[Ellahmae]

I'm still trying to navigate my way around this new therapy world. When your T says the words crisis or emergency session what does that mean? Have you ever been on crisis or needed an emergency session? If you needed and emergency session how did that help you? What does it consist of?

[Parva]

I've had several. We'll be on the phone and she'll ask me how soon I can get to her office. Sometimes a text. I never ask, though. It always comes from her. We use these times to address the immediate problem. Sometimes 45 min, been as long as 3 hr. For us, crisis is usually suicidal thoughts or life incapacity. We figure where the feelings come from and resolve them. Usually, it has helped a lot.

[junkDNA]

in the past it has been if i am suicidal or psychotic. sometimes i would wind up in the hospital

[SheHulk07]

Good question, I'm interested in hearing what others consider a "crisis", too. My T1 said before that a year and half ago when we first started working together that I went from one crisis to another. I have no idea if he'd consider what I'm going through now with SH/SI but I consider it as one when they both grow in intensity and I'm avoiding things again.

[LonesomeTonight]

I haven't had an emergency/crisis session, but I recently had a midnight phone call with my T. I thought of that as a crisis situation because of how badly I was feeling. With it being midnight, we just talked on the phone for 15-20 minutes. I'd had a sort of crisis thing a month or two before that, also around midnight, and had been unsure whether it would have been OK to reach out to her or marriage counselor, like what exactly constituted a crisis where they wouldn't be mad that I'd called. They confirmed that in that situation or a similar one, it would have been fine to call. (Reasons in this case are under trigger warning below.)

Possible trigger:

If I either had self-harmed or felt a strong desire to self-harm and nothing else was working to eliminate the desire/need to self-harm. T recently told me that feeling like I didn't want to go on anymore, i.e., suicidal, would merit a call, under my new safety plan.

[atisketatasket]

I am wondering too. Is a crisis defined by something objective, like

Possible trigger:

self-harm or suicidal thoughts

or is it determined more subjectively, by the client's normal state? By this I mean if a client who is normally calm and collected, etc., suddenly enters a state of emotional upheaval but does not have the triggers mentioned above, is that judged a crisis for them? (I have felt this way a lot lately, but am hesitant to say it's an actual crisis to either therapist.)

Or is it defined both ways?

[ruh roh]

Usually, I email and let her know I'm crashing. Hearing back is enough to hold me until I see her. When I've had an extra session, just having someone to touch base with was enough to relieve some of the pressure. Specifically what it looks like is that I'm taking a lot of risks and making rash, unsafe decisions, or that I feel I might. I don't let it get to the point of having a plan, and have let her know that when I say it's serious to me, it's serious, but that I'm not going to wait until it's level 9-1-1 to let her know I'm in trouble.

A lot of it, for me, is knowing my own signs and being the judge of when I'm in the danger zone. My therapist said the goal is to keep backing that up farther and farther (so, I guess, intervening sooner). In other words, she sees a value in tackling these things early on and not waiting until it's some red letter definition of a crisis. So much of it is being able to find a manageable level of worst so that I can get to a better place more consistently. Not sure if that makes sense...just trying to encourage you to reach out when it occurs to you and not wait. It's a really good discussion to have with your therapist, even when you are not sure how bad things are.

[Soccer mom]

I had times I felt horrible but would feel like it's not a crisis because I was not suicidal. Because of that I never felt I could reach out. Good question.

[stopdog]

The second one I see has repeatedly said I could and should call before things reach a crisis. I usually don't consider anything a crisis - so I don't call - but several times when I have related things, the second one has asked why I didn't call her.

[nutters]

Having been through it I would tell you that thoughts of suicide and wanting to harm yourself is a crisis. Even if the thoughts are without a plan but is constant, it's a crisis in my opinion. It's better to have a T make themselves available or a friend to be with you. What sucks is someone calling the cops on you like a T or a friend and you wind up in the hospital where it may have been better had they been willing and available to be with you and talk.

Now my previous T called the cops on me, my new T will talk with me on the phone. I'm sure this new T would also make himself available but I hope to never be at that point ever again.

[LonesomeTonight]

Incidentally, when asking about whether it would have been OK to call at midnight in my situation, I had told my marriage counselor I wasn't sure if he would have been mad. He asked what I thought would happen if I called him late at night a few times in a row for something that didn't constitute a crisis. I said I figured he'd either block my number or tell me to stop ****ing calling him. He said it bothered him that I thought he'd have that reaction. He said he wouldn't cut me off or be angry but would talk to me about when appropriate situations to call would be. So basically, if I thought something was bad enough to warrant a call, it was OK to call. I'm guessing most T's are like that. They'd rather you call than not. I mean, if you're at the point of thinking you want to call/text (or request an emergency appointment), then better to try reaching out. (My T has basically said the same.)

(I guess MC sort of proved that comment by not seeming annoyed about a 3 am text when I was really upset but not technically in crisis a few weeks ago. He replied very kindly the next day.)

