[ThingWithFeathers]

I've read a number of different accounts of Ts really disliking working with suicidal clients, or simply refusing to see them. Now, after reading numerous accounts frim various sources, it's something I have come to believe.

The other day, my CBT psychologist challenged my belief that patients like me are not wanted around.

Now I'm curious what others think or have experienced.

Is it actually true that some Ts won't work, or hate working, with this client group? What could be the reasons?

It is true. My ex-therapist, even though he denies that he terminated with me because of my constant suicidal thoughts, said working with suicidal clients is a huge liability. I'm not sure if many therapists would admit it though. And when I was looking for a new therapist most of them were more CBT oriented and didn't have the skills to deal with someone like me and turned me away. I didn't talk to that many because there aren't that many in the area. Actually the ones I talked to are about two hours away, but that is as close as I could find. I know that has nothing to do with the suicide question. It's just really frustrating trying to find help for deeper issues. For me anyway.

Well, if they do, then they are awful therapists. People with mental health problems such as depression are so often suicidal; probably a large amount of their client base has felt suicidal at one point.

[anilam]

I do believe it's true. I wouldn't even say they are bad Ts for that only. Knowing your limits is an important skill, essential for Ts I think. Not all Ts have to work with severely Sui clients.
I can well imagine some Ts not being good with clients stuffing great personal loss, specific diagnosis, or even (take it from Yalom) overweight women :/

[Chummy]

Some probably are. But I think those aren't very good therapist. Someone with sui thoughts needs help more than ever.
I don't really have experiences with sui thoughts and therapist. I have Always kept is to myself. My current T and pdoc know I have sui thoughts, but I don't talk about it. They also know I don't have plans, so.

I imagine individuals within the 'therapy field' who are poorly trained and unconscious of their own defences would find it hard to work with all sorts of issues.
A highly skilled T who is aware of their own defences or at least willing to question themselves, would work with all issues.

The question should be "is it true there are poorly trained T's out there with no ability for gainful insight".

[NowhereUSA]

Without seeing a study, I'm not sure if it's true or not. I know my T has stuck with me and SUI is a huge part of my illness. And, he's lost a client to SUI, so he knows exactly how bad it sucks so... idk. I think he's very competent though and he's also DBT trained.

[The_little_didgee]

I think so because a lot of clinicians associate chronic suicidal ideation with personality disorder. This isn't always true, since there are many reasons why someone could feel that way, such as an adverse reaction to psychiatric medication, psychosis, agitation, and coping with extreme emotional pain.

A therapist may see chronic suicidal ideation that doesn't improve with treatment as a personal failure. It is so much easier to refuse those clients than reflect and learn where they went wrong.

I would assume there are therapists who don't like to work with certain clients with a variety of different issues; I don't think suicidality would be the only thing some would reject, but I know that's the issue you are asking about.

Personally I've never run into that, thank goodness, but just from what I've read right here on PC, it is quite clear that some therapists are better skilled at handling serious mental illness and personaility disorders, etc. that have suicidality as part of the problem.

In someone else's post the other day I made a comment along this lines. I really think there is a set of therapists out there who really do not have the skill or desire to work with serious mental illness because when their clients are in a crisis, that is when they seem to freak out, threaten termination, actually terminate, and/or more or less just completely lose all scruples as a therapist. It is almost like they got into therapy with the mindset that they'd sit in a room with their clients, talk about things once a week for a period of time, and all would be well when their time together is over. I don't know if it is a naivete of thinking they will just be good listeners and "help" people in their lives, or just really poor training, but they are very potentially damaging when they run into clients that are "over their heads," their comfort zone, and their skill level.

I've known I was dealing with serious mental illness for many years, so I went into looking for a therapist knowing I needed someone with a broad skill level and LOTS of experience. I've never dealt with a therapist who couldn't deal with my serious issues, but I did reject a few over the years that just gave me that vibe pretty early on: therapists that felt to me that they were sort of naive, "save the world" kind of people who right away seemed uncomfortable just to encounter a client with my level of depression and trauma. I suspect they would have done more harm than good for me and I was quick to pick up on that.

