Is it true that some Ts really dislike working with suicidal clients?

I am not sure if I was a difficult client. I only missed maybe two sessions in 7 years and that was due to weather and he didn't make it either. I rarely called. I never expressed anger toward him. I only really remember feeling anger toward him a few times. We never had a rupture. Sometimes I wonder if I was too "good." I just had constant suicidal thoughts. And I do think it worried him. I would say, "I think I will eventually kill myself" and he would say, "I think you might."

I don't have borderline personality disorder. I do think I was stressful to work with though because of the thoughts. But as I said I rarely called and there was no texting or email.

Here is an article, certainly not research, but interesting nonetheless: (It may TRIGGER, PLEASE be careful)
How to Find a Therapist Who Does Not Panic | Speaking of Suicide

I sort of feel like a therapist who won't take any suicidal cases is like an oncologist who will see cancer patients so long as they are guaranteed to survive.

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Yes, 'tis true ...

Sadly.

I kinda understand, then again I kinda don't ...

Personally, I hope and am glad that certain therapists don't take suicidal patients. People need to know their strengths. No one that goes through school is told "you need to be capable to take and handle every patient, even if you are uncomfortable." Hell no!

Would you make your family doctor provide surgery? No. They didn't specify their schooling in surgery. Maybe they could do it just fine...they know anatomy, proper procedure... But would you want them to? When you have an incision scar the size of Texas afterward, whom is to blame?

Ladies (or gents, but prolly mostly ladies, haha), would you ask the aesthetician that waxes your eyebrows to make an exception and do a Brazilian for you? They had to do it during school after all...they should know how. Waxing is waxing. They've been doing faces and underarms for ten years and haven't done more than three Brazilians ever, but it's waxing all the same. They should do it anyway! If they don't, they're horrible aestheticians! Uneducated and incompetent!

Would you berate a landscaper for not growing their own flowers? Tell a master French chef that they're a sham of a chef because they make a crap sushi platter? Go to a top-rated psychologist in their field of bipolar treatment and consider them uneducated and incompetent because they weren't comfortable treating your eating disorder?

...If someone isn't comfortable with something that I am hiring them for, why would I bother hiring them anyway? Most therapists specify what their expertise are. When I go to my acupuncturist, I schedule with the provider that specifies experience with mental health instead of the one that does sports injury. Is either provider better than the other? No! Better at or more knowledgable about certain things? Of course!

People have specialties, and that's a good thing. It means the availability of better-than-average care. If a therapist isn't comfortable at all with something but takes the patient asking for it anyway because technically they've read the text books and do want to help people, THAT is incompetence. Know thyself.

Also, there is a certain point when things can go from troubled treatment with a capable provider to being a liability. I used to work in a medical office - when there, there was a situation when a patient had been seen for an ED for yeeears with ups and downs. It came to a point when there were nothing but downs for a very long time, presenting many critical situations. No matter what the provider did, said, prescribed, recommended, whatever....the patient would not follow through, and their risk of life threatening repercussions rose and rose despite continuous warning, though they kept coming back. After months of this, if the patient had a heart attack, how would that reflect on the provider? "Why didn't you do more?" Right? Their relationship was terminated after much trying.

When a patient in your care is getting worse because your care isn't working or they aren't following your care plan yet they keep coming...that sounds like a perfectly legitimate reason to terminate the relationship for liability reasons AND for the sake of the patient.

Different therapists have their strengths and weaknesses and their likes and dislikes when it comes to clients. Some like working with people who suffer from substance use disorders, others will refuse, some like teenagers and children, others find them immature and will only work with adults, some liked the underserved, others want wealthy high-functioning clients. Some T's work with certain personality disorders, others refuse to.

So yes, a lot of therapists will not see suicidal patients. This could be for multiple reasons: it triggers them due to personal stuff, it's too stressful and upsetting for them, they are worried about liability issues.

Want to add that suicide issues can come up with any patient. Here we are talking about people who have frequent suicidal ideation and behavior. But it would be nonsense to say that a therapist would not have any expertise in dealing with suicide. Like what's she gonna do, have a patient sign a paper that they will never talk about suicide?! Suicide related concerns are quite common in therapy and all therapists need to know the basics about how to handle the situation.

I think what's difficult is that there's a lot of fear and shame around those thoughts. While certainly, now as a savvy, experienced depressed person with some therapy under my belt, if I needed to switch therapists, I'd know to ask, but when I first went in? I was just desperate. I was afraid of my own thoughts and struggling with my life. It took me a while to be able to voice these thoughts and thank goodness I have a great T.

