Tag: psychotherapist

commitment to living

by Midnight Demon, posted in depression, mood disorders, suicide, suicide attempt

Seeing as I have been suicidal the past few weeks, sometimes intensely, other times not so much, I thought I would talk about the dreaded “no suicide contract”. In an article by Rudd, Mandrusiak, and Joiner (2008), the authors describe that there is no empirical data that proves a contract is a deterrent to suicide anymore than say pinky swearing (my words not the authors). In these times where suicide rates are going up rather than down, it is important to have something in place so that the therapist and client feels comfortable sharing the suicidal feelings without always resorting to hospitalization. The authors in this article promote a “commitment to living statement” as way to facilitate 1) identifying roles, obligations, and expectations of both clinician and client, 2) communicate openly and honestly about all aspects of treatment including talk of suicide, and 3) identify emergency services usage when client cannot contain the agreement.

This agreement seems to me as a good way to start any conversation of suicide but it also feels like it is an informal consent contract. It doesn’t really focus on a suicidal behavior tracking plan like the Suicide Status Form. All it does is explicitly states that the client make a commitment to living.

I was reading this because I thought it was a unique contract but now I am thinking that it is not. It does however, give the clinician and client a time focused treatment plan that I think all therapists should have with their clients so that if something is not working, it can be changed so it does work. In my experience, I think that this would be helpful for my therapy but I think it might be too late for that as we are no longer seeing one another face to face and this contract requires a handwritten statement to be made.

My therapist and I have reached another impasse and I think sometimes that having a break is beneficial. It gives me time to think things over. I also think that if I had the inclination, I would bring this article up again with her and see what she thinks of it to help my suicidal tendencies. But I am not sure about the whole commitment to living aspect of it. It does seem to me that something needs to give and she needs a piece of mind that doesn’t include me telling her I want to kill myself every week. The biggest thing on the commitment statement is that it allows for goals to be set. In my twelve or so years of being with the same therapist, I don’t think we ever have set one goal in treatment. Usually I was the one to come up with a treatment plan on how I wanted to be treated. That was fine until I ran out of gas and ideas. But what would setting a goal after all this time be like? I don’t know as I have not really thought about it. My therapist doesn’t give me homework, other than possibly blogging about something she has in mind for me to work on. We generally have an unspoken agreement that I will call her should I think about acting on my thoughts to harm myself. The most I have done is text her, a lot, to let her know I am having a hard time with my thoughts. Usually this happens during the long weekend when either she is away or when we have a long few days between sessions due to the weekend or holidays. I try not to text her so much but she seems to like me keeping her in the loop so I do it to sort of please her. Plus it tells her that I am still alive so that eases her anxiety a little.

An example of the Commitment to Treatment Statement is the following:

I, ________, agree to make a commitment to the treatment process. I understand that this means that I have agreed to be actively involved in all aspects of treatment including:
1) Attending sessions (or letting my therapist know when I can’t make it
2) Setting goals
3) Voicing my opinions, thoughts, and feelings honestly and openly with my therapist, whether positive or negative but most importantly my negative feelings
4) Being actively involved during sessions
5) Completing homework assignments
6) Taking medications as prescribed
7) Experimenting with new behaviors and new ways of doing things
8) Implementing my crisis response plan when needed
I also understand and acknowledge that, to a large degree, a successful treatment outcome depends on the amount of energy and effort I make. If I feel like treatment is not working, I agree to discuss this with my therapist and attempt to come to a common understanding as to what the problems are and identify potential solutions. In short, I agree to make a commitment to living. This will apply for the next ____ months at which time it will be reviewed and modified.
Signed_____
Date_____
Witness____

To me, as I have said before, this looks more like a basic agreement contract to therapy than it does for specifically suicidal thinking/behavior. The reason I bring it up is because most clinical therapist do not have such specific language in their agreement and I think it is important to work together in treatment. A client should always have a say in treatment, no matter if it is in psychotherapy or medicine. With a little modification of the wording, this statement can be used in any clinical scenario. It is basic and to the point. Clients should be active in the care but sometimes that is just not possible. I mean if you have a throat infection, you are not going to argue with your doctor about treatment. You will want the antibiotics so that the infection doesn’t spread and you get sicker (if it is a bacterial infection to begin with). But it gets trickier with something complex as say diabetes. This blog doesn’t deal with that so I won’t say anything further about it. Just know that you should always advocate for your say in treatment and ask questions about why you are being placed on medication or physical therapy or whatever your doctor prescribes.

Basically, I have to agree that this commitment to treatment statement (CTS) is better than a “no suicide” contract because it (CTS) allows open discussion and collaboration of treatment whereas the no suicide contract will just state that the client will not kill him/herself.

