[Crook32]

Well today we some how got on the subject of whether or not I thought she should have EP'd me last February. I said I thought she should have and she said it is troubling that I am questioning her judgement because she knew how much I wanted to stay out of the hospital. Then we got to the subject of when she asks if I have intent to follow through with my suicidal urges am I totally honest. And stupid me said no and asked if anyone actually says yes to that question.

So now she doesn't know if we can work together anymore. She said she needs time to think but thinks I should interview other therapists. Also there is the chance that she might just refer me out. I am devastated and I have to wait until next Wednesday to find out what she decides.

I really like working with her and hope this is just a bump in the road but I think I blew it and have lost her trust forever.

[atisketatasket]

Speaking from a nasty recent experience - you can be totally honest about when you're self-destructive, but also honestly reassure them you have no intention of sui and they'll still dump you.

Instead of just waiting, could you call her and suggest the two of you make a deal - you will be honest (and follow up on that commitment) and in return she will continue to be your therapist?

[Demunie]

Hmm... Could you make some sort of contract with her, where you promise to be honest with her?

On the other hand; if you can't be honest about that with her, maybe she actually isn't the right T for you?

For what it's worth: I'd probably have answered the same

[Crook32]

I did promise. I also emailed her and apologized and promised again. I hope she doesn't make me wait until Wednesday for an answer. Or worse walk into session only to have her hand me a list of names.

[awkwardlyyours]

How long have you been seeing this T? It seems like a bit of a knee-jerk reaction on her part but it's hard to say without more context.

If you've been seeing her for a while and this is her response, then perhaps it would be in your best interest to find a different T (as painful as it is) because I'm not sure how she could work with you when she's feeling unsure of herself?

My suggestions come with a caveat -- (while I'm not at the stage of hospitalization) I don't have the experience of a T believing me when I tell them I don't intend acting on it. In my experience, they just have a set of indicators they follow and as long as I don't deviate too much from it, all is well. Move even a bit away and things get weird with them.

[Crook32]

We have been working together for 2.5 years. I have been hospitalized 5 times in that span. So she has seen me at my worst.

[Elio]

For awhile I felt like I had to reassure t every time I brought up the topic regardless if I was talking about it in the theoretical or in the actual. It got to the point that I would start out with the I'm safe statements. I think my t realized that I wasn't safe though because she started making me promise that even though I didn't have a plan, if the urge changed to an impulse regardless if I was thinking I would act on it, I was to call the on call doc. I think things got a lot better once we had an understanding that we both felt we could trust - which was I needed her to trust that I would let her know well ahead of getting to that point that things were turning to the bad and I could trust that she wouldn't jump to conclusions just because I was thinking about things, having urges. I could not promise not to try, I could not promise to contact someone if things become an impulse, I needed her to respect my belief that I have the right to end my life. I could promise to honestly let her know and keep her apprised of the level of my struggles. In short, we created a way to tell where I was at so we could see the pattern of slides and tumbles.

After the agreement, we were able to talk significantly more about my beliefs around suicide and what things are in place that keep me most the time from reaching for that solution. I can now honestly let her know when the urge or calling happens and my response to it. This has been a freeing thing for me because I've not let someone know in the past how often I wish for death or how often it beckons to me; how peaceful I find the thought of it.

Maybe something like this would help with your t?

[slowandgentle]

Oh, Crook, I'm sorry she's made this topic so awkward and complicated for you: I don't think it has to be that way - at least, judging by the really calm, measured way my T approaches these conversations.

I wonder if it would help for her if you had someone else (in my case, a Pdoc) who is aware of the urges and can be another set of eyes, ears and care?

I went to see one a few weeks ago when I was in a bad way (to get meds) not to ease the load on my T, but as a sort of unexpected side effect, it made me feel less guilty about the burden I felt I was putting on T. Not that he ever indicated it/I was. But I did feel that way, and more than I knew I did.

[junkDNA]

my T asked me many times if i thought i should work with someone else when we first started working together, like for the first 2 years i was in constant crisis and we werent really doing therapy... just crisis management. i was in and out of hospitals many times. at the time him suggesting a different therapist really offended and insulted me, and made me think he didnt care. i told him that every time he would suggest it. he would tell me that it;s because he does care, and he wants me to get help and recover, and he wasnt sure if he could help me with the intensity of my depression and psychosis. so, i guess i say that to say that your T probably isnt dumping you because shes giving up or doesnt care anymore- she probably cares a lot, and wants you to get the best help you can get. i know its hard to see it in that light in the moment.i also hope things work out for you whether with this T or a different one. i know how intense attachment can be and how hard it is to even think about leaving...

Ouch, that's gotta hurt! You know Crook, you have been hospitalised 5 times in the 2.5 years you have seen your t. Was this your choice or hers? I can understand your reluctance to tell her if she reacts like this every time. I think this is very dangerous behaviour for a t to threaten referral. Yes, you lied, you made a mistake, you were scared. I would be too. Your t is making a mistake now by threatening a termination/ referral.
I wouldn't wait till Wednesday for her to tell you her decision. This is your life to do with what you wish. I would be very proactive here and tell her that I found her reaction to be an overreaction. Perhaps she needs some support herself in dealing with your case, some really good supervision would support and enable her to allow her feelings of anxiety and worry and bracket them enough to be able to hold your issues here. You are the important one here not her.

