I have been in therapy since I was fifteen. I entered when I had a breakdown over family issues and cut my wrist. By the time I was twenty-five, I have had ten therapists. Number ten is my current one.
Over the course of psychotherapy, I have seen every discipline in the mental health field; licensed social workers, licensed therapists with Masters degree, psychologists, and psychiatrists. The first was a school therapist and moved on after the school year ended. My second therapist got married and then moved out of state. My third got laid off. I saw two psychiatry residents after her, one had her residency end. The second MD was not a good match for me. I just could not see him because after telling him I was going to overdose and get a hotel room, he asked me if I was suicidal. DUH is an understatement!! The next therapist I saw was a social worker at my place of employment. She was ok but after ten months. One day I got into a fight with my sister and she wanted to know more of my sister’s social life than the anger I was feeling. I’m sorry but I thought this was about me and not my sister? I just decided she was useless and told her she was fired. She responded saying she wasn’t going to get a referral from her for another therapist and I told her, I didn’t need one. I’d find my own. There are other therapists out there. I then called the local mental health center and two months later I had therapist number eight. I really like this one. She was the first to introduce me to DBT (dialectal behavior therapy). She thought traditional therapy was not going to work for me and this would. After the first group session, it was a crock of shit. No disrespect to the creator of this therapy, Dr. Marsha Linehan, but come on…I had to write down every time I thought about hurting myself and at the end of the day it was over 100 times. I felt worse than better for realizing this.
I was part of the lower class system. I was also part of the state’s mental health department’s care because I was frequently in and out of the hospital because of my mood swings, psychosis, or suicidality. After ten years of this and once I found a job that had a stable insurance, my therapist of two years was leaving the local mental health clinic she had worked for the past fifteen years. I was devastated, again. She did not disclose her reasons to me, not did I ask (if I did, I do not remember her answer). I got really mad at the system. I really didn’t want to find another therapist as losing this relationship was so painful as we were in the midst of real work and now it was ending.
I decided to go private after this experience. My yellow pages was my resource book. There were a few things I learned over this process of therapy. Not everyone is suited to be your therapist. You need someone to laugh with, cry with, share intimate things with yet also need someone to be there for you. My search for my current therapist was more like me interviewing the therapist than the therapist interviewing me. I was not going to see someone who did not answer my questions or answered my question with a question. I needed someone to collaborate with me on the treatment plans, not follow some “one treatment fits all” scenario. Each person is different and so is the therapist. What works for one might not work for another.
One thing that has been the glue to most of my therapeutic relationships is the alliance and collaboration between myself and the therapist. We work together for a common goal, usually trying to save my life, or at least make it a little bit better to live it. Let me be clear on this, this is the MOST essential piece not only in a therapeutic setting but also personal relationships. There can be no hierarchy when dealing with a suicidal person. The therapist cannot take the “I know best” routine with a suicidal client. No one knows best except the patient. The patient is the one that needs to have a say over treatment. Being “thrown” in the hospital every time suicidal thoughts come up is a waste of time for both people involved and it only angers the client more than you can imagine. Just think, you are the one seeking help to figure out why you are suicidal and the moment you mention it, you are in a locked unit for 3-7 days, watched like a hawk and then when you get out of the “safe place” , the next session might not happen for several reasons. One, the client is too pissed off to resume and decides to go on their own. Two, the client, once released, does indeed go through with their plans as the ultimate end all plan. Three, the therapist terminates or decides that another therapist might be better suited for the client. Most therapists do not have training in suicidal crisis and suicide scares them more than the clients they are treating. Since the beginning of 2012, I have been trying to find a therapist that is within my 5 mile radius because I do not have a car and rely on public transportation to get me to where I need to go. Soon as the prospective therapists hears that my last hospitalization, which was involuntary, it’s pretty much “have a nice day, I don’t treat really ‘sick’ people”, least that is my interpretation of it.