The second part of the CTS agreement is the Crisis response plan (CRP). It states:

When thinking about suicide, I agree to do the following:

Step 1: Try to identify my thoughts and specifically what’s upsetting me
Step 2: Write out and review more reasonable responses to my suicidal thoughts
Step 3: Do things that help you feel better for at least 30 mins (examples can include, trying to sleep, play internet games, brush hair 100 times, write in a journal, listen to music, etc)
Step 4: Repeat all of the above
Step 5: if thoughts continue, get specific and I find myself preparing to do something, I will call XXX @ 555-555-5555 or suicide hotline
Step 6: if I cannot reach above I will call my therapist or psychiatrist
Step 7: if I am still feeling suicidal and I don’t feel like I can control my behavior, I go to the ER or call 911 (or whatever the local emergency line is for your country).

Either plan is effective even though neither have been empirically tested. The CRP I have used in my treatment and I have found it useful. During one of my recent hospital stays, I actually gave out the CRP to other patients hoping they would benefit from its usefulness.

awful session with therapist

by Midnight Demon, posted in blogging, depression, mood disorders, suicide, suicide attempt

It came! My World Series cap finally arrived today. I hope it would have lifted this awful mood I am in but it hasn’t.

I don’t know where to begin. I had an awful session with my therapist last night. She was asking what to do with her anxiety and how it could be put to rest. I said valium is the answer. She said that wouldn’t make me less suicidal. True but she could zone out about it. I am joking here. I know suicide is not a joking matter but this is my blog and I will say what I want. She talked about how her anxiety revolves around my safety and she just doesn’t think I am safe anymore so how can she simply ignore that when I keep talking about putting a rope around my neck. And that is not to accessorize. (ok, another bad joke.) I think she should consult with someone. I really think that SHE needs someone to talk to about my case. Maybe they could help her. I know you can’t go alone when you are dealing with someone and their suicidality. That goes for client and therapists. I will tell her this on Tuesday when I see her. Or just send her this blog so she reads it and maybe it sticks in her head a little bit better.

I don’t know why I am in such a rotten mood. I guess because I made my therapist cry and I feel bad about that. Another indication that we are too close. I so very badly want to cancel Tuesday’s appointment but I have no where to go that day. Monday I see my psychiatrist. I don’t know how much of this I am going to tell her. We (therapist and I) talked about the hospital but what good will it do me. They don’t have you talk about stuff when you are there. They make you fill out a distress tolerance bullshit form. Like that is really going to help in times of wanting to put a fist through the wall. I don’t feel like doing that. I do feel like finishing off my bottle of whiskey. What would it hurt? Except for writing more “truth serum” blogs? I guess I am feeling hurt because that is really the only time I want to drink. Listening to Lady Antebellum is helping. They have made some their song acoustic and it is really cool. I need music right now to right this wrong I feel that I have done.

No one in my family knows about this. I haven’t talked to anyone. I wrote a friend an email asking what do I do but I haven’t heard back from her yet. It might be a few days till I hear back from her. She is the slowest person to respond to email because she is so busy. So I wait.

Other than a blogger friend, I really have no one to talk to about this kind of stuff. But I am just not in the mood for talking right now. Today is my sister’s birthday and I am supposed to go to her party in about four hours from now. I really don’t feel like it. I just want to stay in my warm bed and hide under the covers. I forgot to get her a birthday card but then I think that birthday cards are stupid. All anyone cares about is what is inside. They don’t care what the card says. And they are more expensive now than they were in the past. Some as much as four fricken dollars? For something someone glances at and then junks? Seems ridiculous to me and a waste of money.

I have eaten only small meals today. I am starting to get hungry but I don’t feel like eating. I hate that. I just don’t know what I want. I kind of want Pad Thai but I think I will get that Monday when I see my pdoc as the restaurant is around the corner and it is a late appointment. Even if I wanted to go into the hospital I can’t. Not until I see my PCP for my monthly pain check visit. He is another one that wants me to call him if I feel like acting on something. What is he really going to do I have no clue. Not like I am really going to call him anyways. I have a crazy, lunatic therapist and my pdoc to call first.

it doesn’t take too much to be overwhelmed

by Midnight Demon, posted in blogging, depression, mood disorders, suicide, suicide attempt

****WARNING MIGHT BE TRIGGERING****

I didn’t mean to start off the day like this, I don’t think anyone does. But I am feeling miserable and when I am miserable I write. This darkness has invaded my soul. I am no longer a good person but just an empty shell off what was, if that makes sense. I haven’t had coffee and wouldn’t you know it, I forgot to order cream with my groceries? Figures. Guess no coffee today, unless I go to Walgreens and buy it when I pick up my prescription. I also need a case of water. I need to try and keep myself hydrated which I have not been too successful at, if my lips are any indication. My lips are wicked dry and chapped, like a desert. I never made my chamomile tea last night. I got too sleepy and wanted to stay in my nice cozy bed. I will have to change the sheets after I take a shower. It is going to suck as I hate changing sheets but if I smell, I know my sheets do, too. I don’t know why everything has to be a struggle. I am struggling to stay alive. Struggling to do normal living activities. It is just so overwhelming. I hate being overwhelmed. But then, it doesn’t take much to become overwhelmed.