My current T is by far the most broadly experienced, skilled, and able to work with my suicidality. His clinical training gave him a broad base of therapeutic techniques to pull from: he's not limited to only one skill base to work with. He comes from a variety of professional settings including having worked in a psych hospital and in assessment: he doesn't shy from serious mental illness and has deep understanding of various diagnoses. He has a strong background in psychopharmacology which is an added bonus for someone like me who because of my particular diagnosis has had to be treated with medications: he's been able to help me distinguish when problems I was having required medication adjustment, were perhaps side effects or withdrawal effects, etc. or were perhaps medically/physically based and I needed to consult my pdoc or other physician.

I do think those of us dealing with serious mental illness have to be cognizant that we find therapists with solid experience and training. I think it is important, as hard as it is to tell a stranger these things, that we are up front right away if we have a history of suicidality and ask some tough questions (if they don't come right out and tell us which is exactly what my therapist did for me which is one reason I knew he'd work) about how they work with clients with such problems. They should know how to answer those questions and be comfortable doing so. I would absolutely never work with a therapist in training, or even in the early years of practice. I don't need them to be still in the early years of figuring things out and making early errors on me. Experience isn't the only factor obviously, nor is it a guarantee, but it is one factor on my list of requirements.

Suicidal ideation is a massive part of all my illnesses and a part of my life... If my t hated working with SU clients she'd have given up on me long ago.

I think of them like car mechanics. Some just do oil changes, air filters and wiper blades; some are good at routine maintenance and repairs; others specialize in certain makes and models; and a very few will take on vehicles that are hard to find parts for and costly to repair, but they enjoy working on those cars a lot and love to see them back on the road outperforming the rest.

eta: and some tell you things are broken that don't need fixing at all, or they are in over their heads and end up doing more damage; and by the time you stop giving them any more chances and listening to their "this should do it, trust me," you find yourself having to find one of those rare specialists who can fix a mess that you did not start out with.

I think so much depends on the therapist. My T has been pretty unfazed by my suicidal thoughts and was quite calm about it from the beginning. He was quite practical and matter of fact about the whole thing. I did notice at some point that a book about dealing with suicidal thoughts showed up on his bookshelf that was not there before, but he certainly never indicated to me that it was a hard issue for him. I asked him about it later, when things improved a lot, about the issue that you just raised and he said he did not dislike working with people with suicidal thoughts, but it had been a couple of years for him between clients with serious suicidal thoughts, so he wanted to be sure he had the most current information to be as helpful as possible.

[KayDubs]

Originally Posted by licketysplit

I think of them like car mechanics. Some just do oil changes, air filters and wiper blades; some are good at routine maintenance and repairs; others specialize in certain makes and models; and a very few will take on vehicles that are hard to find parts for and costly to repair, but they enjoy working on those cars a lot and love to see them back on the road outperforming the rest.

GREAT metaphor!

Originally Posted by licketysplit

I think of them like car mechanics. Some just do oil changes, air filters and wiper blades; some are good at routine maintenance and repairs; others specialize in certain makes and models; and a very few will take on vehicles that are hard to find parts for and costly to repair, but they enjoy working on those cars a lot and love to see them back on the road outperforming the rest.

And trick is to find the right mechanic for the right job . . .

Exactly!

[InRealLife45]

Originally Posted by ThingWithFeathers

I've read a number of different accounts of Ts really disliking working with suicidal clients, or simply refusing to see them. Now, after reading numerous accounts frim various sources, it's something I have come to believe.

The other day, my CBT psychologist challenged my belief that patients like me are not wanted around.

Now I'm curious what others think or have experienced.

Is it actually true that some Ts won't work, or hate working, with this client group? What could be the reasons?

we are a liability-always putting T at risk if we ever complete suicide and our families sue. some t's like the challenge, others (most) want easy clients with no serious pathology.

[ThisWayOut]

I've found liability a huge factor in that. Even if the individual T is ok working with "high liability" clients, the agency they work for may not be.
I try to be upfront with new T's about my sui issues, my self-harm, my history with intensive mh care, and my trauma history. I don't necessarily parrot off the various diagnoses I've recieved over the years, but I am up-front about some of the things I consider "challenging" to work with. I have not had T's outright refuse to do an initial interview, but I have walked out of a few offices based on their reactions.
I don't see the benefit in not diclosing my sui/sh/trauma/refusal of meds. Yes, it may make finding a T more difficult, but at least I know I have not wasted my time building trust with someone that will over-react or freak out when that stuff does come up.
There's a lot of stigma around bpd and chronic sui ideation. I would prefer knowing where any potential T stands with that...

Originally Posted by InRealLife45

some t's like the challenge, others (most) want easy clients with no serious pathology.

