Urgency-emergency

(((((MissCharlotte)))))))))))))))))))) I think you are wonderful...
I have followed this thread as I think of you as a friend and Its so very true .
Along with your poem. I do not have a T.
The theme of (((what constitutes an emergency)))
really got me. Its odd with our kids we know what a emergency is no problem.
With ourselfs I think we are trained to put ourselfs last...That we have to think so very hard on weather or not its a emergency?
The truck thing made me laugh (((ty))))
As thats how i think now. awwwww
Your a very wise person...
muffy

(((((MissCharlotte)))))

On my machine at work, I say something like, "If you have a clinical emergency, please to go your nearest emergency room, crisis response center, or dial 911."

In terms of that message, an emergency is-- if someone is having feelings that are so intolerable that they believe they might hurt themselves or someone else.

Sometimes clients call because they want to see their psychiatrist sooner than their set appointment. They say that their depression has increased, or they are extremely anxious. They are not having thoughts of harm. I do not consider this either an emergency, or a crisis.

I think have more trouble with the word "crisis," rather than "emergency." I don't really believe that I have ever called T in crisis, except for the time when my father died. A crisis implicates that all events that are happening will lead to a major change in events, for better or worse. If I call T because I have self-injured, or I am having thoughts of self-injury, I don't think this indicates a crisis, since it is something that has been going on for ten years. Similarly, as I indicated in my previous post, I called T because I am not dong so well, emotionally. This wasn't a crisis, either. Our "boundary" is that I can call him whenever I need to. There is a major difference between calling in an actual crisis, and calling just because you need your T to help you a bit in getting through something-- even if it is just as simple as a soothing voice.

I am sure I could manage this by myself. We all manage our emotions without them when our Ts go on vacation. However, I know he's there, so I consider it to be somewhat of a helpful bonus-type-thing that I can reach out to him to make things a little bit easier.

My T as an answering service. You can leave messages with them in emergencies. I can't imagine ever leaving a message. To me emergency means life-threatening. I'm bleeding to death or can't breathe. The answering service nor T can help at this point so its not really an option in my mind.

A crisis to me means something different.
It means I am in some place that is overwhelming and I can't get out of. That something critical is happening that feels like it needs to be attended to or it will get worse or something will happen as a consequence of not attending to it.

Well, yeah I crisis is different than emergency. When my son was admitted to psychiatric hospital it was a crisis. Other than that I have never called him in crisis, or emergency. He has said to call him if I need to and he always calls me back. Twice he complained about the phone calls and then I freaked out and asked him why he gave me all the damned phone numbers then.....

I think he wants me to try to manage things on my own if possible; well, duh, yeah.

So....what about the word urgency? Where does it fit on the continuum? Is it like this?

1. Crisis (death in the family, etc.)
2. Emergency (suicidal ideation; intrusive thoughts)
3. Urgency (panic, unrelenting ocd, drunk husband, etc.)
4. Advice that can't wait till next session
5. Medication consult that can't wait but isn't urgent
6. You can't wait to tell T your amazing insight
7. You can't wait to tell T what a jerk he/she is
8. You realize in the middle of the night that T is the most important person in your life
9. You watched an episode of the dog whisperer and you realize that it's just like therapy
10. You need to make a schedule change so you don't have to see the client who comes after you.

haha, MissC, your post made my lol. especially #6. i wonder how many Ts get calls like that, and whether they honestly care *right then* as opposed to say, in session when it's the client's dedicated time.

i have been thinking this over more, and realised that i probably have called my pdoc (or got an "emergency" session) even when i wasn't in crisis or when it wasn't an emergency. i've become a lot more dependent on him, over the past year. but he encourages this - he says it's important to nip things in the bud rather than let them spiral out of control. e.g., one of my big 'triggers' is my sister - sometimes she starts to 'act out' and will take a mini-overdose to make us worried etc, even though she has no intention of doing lasting damage to herself. this is one thing that kind of makes me shut down completely - i am guaranteed a good spell of depression after such an event. so even though it's not an emergency, or a crisis, i'm still allowed to call pdoc and tell him what's happened, and he'll debrief me and maybe bring our appt forward so i can see him sooner.

if only everyone had a pdoc like mine .

I'd think that would be certainly urgent! Course, I'm in the same boat of confusion about emergencies/urgent/ and boundaries.

Yep - same - infact, I may really feel like it truly is an emergency for me... but i know no one else will unless, say my arm were disconnected from my body or i had *just* jumped off a bridge... then they might believe me. But other than that, no. I have called t twice now when I was having some scary body pain thing and was alone and didn't want to call 911. The first time she called me back in a few hours and by then, i could move and was semi ok. The second time, she had the dr assistant phone me *sigh*. Why hadn't i thought to call the dr?? Hello, brain..... I dunno. It's a weird life....

