[jesusplay]

what can I expect from a T, Pdoc, or psychologist?

[Leah123]

It can vary, no absolute guarantees, but I have mentioned suicidal ideations to my therapist and she has held them in confidence, supported me, comforted me, and stood by me until I felt better.

My belief is that most therapists will not report suicidal ideations: what they must be wary of and report is suicidal intention which is at all likely to be carried out. Do you have a plan, do you have a timeline, is the suicidal condition persisting. In other words, I think they realistically judge the severity of the situation and your history to determine if they need to report it to keep you safe, or if keeping that confidence will help you more.

Of course, every therapist is different, it will take some of your good judgement to assess yours, but I strongly encourage you to share your ideations as best you can.

P.S. I see you added "from a T, Pdoc, or psychologist"

I would expect more tolerance from a T or psychologist based on their training than a Pdoc who I don't think is equipped to hear about that so much and who *in my personal experience only* works in a more clinical, limited framework, but... I'm sure others will have more depth to offer on that. If it were me- I'd tell my therapist, or whoever I was closest to, whoever knew me best, if I was hoping them to realize it was just ideas, not plans, not intent.

[ScarletPimpernel]

I agree with Leah123. Each T/pdoc is different. But if you're suffering from suicidal ideation, then the professionals should know. Therapy and "some" meds can help with that.

I too suffer from suicidal ideation. I made a deal with my T that she isn't allowed to put me in the hospital unless fully discussing it with me first. She has kept to her word. I even left one session telling her I didn't feel safe with myself. She told me I could go home, but if things got worse I had to tell her, someone else, the access line, or call 911.

[Daeva]

My T just supported me an show me she cared, told me what to do if it went further, etc. Confidentiality still applies.

[Rosondo]

Yeah ideation only usually kept in confidence unless it's so repetitive every session and person also has history of suicidal attempts then I think they might decide to break confidentiality and get the cops involved or something. I think it's case by case basis. When I was going for therapy I mentioned suicidal ideation but my therapist did not react...in fact I felt I was talking to a wall, as if such things were so common the therapist feels nothing about it. But in reality good therapists do listen to it and keep it in mind. They want the patient to feel better, so if expressing that pain in that way is helpful then it helps the therapy move along and pain to lessen.

But if someone is showing more and more that they see suicide as escape from problems and they say it more and more and seem also to kind of not participate in therapy, the therapist obviously becomes more concerned for the patient's safety. For me it was a way to express how much hurt there was. And usually I felt better, the week after. It's such a scary thing to say. In that moment I felt so afraid.

[archipelago]

They are allowed to break confidentiality if your safety is involved. Some react more strongly than others. I had one who overreacted so I was called in a few times. Mind you I had already done something but was not seriously suicidal. But I really didn't like it. When I switched shrinks, I made sure that it was clear that I didn't want him to ever do that without a discussion of what it would be like for me. I haven't had to worry about but I haven't really been thinking that way for a while now. Good luck. Best to get clarification upfront from the person so there are no misunderstandings.

[BlessedRhiannon]

I think it really does depend on the T and pdoc and your own history.

With my T and pdoc, we simply discuss it. They will ask me how likely I think I am to act on the thoughts. They've expressed concern, but never taken any direct action. Once, T did ask me to keep in daily touch with her, and that was helpful for me at that time.

[Freewilled]

I am too worried about the potential to be hospitalized so I don't tell my T directly about my thoughts of suicide/self harm...I wish I could, but I just cannot risk it. I hint at it a lot though by saying things like, "sometimes I'm just so tired, I want to give up." Or "things got so bad...i got VERY scared." I strongly emphasize that these feelings are serious to me. I like to think my T catches my drift but I dunno....

[critterlady]

Both my T and my pdoc have just ensured that ideation was as far as it went and supported me through the difficult period.

[Petra5ed]

I agree with Leah. Just thinking of suicide won't be enough for them to have you locked away, but if you tell someone "I'm going to..." then you run the risk. I have mentioned suicidal ideation to a pdoc, and he just punched it into the computer like everyone mentions it. The only change I've noticed is I am now asked every time I go if I'm having still having those thoughts.

[Karrebear]

I only mentioned that to one T that I saw about 5 years ago. She became alert and looked for a safety contract to sign, couldn't find one so I made a verbal contract with her. I had no intention of doing anything..I was just explaining thoughts.

My former pdoc wouldn't let me leave the office and called my mom to pick me up (even though I was 26-27 at that time) otherwise she was going to call 911.

This is very, very t/psych/pdoc specific when it comes to how they will react. I do encourage you to be honest with them though. They are only there to help you. And them them that your thoughts are just that, thoughts (unless they are deeper, of course).

Good luck

[archipelago]

One thing I have done is use a crisis hotline which is anonymous and specializes in these feelings. I used to volunteer at one and so I know they are well-trained and are used to all kinds of things so they are often quite helpful. I don't necessarily tell my therapist that I have done so. It is just a buffer so I can express it without raising personal concerns that would lead to something else. Sometimes these feelings come up and talking to people who really are used to them can be helpful.

[photostotake]

With my pdoc, she asked if I had any thoughts, I said yes with no intention of acting on them, she said ok and moved on. She also knows I'm seeing the T across the hallway, so she knows I'm talking about things with him.

With my t, I'm pretty open with him. One time I wasn't and he called the County Crisis team to get a second opinion. Either that or I was going to the ER for an evaluation. I wouldn't tell him the plans I had in my head. Wasn't going to act on anything, but I was too scared to tell him anything more than that. He wanted to make sure I was really ok, so he contacted the crisis team. Since then, I'm much more open & honest about my ideations, he can get a much more realistic view of how I'm really doing. He asks if I'm safe before I leave and if I'll contact someone if needed. I trust him not to overreact as I thought he did before. I know why he called the crisis team, but at the time, I was ticked. I knew I was okay, the lady evaluating me released me pretty quickly, but it took quite awhile to build that trust back with him. Really freaked me out and made it pretty hard to be open and honest with him about my ideations. We're all better, which is good because ideations come up almost weekly and I feel safe talking to him about it now.