I would be interested to know how you know that most Ts want "easy" clients? That sounds very counterintuitive (why get into a helping profession and avoid the people who need your help the most?), but I actually don't have any hard data at all - presumably you do, though, since you are making this claim.

Where I live it is more difficult to get help if you don't have a serious condition, because of the way the system is constructed. Unless you pay for the therapy yourself, that is, and then it makes no difference, as far as I understand.

[InRealLife45]

Originally Posted by Mastodon

I would be interested to know how you know that most Ts want "easy" clients? That sounds very counterintuitive (why get into a helping profession and avoid the people who need your help the most?), but I actually don't have any hard data at all - presumably you do, though, since you are making this claim.

Where I live it is more difficult to get help if you don't have a serious condition, because of the way the system is constructed. Unless you pay for the therapy yourself, that is, and then it makes no difference, as far as I understand.

Because I read, because I've seen a lot of therapists myself, because I have a lot of friends who are therapists- established therapists DO NOT want an entire caseload of BPD's or BPD trait, or personality disorder clients- I've actually had more than one psychologist tell me they preferred to have 5 schizophrenics over one borderline, bc schizophrenics can be treated with medication and show obvious improvement, but BPD lingers and resists most efforts.

So T's will have one, maybe two on their roster, if any at all. The people who get stuck with us are the ones at county clinics, those doing their hours, or who are just starting out, have small caseloads and have the time that we inevitably demand.

But your part time therapist of course would like to fill their caseload with your "normal" average client with a bit of situational depression, mild anxiety, a custody issue, an ED in its very beginning stages that can be arrested, marital problems- something they can actually fix, and feel good about. Who wants a client who is suicidal no matter what the T does? Who is constantly in crisis no matter what the T does? Who is anxious and needy every single day outside session? Again-no matter what the T does. Who takes every single slight, real or imagined and turns it into a nuclear event?

Are you that therapist? I don't think I will be, and if I was, I'd be burnt out in a matter of months bc no one can sustain that kind of need for numerous people and still have their own life.

Honestly, if I was a T and I walked in the door, I wouldn't want to see me. Not after I realized what was going on. I'm difficult at the best of times. I'm demanding. I'm not actively suicidal atm, but when I am, it is constant and pressing and draining- for me- what is it like for my T?

Additionally- there's a reason a lot of private practice T's don't take insurance.

One of my T's said to me once that the "average" client-the young professional/family man/woman-makes their appointments, pays the full cash fee without haggling over the price, shows up on time every time, talks through their issue, gets better, leaves.

But the real serious cases- the personality disorders, the chronic depression etc- those cases make appointments, they may or may not show up, they put you through the ringer, they hate you they love you, they need you in between sessions, theyre constantly suicidal, they DONT get better, they make you doubt yourself, they're emotionally demanding AND to top it all off they want your services (where you are working extra hard) for free or at a serious discount/sliding scale. THAT is what the BPD/sui ideation stigma is based on, IMO.

So we get shunted off to "county" where they still don't give us therapy, (bc they're thinking "why waste valuable resources on a lost cause?) but rather groups and case management to keep us afloat and out of the hospital but the goal is never to cure, bc once you are an adult and have developed an extensive and persistent psych history, no one ever thinks you're going to get better, no one ever thinks you're going to leave. You are just herded like cattle and the case managers try their best to keep you alive and borderline functional.

I'm sure many of you will disagree with what I've said, but it's what I have observed myself, and been told by people in the field. Actually had a professor talking **** about one of her BPD clients in my ethics class the other day.

From the client's chair we do not see things like this, from this perspective, but if you can really put yourself in your therapist's chair and see through their eyes, how would you see yourself, what impact would your behaviors be having on you?

My T told me in my last session after a really long pause that she didn't think I wanted to understand the impact I have on people.

I didn't understand what she meant at the time, but I think now maybe I am beginning to.

[NowhereUSA]

Originally Posted by ThisWayOut

I've found liability a huge factor in that. Even if the individual T is ok working with "high liability" clients, the agency they work for may not be.
I try to be upfront with new T's about my sui issues, my self-harm, my history with intensive mh care, and my trauma history. I don't necessarily parrot off the various diagnoses I've recieved over the years, but I am up-front about some of the things I consider "challenging" to work with. I have not had T's outright refuse to do an initial interview, but I have walked out of a few offices based on their reactions.
I don't see the benefit in not diclosing my sui/sh/trauma/refusal of meds. Yes, it may make finding a T more difficult, but at least I know I have not wasted my time building trust with someone that will over-react or freak out when that stuff does come up.
There's a lot of stigma around bpd and chronic sui ideation. I would prefer knowing where any potential T stands with that...