I feel like this is an area that a T needs to be trained in.

I think it is FINE to state up front you don't want to work with suicidal clients, but to take them on and work with them for months or years and THEN decide it is too much is completely unethical unless you terminate in an ethical manner. It's WRONG to just dump clients who are suicidal and "difficult" with no warning.

Terminating if someone isn't getting better is okay too, but it is the manner in which it is done that can be SO SO damaging and traumatic. A decent therapist won't just dump a client. WRONG on so many levels.

Not disagreeing, but who is supposed to help these people? Therapists are the failures I think. They are the ones who are supposed to have the skills to help people no matter how resistant. Yes, clients have responsibility to work and blah, blah, but they go into therapy because they need help. If a therapist feels they can't help they should NOT let things drag on. They should find someone better suited to help. NO dumping the client. That is what infuriates me. It's unethical to terminate a suicidal client in many codes of ethics.

I feel suicidal a lot. I wonder if I should stop talking about it. I don't want my t to terminate me.

I agree they shouldn't just be terminated and left out to dry - referrals and sources are needed. But I definitely don't agree that the therapists are failures. Where is the line exactly, for things being officially dragged out? When do you give up hope for helping someone when that's what they came to you for, when that's your job? When is too early, when has it been too long? It is not so black and white.

If the therapy fails because a patient is reluctant to a point of complete resistence/inaction or lacks the capacity to try, regardless of how badly they actually need the help, the patient was not ready for therapy. They need to want it. They are the one that enlisted the therapist's service in the first place. If it is so serious as to warrant action still/they do not have the capacity to think clearly for themselves, that would be out of the depth of the "regular" therapist role that is being discussed here and into inpatient stuff.

I mean, a completely trivial example compared to this subject, but: If you went into a hair salon and asked for a haircut, but then partway through didn't walk yourself to the sink, didn't move your head, couldn't choose a style, refused to have your hair dried or parted for the process, maybe turned your head the other way mid-cutting, changed your mind about the style, changed it back, stood up randomly to get water, made them switch cutting tools....at what point does the stylist give up, even if your cut is half done and haggard? They've had nervous or indecisive clients before, but had they known you would be so incredibly resistant, they never would have agreed, they know this isn't something they're great at - but you went to them, so how could they know? Are they supposed to strap you to the chair to finish? It may be time to call in someone with experience to better handle it. The road to success is not so one-sided.

I also think it is just really important to remember that therapists are just people with a different job than us. They wake up in the morning, have coffee, check their schedule, and return the phone calls of potential new clients and get excited, hoping they can be of help and do what they set out to do. During the appointment, they are still a human sitting there, not a calculating machine, processing the barrage of thoughts and heavy ideas we as patients throw at them, thinking heavily on their responses, how to progress things in a productive way, hoping they've phrased things correctly. After appointments, they think about the visit, consider options. I'm sure many agonize over the things they've heard...maybe they feel overwhelmed at that moment, maybe it brought up hard memories for them personally. Our relationships with therapists may be stark and stolidly professional, but up until the moment they see you, they are just another human dealing with their own humanity. No one can be consistently close-to-perfect every time.

Wow! Just wow...

It's a shame that fear of insurance companies, lawyers, etc., stop practitioners from doing their duty: work to heal their clients.

I think a lot of the failure and frustration comes more from not being able to "think outside the box" to help a client when other methods have clearly failed, than from a resistant client. One of the biggest things drilled into me by several professors was that clients are not so much "resistant" as scared or stuck. If we constantly throw the same intervention at them, and it constantly falls flat, there needs to be a change in the approach to the client. There are so many regulations and rules for insurance however, that many T's forget how to draw from a varied toolbox for their clients. What works wonders for one may trigger another beyond belief.
It's incredibly exhausting to constantly be thinking of different strategies and interventions with a handful of clients while also trying to maintain "status quo" with everyone else. And as mentioned several times, different T's have different specialties. I would not want to see a therapist who specializes in addiction if I'm trying to tackle ocd. The addictions T may well be on top of new approaches and current research on treating addictions, they may have no clue what is involved in treating ocd. Yes, there's that overview you get in school, but it's akin to asking a geneticist to cover chemistry reasearch. Yeah, they took chem in school, but their life after was consumend by genetics...