In 2005, I suffered another severe major depressive episode. My psychache, as Dr. Shneidman, the father of suicidology would call it, had become so severe, I had had enough and decided to end my life in November. One of the greatest books on suicide is by Paul Quninnett, Suicide: the forever decision. I learned from that book that somehow suicide was not to be done in haste. You should give yourself some time and planning. And one of Dr. Shniedman’s famous line is “you should not kill yourself while suicidal”. This is tricky as I am sure most therapists reading this right now are thinking, that is terrible and there will be no coming back when this time has come and the planning is in great detail. True. This can be the case, but is also allows something called ambivalence to take over. When I made my plans for November, it gave me time to think it through, whether I was to go through with this or not; the choice was mine. No one else could make that decision for me and maybe by that time rolled around, I didn’t feel like taking my life, maybe I no longer would feel that way and the day would pass without incident, like, fortunately, many times before. On this occasion, I was hell bent on going through with my planning. Therapy had become useless. I no longer wanted to be in therapy, I was just going to “please” my therapist and made it look like I was fine if I did go through with this. By mid-October, I could hardly wait the next few weeks. My mood was becoming more bleak, baseball season was over as my beloved Sox had a horrible year with injuries, the psychache was so intense sometimes I couldn’t breathe. But I still carried on like there was nothing wrong with me. I was being cheerful to the outside world. My therapist and I had this game we played to get things going when I didn’t know what to talk about and I sure as hell was not going to tell her my plans so she could stop me. This pain was going to end and no one was going to stop me. The game was twenty questions. She could ask me anything and I had to answer truthfully and honestly. This is because only under direct questions will I open up and I think most patients in my shoes would do the same. I’d rather talk about the weather in therapy than what was really bothering me. This questions game was to delve into that. Except this time, it back fired horribly on me. Twenty minutes into session, I was bored and decided to play the game to pass time. At this point I was seeing my therapist twice a week and though I could cancel, I found it hard to do it. Ambivalence would get me to call and reschedule. My therapist asked, “what was really, really, really, really going on”? I was floored and remembered laughing as I could not believe she asked the one question I was not expecting. It took me a few minutes to collect myself and then the dilemma started. Should I tell her what I was planning to do? I was so damn torn. I wanted to end my life but I also did not want to hurt this person that (at the time) I had been seeing for the past four years. I waited a day then called and scheduled an additional session as I could not wait till out next appointed time and told her everything I was planning on going through. Her response shocked me. She started crying. Never had a therapist cry in front of me. It brought the realness of the situation to light. I obviously meant something to her and though I don’t recommend every therapist to cry when their client tells then they are suicidal, they should at least feel something.
Some people will say that people who commit suicide are selfish. Seeing as my father drilled into me that I was selfish, I decided when I was about eleven to just give myself to others and their needs, even if that meant ignoring my own. When my therapist started crying, I grew ambivalent about my decision to end my life and put the brakes on so to speak. We worked through not going ahead of my plan and I was lost for months afterwards because I felt defeated. Again, I had broken a promise to myself that I would end my suffering.
I think it was a year later that I finally discovered the real reason why I was so suicidal. I was thirty years old and all my life I thought that one day I would grow into being a man. I realized during this time that this would not happen. I would still have female parts, especially breast which annoyed me to no end. A few years later, I realized that periods, being transgender, and suicidal thinking do not mix. I had not said anything to my therapist about these things as I could not put words yet outside my head. I could not face it if she rejected me for feeling this way and neither could I face the possibility that she would say that I am a woman and always will be so get those thoughts out of my head like my family has been saying since I was a kid. I could not possibly deal with it and so became again intensely suicidal. By this time I had found the works of Dr, David Jobes. With his SSF (Suicide Status Forms), we pieced together the reasons why I was suicidal and for the first time in my life while in therapy, my therapist sat beside me while I was crying about not being the real me and hugged me. I was so overcome with emotion, both at her tenderness and my feelings of despising myself, that I just bawled my eyes out most of the session while she sat beside me and let me cry. She told me that we were going to get through this. And those words meant the world to me.
It is this type of work that makes therapists golden. To have a therapist tell you that you are going to get through something very painful, means a lot to someone suffering so much. I know that most therapists do not have physical contact with clients because of boundary rules. I am not saying that all therapists need to be touchy feely to be a good therapist. I am saying that therapists with suicidal clients need to be open minded and try to work through the suffering rather than just say that if the feelings get worse and you can’t keep yourself safe, the ONLY option is hospitalization. Therapists need to work through the pain, despair, and hopelessness to help the client work through their feelings. If they don’t, and the feelings to not get talked about because of the fear of always going in the hospital, then nothing will change and the client will either end up committing suicide or end therapy thinking it is too hopeless to carry on. To build this alliance can be tremendous and life saving.
The things needed to find a therapist are difficult to explain. Everyone is different and so too are therapists. Not every therapist is the same. Each may come from a different discipline such as psychodynamic, cognitive, behavioral, and eclectic. Eclectic therapists means they do not have a specific discipline. They run their practice more on the patient’s need and use each of the different disciplines in a different way. For example, they may use cognitive-behavioral therapy (CBT) for people who are trying to modify their behavior to quit smoking or they might use a combination of psychodynamic and CBT for those with trauma issues.
For those entering therapy for the first time, it can be scary and frightening. Asking for help is not an easy thing and when you do, it can feel really vulnerable. Opening up to a new person about problems that you are having can be challenging. I know every time I walking in the door of my therapist office, even after years of knowing her, I felt a little nervous. No reason why anyone going through the door for the first time wouldn’t. The main thing to remember is that you have the control. If this person doesn’t work out, then there are others out there that might. The important thing to remember is not to give up after the first try or the third. Eventually you will find someone that you can connect with and they to connect with you. That is what makes an alliance of therapy.