Hahahah ok so i have to share this... this was my late night realization-via-migraine; this will look familiar to some, but I still think it is important:
AWARNESS
I just watched Martian Child.... what struck me (you'll see the relevance here in a moment, promise) is the ending. John Cussusk's character said something like "We forget that children are so new here. they really are like little Martians, learning how to be in this world; to adjust, to belong." And I think for a lot of us, it is the same way. Parents are "the blind leading the blind" but so are our T's. It's all estimated guess work based on knowledge. Our feelings and emotions are often totally new to us, we've buried them for so long. T's try everything in the book - and when that doesn’t' work, they try what worked for the other T... and when that STILL doesn't work... they make up stuff and try that. We're confused and hurting, they're befuddled, bumbling around trying desperately to help... and eventually we learn to speak and correct them and thus they learn what helps.

Never ever ever ever EVER never ever give up. Churchill said that... we think... By hinting around in the dark, our T's teach us to speak. By us speaking, we give them the tools to help us.

LOLOL - I love your top ten. I swear, I thought the same thing about the Dog Whisperer. I saw an episode where the dog bit people's feet as soon as they started to leave. The dog never did this when people came over, just when they left. He had a bad case of separation anxiety, or as we would call it an attachment issue. Maybe the dog is just loudly delivering a doorknob confession?

I liked these.

Kiya, Your animated gif made me laugh too

Gosh soli, i soo feel like that dog sometimes... wanting to bite the feet so they won't leave me. I never even let on tho that something is wrong. I just bottle in up, stuff in back down, nod like things are fine.... and cry all the way home (in the case of T apnts.)
I've decided I do not want a stand in for T while she is gone for 2 weeks. No other will do. That'll be a fun conversation next time... when ever next time is....

Meeeeeeeeeeee too! 'Twas a gift from Her Soliness

1. Crisis (death in the family, etc.) This is a complete crisis, and I called my T on Labor Day for this, while he was still on vacation.
   
2. Emergency (suicidal ideation; intrusive thoughts) I don't think that ideation or intrusive thoughts are an emergency, unless you are going to act on them. And like my T says-- if it gets that bad, he can't do anything about that over the phone, so just get to the hospital.
   
3. Urgency (panic, unrelenting ocd, drunk husband, etc.)This is definitely urgency. I think that suicidal ideation and intrusive thoughts are also urgency. I have called my T for these (even drunk husband, lol) because it has helped to connect with him at times of urgency. However, I have also managed these things myself many times.
   
4. Advice that can't wait till next session Do you mean advice that you want to give your T? LOL.. I only ask this because one time I actually did call to give him advice on how to be a more effective therapist in our sessions, hahahaha. I was in a somewhat hypomanic stage, and I spoke to him with a strong agenda, giving him advice on how to make our therapy more effective.
   
5. Medication consult that can't wait but isn't urgentThe only example I can think of here is when I was breaking out a little bit from my Lamictal and I was 75 percent sure it wasn't the rash that they talk about... but the other 25 percent of me needed to know in order to be safe. My pdoc was away so I called his covering doc to find out.
   
6. You can't wait to tell T your amazing insight I do this by email because my amazing insights tend to take up 30823098123 pages.
   
7. You can't wait to tell T what a jerk he/she is I have done this over the phone, by email, and in person.
   
8. You realize in the middle of the night that T is the most important person in your life I have called his cell phone at 2am to wake him up to tell him this exact thing. JUST KIDDING.
   
9. You watched an episode of the dog whisperer and you realize that it's just like therapy Well I haven't seen this, but when I find a part from a book that relates to my therapy that I won't remember to tell him about, or can't wait, I will email him about it.
   
10. You need to make a schedule change so you don't have to see the client who comes after you. Obviously I don't have to worry about this one because my T doesn't have any other clients.
    

Hahaha - I too did this - the first time i ever called her like in my 2nd week of seeing her. She didn't let that go for a long time. But I had finally reached that point where "THis is MY therapy and I can't have her do it wrong like all the other 4 i've seen". she quoted my list for several months.

((Kiya))

I love your post re: Martian Child (which I never saw,so now I have to watch it!). This is beautiful!

((Soliaree))

Soooo, if at the end of session today I start barking and biting T's feet, what do you think he would do--pet me, give me a biscuit, hit me with the newspaper?

It just struck home so much, that line about children being so new (he's the new adoptive parent who takes in a boy with terrible attachment issues) and how slow and tenative the process is. As kids, they don't think shame on themselves for their actions, or 'how childish' they are. We should not have to either for the same abandonment issues when learning to trust for the first time.


Hahahahahah.... send you in? Give you rabies shots?? Ohhhh i nearly fell off my chair laughing....