I think there's a lack of thoughtlessness on the part of the T though. I think my T rocks it. I'm dealing with chronic suicidal ideation, was just recently IP because he believed (rightly) that I was going to attempt. His method? Get me IP. Okay, now he wants me to have a few sessions with a colleague of his that he trusts. He still wants to work with me, and he says that he's been working with me for so long that he might have built up blinders to areas he needs to address. From there he also got me in with some specialists at a nearby research hospital to see if we can come up with some other treatments.

I don't think he did anything particularly out of the box - nor did he refer me out - he's just getting extra eyes to help him do his job.

Therapists are failures when they allow things to drag on without referring the client on. It's a failing. It just is.

And comparing them to any other profession is really irrelevant. It is not like any other profession at all. The comparisons are meaningless really.

Not asking for perfection, just that they not inflict horrible trauma on someone. Not too much to ask for. They are the ones who went to school to work with troubled people. It's irrational to expect the troubled person to know when the therapy is bad or wrong or not working. That is on the therapist. Totally. I know it isn't an easy job, but no one forced them to go into the profession. No one made them and they should accept the huge responsibilities of their difficult job. Like I said I do not expect perfection, but some of them fail, most probably fail at times. And it can be devastating. I just get so sick of client blaming. The therapist has the responsibility and the liability and the training. They should know what they can handle and what they can't handle and if they can't handle it then find someone who can and do it in a humane manner. That isn't asking too much really.

And trust me, I've heard all of what you said before. Over and over and over. Really. It doesn't change my mind at all.

Also, where did anyone say therapists are supposed to be perfect? Haven't seen that.

I would consider that "out of the box" only because I simply had T's suggest the same, tired, failed interventions over and over again. Of course, I also have not seen a T for more than 3 years (because I see mostly students or community proivders who turn over every few months to a year)...

I guess I hadn't thought about that. I mean, it seems like a natural thing to get a second opinion. I approach therapy like medicine for the head and I'm used to doctors going "Idk, let me get you to go see my buddy over at this specialty clinic" and so I do and they work in some happy harmony. So then my T's like "Idk, let me get you go see my buddy a few doors down and get some feedback." and I'm like okay. Cool.

Well not totally cool because I struggle with liking people but I trust my T and he's asked me to be open so I will. I want to help him help me.

Yeah, again I would whole-heartedly agree (not to say I don't at all now) if the world was more black and white. Like...Yes, it's wrong to drag something out. Yes, it's crap to get in knee deep and then bail. No, they obviously shouldn't inflict trauma on someone. But not everything is so obvious from the get-go. There's not going to be textbook redflags and signs every time. There's not always going to be an event/appointment that makes it obvious to the therapist, whoa, things just got too heavy for me to help on my own. There is not going to be a big line that appears separating what is "trying hard", "working it out", and "dragging out" states.

To me, not comparing it to any other profession or similar removes the humanity, which is dangerous.

There is just a lot of grey. Too much grey.
...Which is why the kind of thing that NowhereUSA has mentioned is awesome - getting many minds of different strengths/specialties together when needed. it eliminates the intense demand of being ready for and black belt level for anything that hits you out of thr DSM, and allows people to nurture their strengths. Unfortunately, without insurance, this is costly.... But, it also provides a higher chance of getting spot-on help the first time.

How does not comparing it to any other profession remove the humanity? That doesn't make sense to me. How many other professions get into the deepest, darkest secrets of your mind and require such a level of trust and attachment for a lot of people? Really there is no other profession like that. It doesn't take the humanity away to not compare it to other professions. Dangerous? Nah. Not at all.

I'm not saying at all that the world is black and white, but you cannot deny that A LOT of people are harmed by therapy and incompetent therapists. The profession needs more research, regulation, funding, and on and on. And it doesn't make sense to say there isn't an event/appointment that makes it obvious to the therapist that it isn't working or whatever, because that is EXACTLY what seems to happen over and over. Clients are blindsided by abandonment. Over and over and over. Something needs to change. If a therapist is meeting "resistance" then they need to go back to school or a workshop or get supervision or go "out of the box" or find someone else to help.

And in a way you're highlighting the problems with therapy by saying it isn't clear. If a therapist doesn't know this stuff then how the heck is a client supposed to figure anything out?

