What does your therapist say/do when you're in crisis?

I stopped calling their emergency line because they just tell me to take a shower or go for a walk. Once they told me to eat something sour. A couple times it was to play an instrument (I'm a musician). Sometimes watch a movie. I don't even like showers or movies, and if I'm calling chances are I'm too paranoid to really enjoy a walk. Music is good, that's why I try it BEFORE I call, and call after I've done it long enough I want/need to stop, then I get told to shower.

When I'm in an actual session with my T, she says stuff like "I don't know how you manage" and "that's actually pretty good for you that you only had 3 fifths of vodka since last week."

I mean, I'm alive so I guess it works??

Just curious as to other T's approaches (but also how you/he/she define a crisis)?

There's different levels of "crisis" for me:
- struggling, but kind of managing: I get phone calls. During those, we discuss strategies to feel better, like what I'll do during the day, things to make me feel good like sports, distraction...
- chronic sui and sh: it's discussed briefly and we then move on to discussing whatever is important at the time
- acute sui or otherwise severe crisis: extra sessions and/or phone calls, possibly discussion of going inpatient for a bit. Other than that it's mostly just support, being in the moment and feeling understood, as well as coping skills. This is not a time during which we work on trauma for the most part, but to some degree it happens because I'm just so activated normally.

I have direct contact with my T, there's no emergency line or similar of his office. This is true for all my Ts.

I have only ever reached out to an actual emergency "hotline" (online chat) once, when I found out about my Ts health issues. Since I didn't know flipper or forensic T yet and was really struggling, I reached out to basically everyone I knew (friends, this forum, as well as a chat line). I've not done so otherwise mostly because as you've described, these people don't really know me and can only give skills to use in the moment. And I'm not stupid, I know those for the most part already. For the issue of that day, they were able to help well enough. They sat with me for a moment, I was able to just voice all my concerns and they came up with some steps to do next, mainly: talk to T when you can, look after yourself before then. I think the most important aspect of that chat was feeling like there's some kind of option to find somebody who is able to help me deal with Ts stuff, even though I didn't know how yet. So kind of hold me over water until I can talk to T.

Oh yeah that emergency line is specific to my team, so there's like 10 people working there and I know all of them, some of them better than others, and they all have access to whatever info they have on their computer about me. They know what normally helps, but they (and I) have no clue when that tdoesn't so they suggest stuff like that when either I've already tried it or I know from the past it never works.

@ChickenNoodleSoup when you say phone calls, is that just periodically checking in and (how) is it different from struggling vs. severe crisis?

My normal T works Monday, Wednesday and Friday, my sessions are on Friday. I can have a phone call on Wednesday when I'm struggling. I can text him, he tells me a time, we talk for about 10 minutes. If it's a crisis, it might be extended to Mondays and more often than not it'd be in person. Over the phone it's just difficult, especially without video. Early on I had a few phone calls during severe crisis, but that was then more just like "let's meet asap, this doesn't work over the phone".

What if they keep asking about the hospital, saying they're not forcing you, but don't say either way if they suggest it? I know this means they're concerned my state is beyond what they're comfortable dealing with, but it feels like a "fck we can't and don't want to help so we're putting it on someone else" (which is kinda the same thing but with different vibes)

I've been in a state of crisis all week. For me, it's the severity of my SI. It's also like a state of panic and overwhelm. And lots of crying is a probable sign of a crisis.

They always ask me am I safe. What are my thoughts. Do I have access to anything to harm myself. Can I follow my safety plan. Do I need a hospital.

I hate when they ask about the hospital and they know it, too. But it's their job to ask. They need to know if you do need a higher level of care. It's not to punish or reject you, but to protect you because they care about your safety.

I find crisis lines a hit or miss. If I get someone skills focused, it doesn't help. I know my skills. Just talking, sharing, and even processing helps me the most in a crisis. And you have to tell them what you need otherwise I find they default to skills.

How do you define “safe” though, and how likely would whatever harm is would have to be before you’d go?

Do they think about how clients may confuse want with need, in either direction?

I’m asking because I’m in a spot where I wake up crying and yelling out, throwing clothes that no longer fit (started quetiapine recently) with a lot of aggression, and then I’m fine until I have to leave then I look for opportunities on my way, and I’m fine, and then every little trigger makes me think life is absolute shyt not worth living, but 2
Hours later I’m ok, ad infinitum. I never know how to answer the hospital Q because I never know if I will hurt myself and to what extent. I don’t feel like a little minor SH for me needs inpatient. He’ll, I’ve had attempts where I was just medically treated and d/c.

But I never feel what I think most people’s conception of “safe” is, from myself or others.

I think "crisis" can be difficult to define, too. Along with what "safe" is.

The "crisis" definition came up a while back with my therapist, when I said I was struggling and asked for an extra session. He was booked that day but said he could fit me in at the end if it was a crisis. And I wasn't sure whether it was in his eyes. For me, it was, as I hadn't been able to stop crying for hours, I wasn't being functional, I couldn't seem to calm myself, etc. But I think to him, "crisis" is more like my life is at immediate risk (I think we still ended up meeting that time?)

There was a time a few years ago when I was out of town by myself and contacted him in the evening, around 8 pm, really upset. I texted him, even though that's usually just for scheduling changes. And I think both because he knew I was out of town alone (if I was at home, my husband would be here) and that I wouldn't normally text, he realized I was in a risky place. So he asked if I wanted to meet over Zoom, even though it was 8:30 at night and he wouldn't normally do that. We ended up basically having a normal-length session (which he charged me for, but I knew he would, so it was fine).

But it was unusual for him to do, and I wouldn't expect it again except on a very rare occasion. He doesn't even really allow phone calls that aren't scheduled, though he's said if it was a case where I was trying to decide whether I needed the hospital (and was before 9 pm, as he turns his phone off then), we could have a brief call to determine my next steps.

Normally, my only options would be to ask for an extra session (which would depend on his availability--he does often have them because of how he does his schedule). Or to email him--and he generally only replies for an hour in the mornings (so if I emailed him at 8 pm, I wouldn't hear back till the next morning). Though once, about 5 years ago, he replied on a Friday night when I was in crisis, but honestly, at the time, he kind of made it worse, And we had another exchange then, too (I wish we could have just talked for 10 minutes instead).

I have contacted the 988 text line a couple times, and they were only marginally helpful. The one time, I think I mostly did it just so that I could say later "I tried the text line."

I don't usually see hospital offers as "I can't deal with you" but as "I don't have enough capacity to be there as much as you need". I have always refused to go to hospitals and managed to deal with it myself and with support from phone calls and so on. Forensic T a while back offered some kind of option where I would've been able to go home at night, which I did sign up for, but the waitlist was so long that now I wouldn't have time to go if they would have a spot.

Safe as well as crisis are individual terms to me. I have lived with sui for most of my life, and if I just have weird impulses to do something during the day, I can deal with it well. I think other people who have something acute coming up and then feel like that for the first time ever might be more overwhelmed and would need more support. To me personally, if I didn't know anymore whether I'll hurt myself or not, I'd not think I'm safe. But I can judge most times that I will not do that, or not if I get some more sessions, so then I'd think I'm safe.

At the end of the day, only you can judge whether you are safe. T once said that people usually know when they aren't safe anymore, unless they are in a psychotic state or something like that.