It might also be worth thinking about the relationship with your old T, how did you know he could talk you down (maybe because he did it?), when did you realise you could trust him and what happened. It may just be you're not there yet in your new T relationship.

BTW your contact with old T sounds absolutely fine, with really quite clear boundaries.

 

[lostforgottensoul]

I appologize if you already addressed this. I couldn't read all of the posts.

I'm not sure, besides distraction, what my management strategies are.

Written or not (I find it MUCH easier written as I loose all ability to think when in that place which is why we started to write it out to begin with) you need management straegies and if actively suicidal or have suicidal ideations it is important to know what else you can do to help yourself during those times. And there is a lot more then just distration for me. Maybe bring this up with the new therapist? Maybe ask them about it and see if you guys can compile something? Most therapists know what a suicide contract is and would be comfortable writing one (or making one verbal). But I would def bring it up. I wouldn't call the old therapist. But that's just me.

 

[Suzetig]

Most therapists know what a suicide contract is and would be comfortable writing one (or making one verbal).

That's not necessarily true - many Ts are deeply uncomfortable contracting around suicide and self harm because it potentially puts pressure on the client to behave in a particular way (i.e. Don't hurt yourself) as a condition of the therapy. Research shows very mixed outcomes around the use of suicide/self harm contracts and by no means are the only - or necessarily the best - way of keeping someone alive and safe.

The value of the contract can often be more about the intention behind it (i.e. My T cares enough to want me alive) or the explicit discussion of coping strategies and what the T is able to offer in a crisis. I'm not being nit picky with you but many very competent Ts wouldn't want to draw up a suicide contract but will work well with suicidal ideation etc.

 

[lostforgottensoul]

many Ts are deeply uncomfortable contracting around suicide and self harm because it potentially puts pressure on the client to behave in a particular way (i.e. Don't hurt yourself) as a condition of the therapy.

I don't feel that way about it but ok. I only know my own experience.

Research shows very mixed outcomes around the use of suicide/self harm contracts and by no means are the only - or necessarily the best - way of keeping someone alive and safe.

Nope, it isn't the "only way" or "best way" and never advised that.

The value of the contract can often be more about the intention behind it (i.e. My T cares enough to want me alive) or the explicit discussion of coping strategies and what the T is able to offer in a crisis.

I don't view it or use it to prove my therapist cares if I die or not. I know he cares if I die or not and knew that before the contract. I use it as a "go to" when in that place or near that place as my ability to think of all the coping stragies that I've learn leaves me. But to each their own. I just think it's worth asking about is all.