I had my therapy session tonight with my pain in the ass therapist. It’s funny but today I was reminded that even though we have been working together for years and years she still fricken panics whenever I get into a suicidal state. It’s like the blog I wrote a few months ago, Mentioning of suicide, therapist panics. Instead of asking me what my story was that went behind my suicidal reasoning, she didn’t want to hear it. She just wanted to listen to my reasons for living, my reasons for dying, and what I was going to do to get me through the next four days until we talked again. It is the SAME THING every single time. Nothing changes. I can hear the panic in her voice soon as I divulge my plan. It’s like she cannot tolerate listening to it. I don’t know why it is. It makes me feel better talking about it. But she doesn’t want to hear it so I don’t speak of it. I keep it inside and I think that is where Mr. Hyde is born. Mr. Hyde is my suicidal part that like to come out and write suicidal notes.

Tonight I was reminded that my therapist is not Aeschi in the least because I scare her. I don’t mean to scare her. That is not my intention. But my suicidality freaks her out. I only have a voice here on my blog to talk about my suicidal plans and thoughts and feelings. You would think, that a therapist office would be the place to divulge this information but it is not. It freaks them out too much. Maybe that is why there are so many suicides. The talking about suicide doesn’t get talked about so the client feels more alone than they already feel. I think that if I was a therapist, I would want to know my client’s thinking about suicide and why he wanted to throw himself out the window. Maybe in talking about it, there would be some underlying thought process that could be explored and then, maybe the feelings wouldn’t be so intense. But my therapist doesn’t want to hear about it. She wants to know where it hurts but not really. It is too scary for her. Where it hurts is where I want to put the rope around my neck. Where it hurts is where I am hopefully dangling out my bedroom window. I want to know what it feels like to lose the oxygen to my brain and lose consciousness permanently. But no one wants to hear that part. She just wants to know that if I want to act, I will call her first or someone else or go to the ER. Those places will not help me. They do not want to hear my story. They do not want to hear my plan or know of my pain. They will just hear that I am suicidal and should be in a safe place for a few days and hopefully in those few days I won’t be suicidal anymore, like it’s a magic cure. They do not want to know the depth of my sadness, the depth of my pain, the depth of my intolerable despair that has come upon me with its unrelenting hold around my throat. I am being suffocated. And no one can see it. No one can bare it. So I say what is expected of me and move on to another session where the same things go on. I am not saying my therapist is a failure. She is not. She is just a person who panics with the mention of suicide like the rest of the world.

I am just tired. Plain and simple.

by Midnight Demon, posted in blogging, depression, suicide, suicide attempt

I have done a lot today. I started the editing process of my book and shouldn’t have added some pieces but then I took away some things, so things evened out a little bit. The page numbers do not correspond to anything right now so I have to go through page by page which is a hassle. The title chapters are becoming clearer so I am happy about that. If I stay on course, I should be ok with a Nov 16th publishing date so stay tuned!!

After the editing, I decided to watch the football game. At half time we were leading 21-13. Or maybe it was 21-17. I don’t know. I was kind of sleepy and not interested in watching the game but felt I had to. I had some French fries for my lunch/dinner and then retired to my room where it is fricken cold. I am waiting for my brother in law to come take the AC out of the window. I just texted him to let him know that I want it done today. I am so proud that he has learned to text. When he got his new phone, he had no clue and thought it was a game. I guess they text him a lot at work and he got a little aggravated one day, saying to my sister that this game just won’t stop. She laughed and said that is the text messaging. He can be a little old fashioned but I love him. He really is a good guy.

It has been good that I am home. I didn’t do too much yesterday as I was so sleepy. I said I was going to sleep for a half hour before the game and the next thing I knew we won and the game was over thanks to Victorino’s grand slam! I can’t believe I missed the game!! I am so mad at myself.

I think I kind of got my therapist worried a little bit. She asked if I was suicidal and instead of giving her an answer, I said that I don’t care, which is true. I don’t care if I am suicidal or not anymore. It’s not like I am going to act on it so who cares! If I was going to act on it, I think it would be more dangerous. So I just don’t care if I feel suicidal anymore. It’s not like they lock you away in the hospital anymore for days on end. In fact, unless you actually act in the hospital to harm yourself, they will just discharge you no matter how bad you say you are going to harm yourself. So I am just DONE with the whole business of it all. And it’s not like she helps me while I am suicidal. She doesn’t implement the SSF or safety plan or any of the other things that will ease the tension of suicidality. She just increases sessions where we don’t really talk about anything. My psychiatrist just relies on me to tell her about my symptoms. If I am not telling her I am having symptoms, then to her, I am fine. I just am so sick of being in a constant suicidal state and not being able to do anything about it. I can’t take my life so why bother being suicidal? I mean I can take it, but it’s too much of a damn hassle. I am tired of the planning that goes into a suicidal plan. I am tired of the contracts for safety telling my therapist I will not act on it no matter how bad I really want to kill myself. I am just tired. Plain and simple.