Therapist’s choice or fear?

Therapist’s choice or fear?

My therapist of sixteen years had decided sometime while on our three week break that she couldn’t work with me anymore for what reasons are still not quite clear. We had been arguing over various things the last several months, including my suicidality and it was becoming apparent that she refused to seek the given evidence based practices I was telling her about to deal with my suicidality. I was becoming more and more frustrated and wrote a blog about it that “opened her eyes”. Our engagement ended in February of this year. I was gutted. I had no choice but to end things with her if she had no idea how to work with me any more. So the hunt for a new therapist began, once I could manage it.

It is very difficult to find someone willing to work with a high risk suicidal patient, such as myself. When my therapist moved to her office thirty miles away and I had no means of getting there, I called ten therapists in a five mile radius of my house. I kept getting the run around. I couldn’t be seen by them because I was high risk and so they referred me to someone else. That someone else then referred me to someone else. I became distraught and just stayed with my therapist event though it meant more phone sessions and text messages.

Now I had the same problem, except I had no back up. There was no one. I had asked some therapist friends on Twitter in my area if they knew anyone seeking new clients. One responded and gave me a name. That therapist never returned my calls. After three weeks (one call a week), I gave up and moved to therapist number two. Same deal. It took me until April to find someone that a) took my insurance and b) wasn’t afraid of suicide. I’ve been seeing this guy for about three months now and it is getting obvious to me that we just aren’t clicking. You need a certain chemistry to work with someone is this guy is lacking. I thought I could work with him but he is my back up right now. I am looking for someone else.

The day that I had my first meeting with him back in April, two therapists returned my phone calls. One had taken three weeks to call me back so I was not in a rush to call her back even though her qualifications seemed like it would match what I was looking for. The other organization I didn’t know too much about but knew they offered CBT, a therapy modality known to work with some people but didn’t for me. I kindly told them I was not looking at this time but if that changed (I hadn’t met the guy yet so it could be possible not to work out), I’d be in touch.

So when I was hospitalized a few weeks ago and my current therapist told the social worker that I was there because of “family conflict” instead of a psychotic episode that happened that weekend, I got pissed off and realized I wasn’t going to waste 16 years with this guy to know it was wrong. I called the other therapist and she never called me back. Then I got in touch with the organization. I had a phone interview with them last week. He first went over my insurance as he didn’t take one of them. OK, but he took the other so I was okay with that. Then we talked about clinical stuff. He asked when was the last time I was hospitalized and I truthfully told him a few weeks ago. He ended the conversation saying his group would be unable to help me as I needed “intensive outpatient” treatment after a hospitalization. He basically said I was “too sick” to work with one of his therapists.

I was floored this happens in 2017. I have been studying suicidology since 2007, reading countless articles about how clinicians, particularly psychiatrists, are more prone to have a suicide during their career than any other profession. Psychologists are second to that. Yet despite the advancements in evidence based practices (EBP), there is still the fear of losing someone to suicide. I can’t make that go away and if I ever become a therapist, I too will have that fear. But there are measures you can take to decrease that risk in the high risk client, if there is a willingness to work with one. That opportunity is lost if you slam the door like countless therapists have done to me. Suicide is inherent in any psychotherapy, regardless of risk factors. It can “appear out of the blue” or not noticed until an attempt is made or a death occurs. The suicide rate keeps climbing. And one of these days, I will become part of that yearly statistic.

I look for help and get denied because of my risk factors, which are history of previous attempts, history of abuse, history of hospitalizations, and history of self harm. These factors I deem “high risk” can also be viewed as severe mental illness or “being too sick”. It was the director of the organization’s choice not to take me on as a client. Pissed me off but his choice regardless. But was it also his fear that I would take on a certain liability because I was chronically suicidal and mentally ill? I will never know but my gut says fear altered his choice. I understand that therapist want to have the kind of practice where things go smoothly and stuff like suicide is dusted under the rug. Suicide is a dirty word. I get that. I have lived it since I was eight, when I first thought of ending my life. No one wants to touch it with a ten foot pole. But excluding these people from these practices, what the hell did you enter the field for?? I have to wonder.

The therapist I work with now doesn’t follow a lick of EBP. I still don’t know what kind of therapist he is. Frankly, he just lets me ramble for 45 mins then it’s see you next week. He has explained what he does but he has yet to actually do it, which is why I want to see someone else, if I can find that person. I live in the hub of academia where there are thousands of therapists. The biggest problem I come across, other than their fear of suicide, is not taking new clients. OK. I get it but can you refer me to someone who IS taking them? No answer or try Susie Q who isn’t within my area of accessibility.

Anyways, these are my thoughts on the matter. Getting screwed by those that are supposed to help mental health patients but don’t want to deal with mental health patients that fit a certain criteria. I think that sums it up nicely.

5 thoughts on “Therapist’s choice or fear?

  1. Unfortunately it is all research and not clinical. But the evidence based practice that i talk about would be better suited to find clinicians that is willing to take the risk. There aren’t that many unfortunately


  2. This might be a dumb question, but does the American Association of Suicidology have any special certificates that they provide to professionals who have gone through their programs? I wonder if, as a client, you or others might have some luck starting with AAS and then seeking out, like, AAS certified counselors (if such a thing exists?).


  3. it’s out there, if the counselor is willing to look for it and get it. There is only one grad school I know that deals with suicidality in the work place, though more are popping up. Least 3 come to mind but they are the researchers I have followed over the years. The American Association of Suicidology is a good place to start.


  4. Thank you for sharing your experiences. I’m sorry that you’ve had to deal with this type of rejection, but I know you are not alone in going through this with mental health providers.

    I am not a clinical mental health counselor, but I did recently complete a graduate program in counseling (the track I was in focused more on academic and general personal development counseling for students). Still, I shared classes with clinical counselors, and we were taught to be mindful of our personal and ethical limitations within our work. For example, I personally would have too much difficulty working with sex offenders to be able to treat them effectively. If I’m unable to work through that bias, it’s my ethical obligation as a counselor to connect that type of client with someone who truly can help them. However, I have to wonder if counselors are treating suicide as that type of limitation — which, I think, is far too big of a generalization.

    Like you mention here, it is inevitable that mental health professionals will encounter suicide ideation and suicide attempts in their work. It’s entirely unavoidable. And, with the statistics being what they are, it’s probable that all mental health professionals will lose a client to suicide at some point during their career.

    There seems to be a need for more professional development to help counselors work through their uneasiness with the subject so that, instead of running away from the problem, they are willing to dig in and work shoulder to shoulder with the clients who have to live with suicidality every day.


any thoughts?

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