[Cinnamon_Stick]

I had a suicidal crisis for a few days a couple of months ago. I had my regular session and I told her about my thoughts and then they got worse so I emailed her and asked for an emergency session the next day because I was scared of how intense the thoughts were. She fit me in and the session was about my thoughts and figuring out a safely plan and trying to find the triggers and stuff. I had to come up with a special plan and promise I would keep myself safe.

In my opinion an emergency/crisis is if you are having self harm or suicidal thoughts and you can't keep yourself safe.

A crisis for me is when my symptoms cannot be managed on my own using the skills that normally do work. Generally that means I have become actively suicidal (not just thoughts - those can generally hold until business hours), but more intense ruminations, plans, feeling impulsive, etc. I can call my T, but he will tell me to call my pdoc (as he should since at that point I require medical management and probably hospitalization).

The other category of "crisis" is more of a life crisis that has put me in great distress; for instance, my husband becoming quite ill, my sister's impending death, the time I ended up needing surgery -- things along that line.

Both my T and Pdoc have told me if I think I may need to call, I'm probably in crisis because I have never called in an instance when they felt I could or should have waited.

[ScarletPimpernel]

For me, crisis means the desire to act on SI or SUI thoughts. Another type of crisis I've been in was when there was DV. I have only had one crisis session. It was with current T. I had a complete break down and she was being cold and distant. I had to stay for another session because it wasn't safe for me to go back home alone. That extra hour gave me time to talk about everything and calm down a little. We talked about what upset me and how I felt she wasn't supportive.

I've also had crisis phone calls. Only one time was it at night and that was because ex-T forgot to shut off her phone. Normally the conversations last about 15mins. It simply consists of them providing support and reassurance.

And ex-T did call the cops on me 3 times

I have no idea what my T thinks is crisis.

Self-harm doesn't count, she thinks there's no need for a safety plan as it's just scratches anyway. My own personal plan is to take care of myself if it ever becomes anything worse, such as going to the GP on my own.

Sui thoughts don't count - if they become action urges, I'm supposed to call the Samaritans.

There's no out of session contact anyway - everything is through the clinic staff, and she seems really busy - so i don't feel I can bring forward an appointment if I've trouble coping.

To me, I irrationally think that this means I don't matter, because there's no way I can reach out to her out of session.

My T encourages me to call her whenever I feel exceptionally bad (it doesn't have to involve SI/SUI urges). I never do (well, I did once but that was during office hours) because I'm afraid she'll tell me to do x or to talk to y and I'm far too tired for that.

Edit: and I don't call when I don't think there's anything that she can do that helps, even though she's told me she'd like to just 'be there' for me.

[iheartjacques]

An emergency for me would be suicidal thoughts. A crisis is when I can't cope and I need someone to calm me down and talk me through things. Say for example a family drama that makes me want to go and die because I can't handle all the crazy conflict

[iheartjacques]

Current t only has contact through the reception and every two weeks. So it's been very hard some days.

I can't imagine any crisis that would prompt me to call my therapist and i would never ask for an emergency session.

If I was having a crisis I couldn't call my T. Or anyone. I'm marvelling at the fact that you guys are able to do this.

[Chummy]

I have never had an emergency session. I haven't really talk with my T about what a crisis looks like. If you consider strong urges to act on suicidal thoughts, then I've had many crisises this year. I've dealt with them by myself. And I haven't talk to my T or pdoc about it, which I probably should do.
I can only call my T during her workhours. I can email her anytime, but I think she only anwsers emails during workhours. So if I have a crisis with suicidal thought/urges and act on it, I should call my doctor or the alarmnumber.
But the chance that I would call anyone is very very slim.

[LonesomeTonight]

I guess I did actually have an emergency session with my p-doc a few months ago. Called T because of something that had happened the night before, she talked to P-doc (in same practice) and she squeezed me in the next morning first thing.

Possible trigger:

was my first incident of self-harm--cutting--in like 18 years

[Lauliza]

My pdoc once gave me a same day appointment when my father passed away. I was having marital trouble so it was a particularly difficult time. Otherwise I've never had an emergency session or anything else I'd consider a crisis. Like Stopdog's T, mine has also asked me a few times why I didn't call in a certain situation. It honestly never occurred to me, but I have good supports outside of therapy.

[velcro003]

In my own opinion for myself, I would consider a crisis if I felt extremely emotionally overwhelmed and didn't know what to do and had no one else to turn to, I'd call my T. I did ask for a session on a different day once because I had such a terrible week, and she had cancelled our session because of a holiday, but I don't necessarily consider that an emergency session.

That being said, I called my T tonight and left her a message just because of how cr@ppy I feel about something, and she is always reassuring me that it is ok to call and e-mail her, even though I hate it/hate feeling needy.

[Victoria'smom]

When I realize I'm psychotic, emergency family trip, and med issues that can't wait.