Yeah, the clinic my T works for had to make sure he made me sign forms and whatnot so that his butt was covered. He hates paperwork, and yet, I was like, "Dude, make sure you're crossing your ts and dotting your is *just in case*" :P

[Partless]

Originally Posted by ThingWithFeathers

I've read a number of different accounts of Ts really disliking working with suicidal clients, or simply refusing to see them. Now, after reading numerous accounts frim various sources, it's something I have come to believe.

The other day, my CBT psychologist challenged my belief that patients like me are not wanted around.

Now I'm curious what others think or have experienced.

Is it actually true that some Ts won't work, or hate working, with this client group? What could be the reasons?

It's true, some don't like to work with suicidal patients. But I also agree with your T about challenging the view that people like you not being wanted.

ThingWithFeathers, you can make a distinction by not 100% owning how others feel about you, as if every reaction has something to do with you.

In other words, based on my personal view, it is the less experienced and less capable therapists that dislike working with suicidal patients. It is nothing to do with the patient herself not being wanted or good or worthy.

But also some don't like to work with very depressed patients or very anxious ones or people who are very somatic, etc. Don't take it personally. It's about them and their preference or abilities or their own mentality.

One therapist (not mine, but a friend of a physician we know) once confided that she disliked dealing with severely suicidal patients. She said because the situation makes her powerless sometimes in severe cases and she feels useless. Like she really wants to help but feels like she's not doing enough or that she's the one who screwed up if the client is feeling suicidal again.

She said but she tries not to think about those things cause they're more about her and what she wants and not the client, and so she tries to focus on the person and do her best in every instant. She said the situation had been worse when she had just started out but now she's getting better and better able to not let her personal emotional reaction interfere with well-being of her patients.

I hope me sharing this with you gives you a window into the mind of at least one therapist, seeing that a reluctance or dislike to work with suicide is not necessarily indicative of the person coming for help not being wanted or valued or liked.

[Jordy]

Actually T needed to vent a bit before my session today and complained about a couple of her clients in front of me. (I know not very professional, but that's the kind of relationship we have and she didn't give me any detail that could identify those clients.)

She said she's scared of losing one client because he for some reasons he can't take the meds he would need, and those he's on don't help and he keeps getting worse.

And she told me one of her clients was admitted yesterday after a Sui attempt and that she felt like she had failed her by not seeing that client's text yesterday. She told me she had cried today when told the news as she really felt bad, though she doubt she could have done anything.

So I could see first hand how much toll difficult clients can take on a T and I understand why they wouldn't have too many like that on their caseload.

Originally Posted by Jordy

Actually T needed to vent a bit before my session today and complained about a couple of her clients in front of me. (I know not very professional, but that's the kind of relationship we have and she didn't give me any detail that could identify those clients.)

She said she's scared of losing one client because he for some reasons he can't take the meds he would need, and those he's on don't help and he keeps getting worse.

And she told me one of her clients was admitted yesterday after a Sui attempt and that she felt like she had failed her by not seeing that client's text yesterday. She told me she had cried today when told the news as she really felt bad, though she doubt she could have done anything.

So I could see first hand how much toll difficult clients can take on a T and I understand why they wouldn't have too many like that on their caseload.

It really does not seem okay for your T to be talking to you about this, and I'm not thinking about confidentiality. It is simply not okay to unload her professional stresses on clients. That's what supervision/consultation with other professionals is for.

[Jordy]

Originally Posted by lolagrace

It really does not seem okay for your T to be talking to you about this, and I'm not thinking about confidentiality. It is simply not okay to unload her professional stresses on clients. That's what supervision/consultation with other professionals is for.

I know, and this was some huge disclosure compared to what she usually tells me. But she's only human and still reacting to the news. I could tell she didn't really want to tell, but needed to because this was obviously on her mind a lot. She probably wouldn't have told me if I had been in a bad shape. But I was doing well and could handle it.

[lunatic soul]

I think they are scared and feel like they are responsible for this and feels awful when someone really kills himself. So I don't say that they don't like working with them , I think they don't like being in stress all the time about them.
My pdoc terminated me because I overdosed medication which was prescribed by him.