Therapists as the gatekeeper to safety

Do you believe the therapist gets to interrogate you about safety or inflict their version of it upon you? Who defines safety and in what scenario?
I don't. If I want to juggle chainsaws while log rolling on whitewater rapids - not the therapist's problem unless I (and I would not) ask for her opinion.
If I decide to go to where my immediate family lives and spend a weekend with my controlling ***** freak of an in-law - not the therapist's problem unless I ask for tips.
And so forth.
I don't think those people get to interject themselves just anywhere in client's lives.

(I am not talking about all the legal issues - I accept they well may be acting in their self interest to protect themselves and if they admit it -then fine - as long as they are truthful about it)

I think that if the client brings up a subject that indicates dangerous behavior (ie. suicidal thoughts, reckless driving, drinking and driving, dealing with an abusive partner or admitting to homicidal thoughts toward loved ones or anyone etc.) the therapist has every right to question the client. If a client doesn't bring up those topics or refuses to indicate whether or not they have those feelings, than the therapist can't force them to talk about them. The reason I feel that the therapist has a right to follow up on those topics if the client brings them up is because guess who gets sued if the client acts on them?

So they are merely practicing self interested questioning? The inquiry is not therapeutic it is for the therapist's well being. Well, at least if they admit it - it would be more honest than I usually find them to be.

Yes, I'd say it is mainly self interested questioning plus a bit of compassion and concern for the client. I don't think most therapists would be happy about losing a client to suicide or know that someone died due to the client leaving and taking out their anger on a loved one. But I also realize that being a psychotherapist is their job--they don't want to lose their license or practice--just as you as a lawyer follow the regulations and rules of your position so as not to be debarred. <<--I'm assuming that you follow the law for this reason as well as wanting to give your clients the best possible legal service you can. If you were debarred, you'd would lose your lively hood. Some might not be bothered by that, stating that they'd do something else with their life, but not everyone feels that way. They like the money they're making being a therapist, filled fulfilled by the job, like their clients and don't want to lose them to a tragic situation that might be prevented.

That said, if I don't want my therapist sticking her nose into my private thoughts regarding suicidal thoughts, I keep my thoughts to myself. I don't need to include her in the conversation about them unless I personally want her assistance in dealing with them!

Oh I don't tell the therapist anything about what I do along those lines. It is none of their business.
It is more the idea of whether others think it is the place of the therapist in general. If it is mere self interest on the part of the therapist, that at least makes it more palatable for me as a concept. If those guys are willing to admit it has nothing to do with clients but all about fear for themselves - then have at it. I am for self protection.

I must admit I was really annoyed when my T said

"I don't like to give advice" and then went on to say (once you filter out the T stuff) I shouldn't go to my brothers for Christmas as it would be too much.

Yes it would be, but that's my problem. Her understanding why I went would have been more helpful!

I wouldn't have put myself in physical danger as I had my daughter with me.

It annoyed me to no end

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Where are these ts that tell clients what to do?? Ive had them say, "it doesnt appear to be in your best interest"; "i spend all week building you up then you go see your mother on the weekend and we are back to square one again." What i NEEDED someone to say to me is, NOT that my parents love for me was imperfect; that sounds like im complaining that its only at 95 percent. What i needed was for someone to acknowledge my suspicions that they were not safe, not normal, and that they were operating at more like fifteen percent. Thats not "imperfect", thats lets get you into foster care.

Did you really have a therapist complain at you that they spent all week building you up and that you undid it when you went to see your mother?

That would piss me off to no end. If I want to buy a cake and run it over in the parking lot and buy another and do it again - it is not the baker's problem. Or break my arm on a hoverboard, get a cast, break my arm on a hoverboard and get a cast - it is not the mds problem.

One time my T asked if I was thinking about hurting myself. I simply said no and changed the subject. Let's be real, if I really wanted to hurt myself, I definitely wouldn't tell my T.

Well.....on the one hand I feel I am in charge of my own life and actions.
On the other, I am still not very good at taking care of myself. I put myself in dangerous positions in an effort to prove I deserve to be alive...and that's not very functional and I sometimes regret my choices later. In those moments I am driven by some deep childhood stuff. In that state I don't always understand my own motivation. Its as if I am trying to exorcize my SELF.

