Tag: psychotherapist

A Drunken Ramble about fear of suicide

by Midnight Demon, posted in mental disorders, mental illness, suicide, suicide attempt

Most people have fears of death, but for those that are suicidal, they tend to want death because they believe death is the only way out. I emphasize the word only because according to the father of suicidology, Edwin Shneidman, “it is a very dangerous word in the world of the suicidal mind”. These people generally will only think of fear due to what Marsha Linehan calls fear of suicide, which is the belief that failure, cowardice, or fear of death that prevents someone from committing suicide.

Aside from these reasons for attempters to try, there is the fear of loved ones and friends of losing someone by death that has not been talked about. Mental illness in some form will affect someone you know more than you think. Even the most upbeat person can suffer from depression but no on knows this because they keep it hidden.

Most people shy away from suicide talk. They don’t want to hear it or will make stupid comments such as “people who commit suicide are selfish”, that “it’s wrong to take one’s life because only God can do that”. Despite these statements, hundreds of people attempt suicide every day. Suicide is the 3rd top killer of Americans more than heart attacks and cancer combined. How can people take their life is a puzzling question. It’s very difficult to kill the human body due to the fight/flight response. I know because on many occasions where I tried, my fight/flight kicked in and I made a call for help, much to my chagrin.  Prevention starts with seeking help but very few people in desperation will call for help before an attempt. They may call for help after or if they survive and don’t want to go through the survivor bullshit (the stomach pumping, hospitalization, stitching of wounds, etc).
Even therapists are fearful of suicide attempters or of the suicide talk. Most clinicians will actually pawn the client off to another therapist “more qualified” or outright refuse to see them. I have had this happen to me ten times while trying to find another therapist within a five mile radius of my house. 10 therapists!!!! TEN professionals refused to treat me because of my history of suicide attempts and current suicidal thinking. I could understand that they did not want to take me on as a multi-risk client and would have liked them to make at least one session with me before I lived up to their presumptions of me. But instead they decided to chuck me off to another therapist who referred me to another therapist who, well you get the picture. So for my therapy at the present time, I have to have phone therapy with someone who is thirty miles away from me because I do not have a car. She took a chance on me and we have been together for eleven years now. She stuck through the depths of my suicidal plans for the past eight years, my nerve condition, and my overall mental illness, which can at times include psychosis and delusions. I don’t know why she puts up with me but she does. Same could be said of her because she is the only therapist I ever had that talks more than I do. I have called her on it so many times that I lost count. Nothing like the analytical consultant I saw. He was strictly Freudian.

Analysis of a Song–How to Save a Life

by Midnight Demon, posted in Bipolar Disorder, depression, mental disorders, mental illness, mood disorders, psychache, psychology, suicidality, suicide, suicide attempt

Analysis of a Song by: G. Collerone. Copyrighted 2012, all rights reserved

Music is an important part of the human race. Each individual has his/her own genre they prefer. Music can help heal a broken heart, discharge stress and to relax while going to sleep.
Often times music’s lyrics can hold a very powerful message. That is my goal with this essay to write about the song, “how to save a life” (The Fray, 2005). By using personal and clinical information, I hope to inform the mental health professionals about how to save a life when a client is thinking about suicide and what it means to get help from a mental health professional. This paper is written from the view point of a clinician and a patient who is engaged in therapy.
Jobes, Moore, and O’Connor (2007) have stated that assessing a patient’s suicide risk at each medical office visit as collecting vital signs. Quinnett (1987) has stated that there is only a ten minute window of when a person thinking of suicide will actually go through with it. It is extending those minutes that is an important step to prevent a suicide.
Sometimes there are signs indicating suicidal thinking such as, giving away of possessions, saying things will be better if I just “go away”. Sometimes these signs are not so subtle. In the wake of a completed suicide, one often wonders, “what they could have done differently”.
The rock band, The Fray, has written a song called, “how to save a life”(Slade, 2005). I would like to express in this essay, how important these lyrics are to help save a life, whether it is someone else’s or your own.

