[chihirochild]

TW for suicidality

Possible trigger:

My T knows that I'm very suicidal right now but doesn't think that I should go to the hospital. He thinks that the hospital is just a holding place where they lock you up and change your meds, and believes that I have BPD and that the hospital is a rewarding environment for people like me. I think that there's a decent chance that I am going to seriously hurt myself if I don't get admitted. He says that if I decide to go inpatient he will help me do it (like will call and arrange for me to be evaluated) but he really really thinks it is a bad idea and advises against it. He discussed it with my psychiatrist who agrees with him.

I feel like I'm going crazy. Has this ever happened to anyone else?

[SlumberKitty]

No, my therapists have all encouraged me to go to the hospital if I felt in the slightest that it would be helpful to me. I don't understand at all where your T is coming from. Please stay safe, HUGS Kit

[ArtleyWilkins]

No, neither my therapist nor my pdoc ever advised against going into the hospital. I don't hold a BPD diagnosis, so I don't really know what they are basing their advise on. If you are feeling truly unsafe, then the hospital may be where you need to be. If they feel that this is a poor idea because of your diagnosis, then they need to work with you on how to handle future crisis situations in different ways, but if this is the first they've made this kind of suggestion and have not worked with you on alternatives, this isn't the time probably to start out of nowhere.

[ElectricManatee]

This doesn't make sense to me. Better hospitalized than dead. No therapist I have seen has discouraged me from going to the hospital if I felt it was necessary. In fact, they knew that I am the best judge of my own mental state. It sounds like you know that you need to go, so you should go. If you end up needing to find a new therapist because of it, then maybe that's not such a bad thing.

This came up in part because of unpleasant things from your past that you disclosed in session, right? A good trauma T should help you regulate if you can't do it for yourself yet. They shouldn't give you the opportunity to get in so far so quickly that you can't function anymore. So it sounds like he messed up a little and now he's compounding his mistake with firmness and rigidity. Your treatment should be tailored to where you are, not where your T wants you to be. It's okay to need more help than what he can provide and to get yourself to a higher level of care.

You don't deserve to feel this way, and I'm so sorry that you feel crazy. You sound like you're in a lot of pain, so I think you should go to the ER right now.

[ElectricManatee]

Also even if you do have BPD, IT IS NOT YOUR FAULT. It's a consequence of trauma, which nobody asks for. And it's treatable these days, which is amazing. You seem like a smart, driven person, so you would totally rock DBT! (Or maybe the structure of it just appeals to my border collie tendencies....)

[chihirochild]

Originally Posted by ElectricManatee

This doesn't make sense to me. Better hospitalized than dead. No therapist I have seen has discouraged me from going to the hospital if I felt it was necessary. In fact, they knew that I am the best judge of my own mental state. It sounds like you know that you need to go, so you should go. If you end up needing to find a new therapist because of it, then maybe that's not such a bad thing.

This came up in part because of unpleasant things from your past that you disclosed in session, right? A good trauma T should help you regulate if you can't do it for yourself yet. They shouldn't give you the opportunity to get in so far so quickly that you can't function anymore. So it sounds like he messed up a little and now he's compounding his mistake with firmness and rigidity. Your treatment should be tailored to where you are, not where your T wants you to be. It's okay to need more help than what he can provide and to get yourself to a higher level of care.

You don't deserve to feel this way, and I'm so sorry that you feel crazy. You sound like you're in a lot of pain, so I think you should go to the ER right now.

Good memory, EM--yes, this current level of distress seems to be due to a recent trauma disclosure. How would a good trauma T help me regulate?

I think you're also right about him messing up--a part of me feels like he pressured me to disclose too much too fast and is now trying to "fix" it by being super rigid.

I have group therapy in 45 minutes and if I still feel this bad after that then I'm going to go to the ED.

My experience of working with people with BPD is that if an individual is unable to ensure that their needs are met, the person will be driven to seek more extreme measures to try and fulfill the need. When I have read your posts recently, I have read a yearning for containment and to be held safely. You are drawn to hospitalisation as a safe way of achieving that. I would be concerned that if that urge continues to be blocked by your therapist (or at least, you interpret his actions as blocking your access to that safety), you will have to double down and increase your bets in order to try and secure containment. You are trying to keep yourself safe and yet I think your therapist is ironically creating a situation where you will become increasingly unsafe because you need to push harder and further for containment.