[Nammu]

If you can not be honest about your intentions then I believe she is right in referring you to another T and hopefully you can find one that you can be honest with 100% of the time. Trying to get an answer before next Wednesday seems a bit gameplaying on your part, trying to push her at this point may insure that she will refer you to someone else. Try thinking about this from her viewpoint, she has an unstable often suicidal patient who can not be honest about their intent to follow though on thoughts of ideation. Therapy is a two way street, trust has to be on both sides, sounds like you have broken this trust before and are saying she can not trust you not to break it again.

[Crook32]

Originally Posted by slowandgentle

Oh, Crook, I'm sorry she's made this topic so awkward and complicated for you: I don't think it has to be that way - at least, judging by the really calm, measured way my T approaches these conversations.

I wonder if it would help for her if you had someone else (in my case, a Pdoc) who is aware of the urges and can be another set of eyes, ears and care?

I went to see one a few weeks ago when I was in a bad way (to get meds) not to ease the load on my T, but as a sort of unexpected side effect, it made me feel less guilty about the burden I felt I was putting on T. Not that he ever indicated it/I was. But I did feel that way, and more than I knew I did.

She was calm but apparently honesty especially around this topic is a boundary of hers and I crossed it. She did tell today that her and my pdoc were in close contact through everything.

[Crook32]

Originally Posted by junkDNA

my T asked me many times if i thought i should work with someone else when we first started working together, like for the first 2 years i was in constant crisis and we werent really doing therapy... just crisis management. i was in and out of hospitals many times. at the time him suggesting a different therapist really offended and insulted me, and made me think he didnt care. i told him that every time he would suggest it. he would tell me that it;s because he does care, and he wants me to get help and recover, and he wasnt sure if he could help me with the intensity of my depression and psychosis. so, i guess i say that to say that your T probably isnt dumping you because shes giving up or doesnt care anymore- she probably cares a lot, and wants you to get the best help you can get. i know its hard to see it in that light in the moment.i also hope things work out for you whether with this T or a different one. i know how intense attachment can be and how hard it is to even think about leaving...

That is the same for us all we have been in is crisis mode until recently. So maybe I just burned her out. I just don't know if I can start over with someone new. I have told her things I never told any other therapist.

[Crook32]

Originally Posted by monalisasmile

Ouch, that's gotta hurt! You know Crook, you have been hospitalised 5 times in the 2.5 years you have seen your t. Was this your choice or hers? I can understand your reluctance to tell her if she reacts like this every time. I think this is very dangerous behaviour for a t to threaten referral. Yes, you lied, you made a mistake, you were scared. I would be too. Your t is making a mistake now by threatening a termination/ referral.
I wouldn't wait till Wednesday for her to tell you her decision. This is your life to do with what you wish. I would be very proactive here and tell her that I found her reaction to be an overreaction. Perhaps she needs some support herself in dealing with your case, some really good supervision would support and enable her to allow her feelings of anxiety and worry and bracket them enough to be able to hold your issues here. You are the important one here not her.

No she never put me in the hospital. She encouraged me a couple of times to go to a clinic that led to the hospital but she never EP'd me. That was one of the things we talked about. She said if we move forward she will be more conservative and quicker to put me in. I don't think she will respond to my email. I really want to call her but I also want to give her her space.

[Crook32]

Originally Posted by Nammu

If you can not be honest about your intentions then I believe she is right in referring you to another T and hopefully you can find one that you can be honest with 100% of the time. Trying to get an answer before next Wednesday seems a bit gameplaying on your part, trying to push her at this point may insure that she will refer you to someone else. Try thinking about this from her viewpoint, she has an unstable often suicidal patient who can not be honest about their intent to follow though on thoughts of ideation. Therapy is a two way street, trust has to be on both sides, sounds like you have broken this trust before and are saying she can not trust you not to break it again.

I know I have screwed up big time. The only reason I want to know before Wednesday is because all I will do is ruminate about it and use a lot of klonopin to try and numb the pain. But that is why I am also giving her space after the apology email I sent.

[Nammu]

Can you try other distractions than just popping meds? Like coloring, movies( animated movies are good) excercise or even meditation.

It's good you are giving her space.

Originally Posted by Crook32

No she never put me in the hospital. She encouraged me a couple of times to go to a clinic that led to the hospital but she never EP'd me. That was one of the things we talked about. She said if we move forward she will be more conservative and quicker to put me in. I don't think she will respond to my email. I really want to call her but I also want to give her her space.