So one reason I am in therapy to start is to work on that. So by being there I have implicitly given the T permission to comment on these choices.

If I really dont want to hear her thoughts on something I do t bring it up.

This implied permission is a case to case thing. If you are in therapy for some sort of phobia or adult life issues then you haven't given that permission. I've repeatedly told my T that I want to stop being self destructive so she has permission to speak/intervene.

But I don't see her as a gatekeeper. Ultimately my safety is up to me and if I choose a dangerous option that's up yo me. Though again if I don't want my T to comment then I don't talk about it. I mean if you say " I think I'm going to play Russian roulette tonight" any reasonable mental health practicioner HAS to say something...hell anyone period would probably say something.

I think it is indeed partly practical self-interest that has them asking such questions - no offense, SD, but we do live in a litigious society.

But I do think if a client says something to a therapist like



I would think very poorly of a therapist who did not at least say, "whoa, let's talk about this."

And some of it is a different kind of self-interest, an emotional one - therapists get invested in clients because they need clients to improve to feel good about themselves as professionals. Though I would hope they would not say that they had spent all week building the client up!

It kinda is, if you keep asking the dr why your arm keeps mysteriously breaking.

Actually eventually it is. My brother had a surgeon he loved refuse to work on him again because he persisted in playing football. He'd have surgery and then destroy his knee again and every time it was worse. The surgeon said he couldn't be complicit in wanton self destruction and that if my brother had that little concern for his body he was on his own. Eventually if you keep seeing a specialist for the same problem they intervene somehow

TRIGGERING

I always feel better if my therapist asks questions because she is concerned with my safety. I share a lot of suicidal thoughts and even a few plans I had. I am scared of my own mind sometimes and I truly don't want to die, I just want the pain to stop. I feel like my T can keep me safe but I know that in the end keeping myself safe is up to me. My T is the gate keeper to my safety and I like that. She has saved my life more than a couple times.

No, I don't.

Either of us can define safety in whatever way we want, as long as my therapist doesn't share her ideas about it (which she doesn't). It might have felt good on one level, when I was younger and thought that meant caring, but it's disempowering in the long run. In that way, it's less safe for my therapist to play that sort of role. I've done a couple things that I could tell were concerning to her, but after she saw the outcomes, she understood that I know what's best for me, and that's not always taking the safest route. If I end up causing harm in some way, that might be the way I figure things out.

I don't think my therapist is the type to do this with anyone, except maybe minors. I don't know, though.

I've never had a T or Pdoc "interrogate" me about my safety or inflict their version of it on me.

But my safety has been a serious consideration out of absolute necessity over the years. I have made serious suicide attempts which are concerning to me and, of course, to my therapist and pdoc. TOGETHER, we came up with plans to help ensure my safety and my life. In reference to those plans, yes, they ask me about my safety. I EXPECT them to do so; that is a very important aspect of their job in relation to my treatment.

If I am in a state of mind where I am unable to rationally protect my own safety (yes, some people have such serious mental incapacitation that that ability gets lost), they may interject safety measures, but I ABSOLUTELY EXPECT them to do so. That is part of my treatment plan. If they failed to do so, I would have been dead long ago.

*****Trigger for Talk about Severe Violent Talk in Psychotherapy******

*****Please use self-care if talk of violent acts bothers you!********


When this topic of what is a psychotherapist's responsibility when it comes to suicidal or homicidal talk comes up both here and out in real life, I can't help but think about the guy in Aurora Colorado who murdered all those people at the movie theater. He was a seriously mentally ill person who was seeing a psychiatrist. She was concerned enough about his talk in therapy about wanting to hurt people that she broke confidentiality and phoned his mother in California and discussed her concerns with her. The mother gave some kind of response that indicated that "Johnny has always been like that." <<--not his name but that was apparently her reaction to what the psychiatrist said. The psychiatrist also notified the campus police. But she didn't commit him and when he didn't come for any more appointments, she didn't try to make contact with him or call the police. Should she have done that? Considering what happened at the movie theater, I'd say yes, but I also know that I'm basing that on what happened. Truthfully, I don't know what I would have done if I'd been in her shoes.