The way you describe the profession is how it is for a lot of people, but isn't how the relationship is for everyone. (It isnt for me. I love my therapist, best I've ever had, but if she said she was moving next week or something, I'd be bummed because she's helped me a lot, but I'd be calling new options the same week and onto the next qualified person.) Which, right there, is an element of humanity - the individual and unpredictable factor, how people react, interact. For you, there is no other profession like a therapist. Whereas for me, it's completely comparable to any other doctoral profession - they're there to help medically and sworn not to blab about it. We just cannot predict the reactions and feelings of others, only be aware, which is where I find comparison ideal, to help add different perspectives, different angles.

In regards to the obvious events, I don't mean the moments when the therapist sees it's over their head. In those moments/events, the therapist should help direct the patient elsewhere, yeah, not abandon just them. I was referring to the times when it's not so obvious that the therapist isn't the best to help because the issue itself isn't obvious.

Like, if a patient comes stating they want help for depression, and mention they've had a lower appetite, but then consistently downplays the severity of the low appetite for months. Meanwhile, the therapist is treating for depression (which can cause low appetite) and trying to understand more, uncovering a new piece of info and gaining more trust maybe. Turns out, the appetite issue is actually a really serious eating disorder, and has gotten worse since the therapist's treatment because of not getting accurate or honest info from the patient not wanting to talk about it yet. The patient now needs serious ED treatment and monitoring, something the therapist isn't comfortable with, maybe inpatient treatment. Perhaps the therapist shouldn't have dragged the situation out. Or did they? Did they fail the patient or were they left in the dark? They could be liable for not doing more. What sign did they miss, or was there one? The answer is just not clear. Maybe if the therapist had asked someone else, they might have noticed something. Perhaps. Maybe. Might. This is what I mean by there not always being an obvious indication that something is being dragged out, or that it's time to get outside help 'right now'. At the first appointment when the patient indicated depression and its symptoms, there is not an obvious event/red flag about an ED to the therapist, if there was, they could have redirected the patient right then. These are the types of things that I mean aren't obvious in therapy, what can make things unclear.

But I think this is going kind of off-topic at this point. :/

So when the therapist can't see they're in over their head then it's the client's fault? I mean if the therapist can't see the ED in your hypothetical situation then what happens? Whose fault is it? Who is responsible?

I'm not sure what you're saying honestly. Because it truly is a terrifying thought that therapists are that dumb sometimes.

What are the answers to this dilemma?

If issues are so unclear to everyone even the therapist then how is there any hope for any of us with very serious issues? I thought I had a great therapist too, but I didn't. What happened to me could happen to anyone. Don't fool yourself by thinking it couldn't.

Yes, I can imagine how horrible it might be for such a patient. Abandoned and rejected just when most in need of help? It's quite unethical of a therapist to do so. If a therapist notices some issues that he's not comfortable with or competent in, he can refer the patient to another person for further specialty consultation while he is still caring for the patient and sees the patient regularly. If it's decided that the patient will benefit from such more specialized care, I think there must be some overlap as the patient separates from one T and adjust to the new therapist.

Many people are not willing to let themselves be vulnerable so they build up a lot of defense against pain. When they finally start to go for therapy, it might take them a long time to trust a therapist and feel safe enough they might open up more and more and deal with the pain. Imagine if just at this time the therapist decides that the patient is too much for her and she says she can't see the patient!

I doubt anyone likes working with someone who's suicidal. I imagine it's a really delicate, nervewracking situation, and you feel responsible. I doubt therapists get a call from a new patient and say, "Gosh, really hope this one's hanging by a thread."

I mean, think about it. Liking it or not liking it is irrelevant. It's whether or not a therapist is capable. Even if a therapist is 100% capable of talking someone off the ledge, it doesn't mean they aren't scared shitless, not about being sued, but because someone's life is in their hands. It's like trying to make it across a lake covered in thin ice without breaking the ice. It must be terribly hard. It's easier to save someone from another person than it is to save them from themselves.

Except that it's unethical to dump highly suicidal clients. And just imagine the potential consequences for the therapist if they terminate a very suicidal client and they actually go and kill themselves. They would be held liable.

And let's be honest, most people can't stay inpatient for more than few days and even that's a stretch for some.

If you're at the limit of your competence and are faced with a situation where you don't know how to help your suicidal client anymore the solution shouldn't be termination, it should be seeking out consultation.

In some places the industry itself has a no admit policy for BPD clients. Maybe, that is one of the reasons clients with BPD have a high suicide rate. Sad.