[Victoria'smom]

The only reason I trusted my old T is she calmed me and made me feel I'd be okay after I tried to give myself a tummy tuck when I was confused, and scared. She didn't make a big deal about it or hospitalize me at the time. Much, much later after I fully trusted her did we talk about when hospitalization was required. Never forcing me but occasionally incourging me.

She kept all my crazy notes out of her files and promised to go to bat for me if needed. I do still have times that my thoughts /actions would normally lead to hospitalization. I'm scared that new T would hospitalize me over these thoughts / actions leading me just not to mention them.

How do I explain to new T that our relationship and trust can only be built by her not "over reacting" to my brand of crazy? I seriously feel if I was ever convicted to go to In patient, partial hospitalization, or intensive out patient it cause me more long term harm then good. How do I explain this in my first session?

[eskielover]

I would do it exactly the way you have done it here.

I understand how you feel because during my really bad suicidal years, most of the time I said absolutely NOTHING about how I felt for just the reasons you have said here......never did process WHY I was feeling that way everyone including me just assumed because there was no way to process the WHY of the feelings.

Sometimes with a new T we just have to say it like we feel to start with.

Is there some way your old T could talk to your new T? Sometimes it's possible to sign the paper that gives them your OK to talk with whomever you need them to. Because of the Hippa laws, it makes it necessary to sigh an ok to do this. If talking between them is possible I think that might be seriously a good thins also.

[feralkittymom]

I would agree that I think you'll get a better result if the Ts can talk "professional to professional" about your level of risk and how you present. In some ways, it doesn't matter how clearly you make your case to your new T because they are still going to be bound by their ethics to assess you as you appear to them in the moment. Whereas evidence from your current T would be entered into the new T's records, and it then becomes part of the new T's documentation for ethical purposes. So it gives the new T some "cover" to not overreact.

[ThisWayOut]

I've had t's overreact. It can be scary. What helped with new t was having that conversation around confidentiality and baker acting in the first session. I didn't disclose anything before we talked the processes through. We then talked about my worries around it, and past experiences. Only after all that was I comfortable in mentioning any of the sui thoughts and my worries about how my sh tends to escalate. We came to an agreement that I will be honest about my level of safety, and we will always talk about an admission before anything happens. We both agree that voluntary is better than involuntary. Also, former t had called the agency and spoken to the supervisor (because old t was leaving the field, and I had no new t assigned at the time, she spoke to the supervisor at the new agency).

I suggest the hospitalization conversation right of the bat (in hypothetical terms) because it can go a long way in deciding to stick with that t. Prior to finding former t, I had seen someone else at that agency who have me the impression that she would not be comfortable in working with me around maintaining safety on my own. I brought up the hospitalization question in the intake, and she spent a while taking about last experiences, one of which involved calling the police on a client after she had let her leave the office. This was a huge red flag and I did not return to her. I wanted to make sure that I found a t I could trust to always at least have a conversation around going inpatient, even if we disagreed.

[archipelago]

As far as I understand it, they have to go over "informed consent" the very first session, which states their policy of when they would break confidentiality, i.e. use hospitalization. They are bound by ethical and legal codes to uphold this and to state it clearly. However, at least in my state they are not required to hospitalize; they are allowed to break confidentiality if they are worried about your safety, but it is not mandated that they have to. This allows for a certain amount of discretion and flexibility, therapist to therapist, situation to situation. This could definitely be discussed during the first session and should be. Then you will have a sense of whether or not you feel comfortable with how the therapist would handle things that may come up.

My therapist knows that hospitalization on an involuntary basis is very traumatizing to me so he doesn't even go there. But there have been times when he has asked if things would be safer and better with more care and there is a hospital in the next town that is very good, not traumatizing at all. So I have elected to go before and felt good about that. Certain issues scare some therapists (suicide, mania, self-harm), who are prone to be more reactive. Other therapists handle these things without so much fear and prefer to deal with them with their clients and not have outside intervention. Only harm to others is mandated to act upon. Other things are the choice of the therapist.