One of the things that is imperative is that your T and pdoc know you will be completely straight with them about your level of safety. What helped for me was that we sat down and really hashed out a step-by-step plan for crisis situations and we all followed that plan to the letter (including me). I committed to doing so, and so did they, so we were all on the same page. We took a great deal of time to devise a system of rating my levels of depression and suicidality so that we all knew we were speaking the same language. Thus, they knew the difference between my just being depressed vs. having suicidal thoughts that weren't really a danger vs. suicidal rumination vs. planning, etc. I was completely honest with them about where I was and they understood how I described myself at each level. We agreed on what interventions were needed and appropriate depending on where I was, and we agreed that I would let them know early on so that we could be as proactive as possible. Taking the time to truly discuss this openly and develop a common understanding about the vocabulary and descriptions I/they would use so we could communicate absolutely clearly kept us from having misunderstanding, kept them from acting to conservatively too soon or not aggressively enough soon enough. They had a great deal of trust in my commitment to being straight with them, and I had a great deal of trust that as long as I was straight with them, nothing was going to happen that wasn't predictable from our discussions.

Have you sat down and talked about plans of safety and action in that much detail? That would be a place to start and would go a long way toward your T and Pdoc feeling more confident they can continue to work with you without risk to your safety. If they don't feel they can keep you safe, they are going to refer you to someone who you might be more able to do so. That's their bottom line.

[Crook32]

Originally Posted by lolagrace

One of the things that is imperative is that your T and pdoc know you will be completely straight with them about your level of safety. What helped for me was that we sat down and really hashed out a step-by-step plan for crisis situations and we all followed that plan to the letter (including me). I committed to doing so, and so did they, so we were all on the same page. We took a great deal of time to devise a system of rating my levels of depression and suicidality so that we all knew we were speaking the same language. Thus, they knew the difference between my just being depressed vs. having suicidal thoughts that weren't really a danger vs. suicidal rumination vs. planning, etc. I was completely honest with them about where I was and they understood how I described myself at each level. We agreed on what interventions were needed and appropriate depending on where I was, and we agreed that I would let them know early on so that we could be as proactive as possible. Taking the time to truly discuss this openly and develop a common understanding about the vocabulary and descriptions I/they would use so we could communicate absolutely clearly kept us from having misunderstanding, kept them from acting to conservatively too soon or not aggressively enough soon enough. They had a great deal of trust in my commitment to being straight with them, and I had a great deal of trust that as long as I was straight with them, nothing was going to happen that wasn't predictable from our discussions.

Have you sat down and talked about plans of safety and action in that much detail? That would be a place to start and would go a long way toward your T and Pdoc feeling more confident they can continue to work with you without risk to your safety. If they don't feel they can keep you safe, they are going to refer you to someone who you might be more able to do so. That's their bottom line.

We have a safety plan but it is not that detailed. I told her the truth almost all the time. It was just a couple times I screwed up. I have also told her many times though that no matter how bad I may want or intend to do it I am too much of a coward to follow through.

[Crook32]

I slept away most of the afternoon yesterday by taking Klonopin. If I am not asleep I am crying. I feel like I can't function right now and just want to sleep. The timing of all this sucks even more because my pdoc is out of town for three weeks and we have been adjusting my meds. So my mood was already dropping before this. I will probably take more Klonopin then I should again. Maybe call a hotline again since that is in our safety plan.

How could I be so stupid and screw up this bad?

[atisketatasket]

You were honest. That is not screwing up.

[kecanoe]

Originally Posted by Crook32

Well today we some how got on the subject of whether or not I thought she should have EP'd me last February. I said I thought she should have and she said it is troubling that I am questioning her judgement because she knew how much I wanted to stay out of the hospital. Then we got to the subject of when she asks if I have intent to follow through with my suicidal urges am I totally honest. And stupid me said no and asked if anyone actually says yes to that question.

So now she doesn't know if we can work together anymore. She said she needs time to think but thinks I should interview other therapists. Also there is the chance that she might just refer me out. I am devastated and I have to wait until next Wednesday to find out what she decides.

I really like working with her and hope this is just a bump in the road but I think I blew it and have lost her trust forever.

Yikes. I understand about not being totally honest about intentions because you want to stay out of the hospital. I've done that.

I hope that your t can come to terms with this. Sounds like you probably need to be prepared to commit to being totally honest. And it seems mean to make you wait until Wednesday to hear what she has to say about it. On the other hand, giving her time to process might be to your advantage. Hopefully she will also reflect on the good work you have done together.

Meanwhile, maybe this is a good time to activate your safety plan. It would show that you are in earnest about staying safe.

[Elio]

Meanwhile, maybe this is a good time to activate your safety plan. It would show that you are in earnest about staying safe.

Yeah... great advice.

[Crook32]

I did call a hotline last night which is in our safety plan. That was a disaster because the person I talked to was terrible. I might call again tonight if I don't knock myself out with klonopin. I did email T to let her know I called and am committed to the safety plan.

[kecanoe]

I don't know how your hotline works, but what if you called now? Could you call later if you get a dud on the first try?

[Crook32]

They are 24/7 so I can call whenever. I will probably call again tonight. I feel like I am walking a slow death march to Wednesday.