[NP_Complete]

If he doesn't want you to go to the hospital, what is he going to do to keep you safe?

[chihirochild]

Originally Posted by NP_Complete

If he doesn't want you to go to the hospital, what is he going to do to keep you safe?

He has me call or text him if I am feeling like I am going to hurt myself and also has me send him a schedule of what I'm going to do every day when I'm not at work.

The problem is that a) he goes to bed at 10pm so I'm screwed in the middle of the night b) when I call him he advises me to do stuff I don't want to do like sit somewhere public so I won't hurt myself.

[ElectricManatee]

Originally Posted by chihirochild

Good memory, EM--yes, this current level of distress seems to be due to a recent trauma disclosure. How would a good trauma T help me regulate?

I think you're also right about him messing up--a part of me feels like he pressured me to disclose too much too fast and is now trying to "fix" it by being super rigid.

I think this is one of those wily therapist tricks because I noticed Amy doing it early on, and it was really annoying. Basically she would gently derail me if she felt like I was disclosing too much or getting too deep. With her, it was usually a slight subject change or a joke to break the tension. Liz is more likely to notice body language and check in if I feel okay to continue with a certain thing or if we should talk about something else (usually shifting to talking about how it feels to be that upset, not about the upsetting thing, or sometimes just talking about something lighter). Sometimes Amy does a "containment" exercise or a "safe space" visualization at the end of sessions where a thing didn't get fully EMDR-ed before time ran out. It's cheesy but kind of helpful to let me put the thing away and go on with the day. These are just examples of things I have noticed them doing to me, but it can be really helpful to have a therapist do these things when you aren't totally able to access the part of your brain that protects yourself.

[RosyC]

Sorry I don’t have a lot of time to comment but honestly this infuriates me slightly - not at you of course - BPD has such a high mortality rate. If you are suicidal and you can access IP, do go for it. Don’t be put off because of your diagnosis. I’ve seen too many people suffer tremendously and needlessly and also die because of this mentality. If your therapist is concerned about how the environment may affect you, they should work on you with that, not deny you safety. They can’t provide the intensive support you may need. Sending love.

[Polibeth]

My T always encourages me to go to the hospital - even when I don't really need it. She has a better safe than sorry attitude.

If you feel unsafe you should go to the hospital - regardless of your diagnosis.

[Lemoncake]

Originally Posted by chihirochild

Good memory, EM--yes, this current level of distress seems to be due to a recent trauma disclosure. How would a good trauma T help me regulate?

I think you're also right about him messing up--a part of me feels like he pressured me to disclose too much too fast and is now trying to "fix" it by being super rigid.

I have group therapy in 45 minutes and if I still feel this bad after that then I'm going to go to the ED.

What comes to my mind. Laying a solid foundation with teaching you grounding techniques and how to manage extreme moments. Making sure YOU were in the driving seat with disclosure and letting you set the pace and offering additional sessions when needed.

Please go to the ED if you need to.

[ScarletPimpernel]

None of my Ts have ever advised against going to the hospital. I think ex-T suggested I go almost every month, but I only listened to her once. I did take myself when she abandoned me. I, too, am suicidal right now, but L hasn't suggested hospitalization yet. I guess because I'm able to stick to my safety plan and my promise to her. My word is very important to me even when I'm feeling suicidal. That's why I have constantly asked her to terminate with me because then I wouldn't have to keep my promise. She said it's her job to keep me safe and to hold for me that I haven't always been this depressed and that I will get through this. Even writing that is hard to believe.

Whatever you choose, please stay safe. That's more important than what your T thinks.

[satsuma]

I don’t want to be unhelpful Chihurochild, and you will know the situation and your T much better, but to me it really grates that he called the hospital a ‘rewarding environment’. Like as if you are just choosing to be upset because it is ‘rewarding’. From my POV just because you have a BPD diagnosis doesn’t make you more or less in need of help, and doctors and hospitals are there to help. If a T made that comment to me I would feel like they were somehow invalidating my pain, implying that it is some kind of reward - choice thing ... anyway my apologies as I don’t intend to get you even more upset, I’m sorry you are in a bad place. My T has always said if you don’t feel safe go to the hospital and that is what the hospital is there for. I hope you can stay safe.

[SheHulk07]

No, neither my T or pdoc have advised me to not go into the hospital. Even my appt yesterday before my 2 week break with T, he informed me that it's perfectly okay for me to go back into the hospital over break if I start feeling like I'm going to hurt myself. He says he'd rather me go in and be safe so I can continue to work with him on my issues that hurt myself in a way that's not fixable.