[Perna]

I would not worry about thoughts, that's what talk therapy is made up of, discussing our thoughts and feelings. But if you do things, act in a way that truly endangers you or those around you, I don't know that you can "hide" that from someone who cares about you? I would work on learning to trust a therapist so you could talk things through with them rather than feel you had to act in a hurtful way. But if you are truly psychotic and don't have a good action plan for that that everyone who cares about you knows and is in on, I don't see how one could avoid hospitalization.

[Victoria'smom]

Is there some way your old T could talk to your new T? I'm sure my old T is willing to talk to new T if my new T is willing. New T has all my files and I hope she reads them. I signed away my life before moving to cover any HIPPA restrictions possible.

What helped with new t was having that conversation around confidentiality and baker acting in the first session. Even with the expected response of "Oh my god this lady is truly crazy"?

They have to go over "informed consent" the very first session, which states their policy of when they would break confidentiality, i.e. use hospitalization. They are bound by ethical and legal codes to uphold this and to state it clearly. Under "informed consent" I'm generally SOL.

Only harm to others is mandated to act upon. Thoughts? or actions or what?

I don't know that you can "hide" that from someone who cares about you? loved ones can tell I'm off but not how off I am as I've learned to keep most outward symptoms hidden even when psychotic.

If you are truly psychotic and don't have a good action plan for that that everyone who cares about you knows. How would I create that?

[ThisWayOut]

I've gotten that response, and then never returned. Current t had gotten all that info first session, and she was ok with it. However when former t talked to new agency, she asked that I be paired with someone who will not overreact to sh or sui talk.
Even now (with new disclosures), I worry that current t will think me bat-**** crazy. She's been pretty unflappable though, I'll give her that (and she's still a student). I think it helps when I preface things as "I know this sounds nuts/crazy/of the wall, but..." she says I'm too judgemental towards myself. Some days I see it, other days, not so much.

Also, an aside: the baker act is written quite loosely, and leaves much up to interpretation. It's really crappy like that. And it grants several job titles the ability to send someone for evaluation & hold. I know they probably had good intentions, but FL is one of the easiest states to be committed involuntarily, which makes it difficult to want to seek help for even the most mundane mental health concerns.

[Victoria'smom]

FL is one of the easiest states to be committed involuntarily I know that's what scares me.

we have to disagree with that-we live in FL and have been Baker Acted only 3 times out of 20 plus years of being in counseling. a lot of it is contingent on the counselor and what they deem "worthy" of that needing to be done and being DID we have done some INCREDIBLY startling things and were not BA except for those few times. dont know if that helps or not ♥

[~Christina]

I know first hand the area you are moving to is always struggling to find a bed for someone.. So unless your really in a bad bad place your T isnt likely to push inpatient on you.

[Victoria'smom]

Given I have an expected 50 more years give or take to live, those few times scare me given my mental health. I'm hoping my history of not acting on things help my argument.

[archipelago]

I don't know what it is like in Florida though the law says "self neglect" which is really vague and loose. In California it is "gravely disabled," but they don't follow that and get away with involuntary hospitalization all the time. If you are manic, you can be and usually are. If someone states that you are behaving strangely, you can be and once brought in are usually held regardless of what you say if you have a diagnosis already. So actually it is probably safer to have a therapist looking out for you.

[Victoria'smom]

I'm guessing my best bet is when she asks why I'm there I can say "to prevent me from ever being hospitalized or incarcerated" so she knows exactly my stance and why I'm there more or less. Or is that to forward?

[archipelago]

No, it is honest and a very clear actually healthy sounding statement. Therapists are supposed to prevent that. Put it right on the table is one way to really emphasize that it is a serious issue for you. Then you will find out right away whether the therapist will be flexible or will insist on being strict and literal about the law. You don't have to stay with anyone you don't feel okay about. You can leave at any time.