(sorry that I rambled)

[SheHulk07]

I have talked about suicidal ideation almost on a weekly basis, and I'm pretty sure I'm walking on a very thin line with what my T will do this week if I'm open and honest like I've been with them. My T has warned me in a session that if my SI continued that he would have to try other interventions, and said if I kept experimenting with pills that he would have to call 911.

But the 911 part was told to me before I actually got 911 called on me by a crisis line for saying I took 7 pills and was taken to the ER. I'm very afraid of telling my crisis therapist tomorrow that I was very ready to take pills tonight. I can not afford to be hospitalized.

[RTerroni]

I mentioned it in passing when I went to the Psych place when I was in school (and only went because a professor sort of insisted that I go there) and they got all freaked out at me.

[neutrino]

When I told my therapist I experience suicidal thoughts quite often (though I'm not suicidal), which really bother me from time to time, he just said it was normal and asked me if I was suicidal. When I said I wasn't he let it go and didn't speak of it again.

[Rosondo]

Originally Posted by Freewilled

I am too worried about the potential to be hospitalized so I don't tell my T directly about my thoughts of suicide/self harm...I wish I could, but I just cannot risk it. I hint at it a lot though by saying things like, "sometimes I'm just so tired, I want to give up." Or "things got so bad...i got VERY scared." I strongly emphasize that these feelings are serious to me. I like to think my T catches my drift but I dunno....

That's sad.

On a different note, I wonder how common suicidal ideation is. I read somewhere that it's like 75% or something in people with borderline personality. But even in nonclinical population, it must be common enough. I bet therapists hear it a lot.

[dumburn]

My Pdoc I think has only once asked me if its somthing I think about. I said yes and he asked if I wanted to talk about it and I said no (well shook my head and cried). He didn't push the subject, just made a note on the computer, but it felt like he really wanted me to open up. I think he was only able to let it go because he read in my notes that in the past when I have been really scared that thoughts would turn in to actions I was able to get myself to the Doctor or hospital, so hopfully he believes that would be what happens if/when I get that bad again.

[archipelago]

When borderlines have these kinds of feelings it is often called "parasuicidal" meaning that it isn't exactly suicidal but rather an expression of pain and a wish to eliminate that pain by any means. And when they act on those impulses it is still considered parasuicidal not suicidal, although they do risk misinterpretation and hospitalization for this behavior. That is why it is good to make sure the therapist is clear about the policy and way of reacting so nothing else happens that could be harmful. I have found that being hospitalized against my will is quite traumatizing so I am very careful about avoiding it at all costs.

How a therapist or pdoc handles this generally depends on a client's history with this sort of thing. My T and pdoc have a very good sense of when I am simply having ideation, which isn't particularly dangerous in itself, and when I have moved on to a stage where they get concerned about impulsivity. For me, that comes before I ever have a plan, so they react more quickly than they might with some patients who would never do anything without a plan ahead of time. What I do isn't parasuidical; it is truly life-threatening, so they don't mess around hemming and hawing about whether to take action or not. Fortunately, I've learned to recognize some clear signals that I have crossed that point (psychosis sets in), so I can indicate to them exactly when I reach that point.

We've had some really helpful and enlightening discussions about that whole process for me which has really gotten us all on the same page. I would encourage you to have that conversation with your therapist and pdoc BEFORE you actually get to that point so that you will all know when to let things go with basic support and when more intensive action should be taken.

[rabbit13]

Originally Posted by archipelago

When borderlines have these kinds of feelings it is often called "parasuicidal" meaning that it isn't exactly suicidal but rather an expression of pain and a wish to eliminate that pain by any means. And when they act on those impulses it is still considered parasuicidal not suicidal, although they do risk misinterpretation and hospitalization for this behavior. That is why it is good to make sure the therapist is clear about the policy and way of reacting so nothing else happens that could be harmful. I have found that being hospitalized against my will is quite traumatizing so I am very careful about avoiding it at all costs.

I am borderline,and I made a serious attempt 13 years ago and two parasuicidal ones.Thanks god I haven't since..I also found it traumatic to be hospitalised.I do not want to go back.The consequence of all this is I cannot work anymore in the post I had.

[skysblue]

My T called me after I had left a voicemail, not of intention but of visualization of 'how'. It was something else to get a call from her when I hadn't requested a return call which is how we handle our communication.

I was out of town and we had a long telephone session. It felt good to feel her caring. She suggested I see a Pdoc and I ended up canceling the appointment with a proc because of the cost and my own determination to overcome the feelings.

So, in my case, my T just checked in regularly during our weekly sessions to see how I was doing. Nothing dramatic.

[jesusplay]

met the psychologist yesterday. Oddly, I wasn't having any suicidal thoughts yesterday. Normally I get them ever day...so when asked I told her everyday but not today...Gave me a suicide help plan.

Today I met my new psychiatrist, he didn't push the issue, I was relieved.

[Merlin]

Pdoc and I both know I will never admit to intent. I will admit to ideation and planning now. That's usually by voicemail and email. If it's severe enough, i.e. I have a detailed plan, he will contact me as soon as possible, otherwise when he first has time. Once we've talked about it and he's confirmed I won't act on it, we usually book an emergency appointment. Usually by the time of the appointment the ideation is less serious. I guess I only disclose to him when I know that he wont, can't legally, certify me.