I remember well that following this horrible incident, people in the US were enraged that the psychiatrist didn't do more. There were calls for her license to be revoked and for her to be sued by every member of the numerous victims families. People wanted that woman's head on a stick! Now, whenever some random shooting act happens, there are calls for a major overhaul of the mental health system--as if reporting every person who speaks of suicide or homicide should be reported to the police automatically and placed on a psychiatric hold until someone can certify that they don't pose a threat to society. I'm pretty sure no psychiatrist or psychotherapist wants the job of "certifying" that any person is perfectly fine and nothing "bad" is going to happen. Psychology or psychiatry isn't a science--there are no sure things. I don't know about you all but that's scary stuff. If you think therapists are being too nosey or intrusive about your life now, just wait. If things continue along this line, anything a person says in therapy will be recorded, documented and reported. And we all know that isn't going to solve anything when it comes to the issue of mass shootings.

I truly do feel that therapists walk a fine line of what they need to report and what they just need to talk through with their clients.

They don't have to let themselves be hired - I agree. But I imagine one could simply find a new surgeon or go to a different country to get it worked on. I don't see it as an md being complicit - I would see the md saying they would not be as being way too intrusive and thinking more of themselves as what they are -body mechanics.

This is a separate idea from a client's safety. I think this sort of thing stems from people believing bad things can be stopped if we make someone else responsible. It is why they can break confidentiality if they believe a client will harm someone else etc and why we have the obnoxious overreaching patriot act - fear creates really really bad legislation and people can be quite eager to give up liberty in the long term for shortsighted illusion of safety-

but I am not intending to talk about the legalities in this thread - I am wondering about how people feel about a therapist's intrusion into their lives on self-safetly where a client has not brought it up as an issue.

I amended my original post to reflect such.

I would not like being grilled about something I hadn't told the therapist if they were just on a fishing expedition. That would be intrusive.

But if I had told them that dealing with X family member makes me contemplate doing Y to myself, I think they should follow up if they learn that I will be visiting X family member for a week over the holidays.

My T is not good in a crisis. A couple of years ago when I wasn't stable she was dreadful when it came to my safety so I don't use her for that. If I feel I'm in crisis I call my pdoc. I do think the T has a duty to ask about safety if the client brings it up.

I guess unless it gets to the level of depraved indifference. Da-dum! Law and Order word. T should probably tell me im gonna walk into a running airplane propeller im unaware of?

These are probably the kinds of things a t mentions only once, but that stick with us. I remember my long term t asking me why i would deprive myself of one of the greatest joys of lige (a child)? My answer was that i never saw a child as a joy, but as a burden. I am only starting to appreciate the joy with current t. I dont think our ts have to tippytoe around our restricted views of reality likd that twilight zone episode with billy mumy, or rlse risk being wished into the cornfield. They are not hired yes-men.

The other aspect of this is that some people with bipolar disorder, schizophrenia, etc. can suffer from psychosis, including delusions, paranoia, hallucinations, grandiosity that makes their judgement seriously impaired. If a T or Pdoc can see that a client is acting out of symptoms that are very clearly resulting from their mental illness, they will step in and probably need to.

I know many here aren't specifically experienced with that level of psychosis and grandiosity and thought impairment and may assume everyone always has control of their faculties, so to speak, so it is hard to understand how incredibly impaired a person can be, but it happens and the consequences of decisions and actions while in those mental states can be serious, long-lasting, and life-threatening. People make decisions that lose them their homes, their jobs, their families, their entire finances, their futures, their lives because of such severely impaired judgment.

Yes, those therapists and pdoc absolutely have an obligation to step in and do what they can to intervene under such severe circumstances. They often have no success because trying to work rationally with someone who is completely psychotic doesn't always work, but to sit back and say, "Oh, it's their life. I'll just sit back and not intervene because I don't want to step on their toes" is negligent.

Fighting for the people who have been diagnosed with serious mental health issues to have that right to refuse various interventions they do not want, keeps me employed in my private practice. If someone wants the help, then I can assist with that also. But for what I do, more often it is people who want free of the intrusive, humiliating and imprisoning medical world and over bearing families that I try to help.

How is it possible to assess that "many people" here don't know or have experience with any particular thing? It's amazing how a simple question about our personal experiences devolves into such extreme judgment about all people here.