[Mountaindewed]

They haven’t brought it up. The one time I mentioned possibly needing it she gave me the whole speech about “only if your a harm to yourself or to someone else.” And severe anxiety doesn’t fall under that. Anyways the hospital they are associated with never has any beds open and the waiting list is long so they have to send you to the abusive one down the road. No thanks.

[JaneTennison1]

Your T is wrong, ask him to put this in writing if he feels so strongly about it. I bet he won't because he knows what he is saying would be frowned upon. If you need help, get it

[wotchermuggle]

I’ve heard comments about having BPD and being in hospital as negative as well, while I was a patient. I really wonder what’s behind the thoughts behind it because it seems (and seemed when I first heard comments made to a patient with BPD) so mean and out of place to say someone doesn’t deserve emergency treatment if necessary.

[velcro003]

No. My T has brought up the hospital a couple of times, and I am sorry your T is being so rigid on this point. Please stay safe and I hope you go if needed.

[ScarletPimpernel]

About people with BPD having a "rewarding" experience with hospitalization: that's an old thought. That's when they thought people with BPD are attention seeking and manipulative. That's actually not the case for most people with BPD.

I actually just read an article about two different types of BPD and it was kind of similar to what L told me on Wednesday. So they think there's two main types: self-criticism and fear of criticism from others. The ones who struggle mostly with self-criticism will often be dependent upon other. The ones who fear criticism from others will most like shy away from being dependent on others. Two Potential Causes of Emotional Swings in Borderline Personality | Psychology Today

The only problem with that article is someone like me experiences both. That's what L was basically telling me. I was taught that I couldn't depend on my self and that people weren't safe.

Anyways, my point is that people with BPD can be so different than the others. Most are not manipulative or find hospitalization rewarding. A T who believes that isn't knowledgeable in BPD.

[Blueberry21]

My current therapist has advised against this, and I mentioned this to my pdoc as an area of concern. I feel like T downplayed my concerns and symptoms and in hindsight, I wished I would have gone to the hospital at that time. Luckily nothing happened, but I was showing mildly psychotic symptoms and so it could have been dangerous if it had escalated.

If you need to go, go. Only you can make that call. If your t doesn’t want to you to go because they think it reflects poorly on them... so be it. Get a new t. This seems to me that it prioritizes their self esteem over a lack of concern for your wellbeing.

Or, they think you’re just attention-seeking and are trying to call your bluff. Problem is, how can they KNOW this is the case? They can’t ever know, so it’s extremely risky for them to make this sort of decision for you.

[maybeblue]

I think I can explain the theory behind a person with borderline personality disorder or for that matter anyone with emotional regulation problems not going to the hospital according to the DBT modality anyway. DBT recommends against hospitalization whenever possible, even in emergency situations.

First, it's not that DBT therapists think that the person with BPD is doing it on purpose or is being manipulative or wants to get attention. Reinforcement in behavior theory is anything that increases a behavior. So this can be adding something pleasant or removing something unpleasant. And this is universal. It works in animals, children, adults, clients, therapists. It can happen on purpose or by accident.

Being emotionally dysregulated is extremely unpleasant. It's a negative stimulus. Whatever behavior removes the negative stimulus (or makes us feel better) will be reinforced. So if you feel really horrible for whatever reason, and you go to the hospital and then you feel better, the next time you feel really horrible you'll want to go to the hospital again.

It isn't that going to the hospital is a horrible thing, but DBT theory says that if you go to the hospital to regulate emotions, you are less likely to regulate them other ways. And they think that it is better to learn the other ways of regulating emotions in your own environment with all the stresses present rather than removing you from the environment. DBT does say that the therapist should be available though to help coach you through the skills.

I'm not saying that this is right for everyone or anything. I just wanted to explain the theory and say that it is possible your therapist is thinking of "reinforcement" this way rather than the hospital being some kind of prize or that you are becoming dysregulated in order to get attention or anything.

[chihirochild]

Thank you so much, everyone, for your perspectives and advice. I decided to just do it last night and am now in the hospital. I’m not sure if I feel any better but at least I’m safe.

Now that I’m actually admitted, my therapist is being supportive about it, which I really appreciate—I was a little afraid he’d be petulant about it.

Be well.