“Step one you say we need to talk
He walks you say sit down it’s just a talk
He smiles politely back at you
You stare politely right on through
Some sort of window to your right
As he goes left and you stay right
Between the lines of fear and blame
You begin to wonder why you came”

These opening lines talk about the initial conversation when the person who is having suicidal thoughts is being confronted. This is a crucial conversation as it allows you to assess what the person is thinking and to let them know you are concerned. The lyrics could also be viewed as the initial consultation a clinician has with his or her client, whether it was initiated by a friend, significant other, or family member. Family and/or friends are hoping that this person, who means so much to them, can open up to this person (therapist, minister, or counselor) to get the help that they (friend or family member) cannot offer or give. This is not to say that the friend or family has rejected the individual in his or her distress. The distressed individual may just need an unbiased, neutral person to talk openly about how they are feeling and what has brought them to the verge of suicide. Life for this person at this point is bleak, hopeless and unworthiness has invaded their soul. The individual feels he or she cannot confide in others. He or she feel they are a burden to friends and family members and have begun to shut himself off from those that love them. He sees only one option left to them: suicide. This is very dangerous thinking. The four letter word “only” is very significant and carries a lot of weight. Dr. Edwin Shneidman spent his career in working in the field of suicidality and forming the foundation for suicidologists in the United States. According to him, this word is the most “dangerous” word to be spoken by a suicidal person (E. Shneidman, 1985).
As long as there is human life, the threat of suicide is always going to be an issue. It is an indiscriminate symptom of mental illness, such as bipolar depression, major depression or schizophrenia. Some times suicide is not related to mental illness at all. It could be a response to a crisis that seems to have no end. Whatever the reason, “suicide will be a permanent solution to a temporary problem” (Quinnett, 1987).
Some experts will say that suicide is preventable, others believe that it is treatable. I say that it is manageable. When suicide becomes the only option, the question becomes what to do with this suicidal thinking: if the individual reaches out, they may go to a friend or family member for help or suffer along and pray his distress will end.
Most clinicians do not know much about suicide. Each clinician has their way of dealing with it or perhaps, not dealing with it at all. Some will refer their client to another clinician the moment suicidal thinking is mentioned. Most almost always use what is known as a safety contract: essentially an agreement, written, verbal, or both, saying that the client will not harm or kill himself or herself in any way until the next session with the therapist. If the client does not agree to this, the option is that the client will be hospitalized, often against involuntarily. If the clinician fails to hospitalize a client that is in danger of hurting themselves and the client dies, the clinician is subject to malpractice and potentially the loss of the licensure. In Rudd’s article (2006) 41% of clients under contract died by suicide or made a serious suicide attempt. These contracts have no legal standing but are used from a medicolegal point of view. To ensure the liability of the clinician, the client is placed in the hospital. In my opinion, this is the clinician’s get of jail free card and the jail term of the client. The lyrics: “Let him know that you know best/Cause after all you do know best” best describe this situation.
Is there a better way of dealing with this small yet extremely vulnerable population? There are structured treatment plans for patients at risk for suicide, but the knowledge of this across all mental health professionals is limited. It takes a mediocre trained clinician to have the courage to want to treat the client’s plea for help and to stick with that person through this difficult time.
There are two clinicians who have revolutionized the understanding of suicidal thinking and behaviors. Dr. Ronald Holden at the Queen’s University in Canada and Dr. David Jobes at the Catholic University of America in Washington, D.C., have two forms that are easy to use and are not time consuming. These forms, the psychache scale (Holden, Mehta, Cunningham, & McLeod, 2001) and the Suicide Status Form (SSF;David A. Jobes, 2006) can be used in the first fifteen minutes of a session to assess the client’s mental health status.
Dr. Holden’s psychache scale is a thirteen question self report of items based upon Shneidman’s book, Suicide as Psychache (1993). Psychache is defined as despair, anguish, hopelessness, psychological pain one feels. Each items are ranked on a 5 point scale ranging from either never to always or from strongly disagree to strongly agree (Holden, et al., 2001). Scores are from thirteen to sixty-five.
The chorus is what brought me to write this paper. The following is the lyrics:
Where did I go wrong, I lost a friend
Some where along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life
Sometimes in my own suicidal thinking I had wished “someone would have stayed up with” me all night. Just to have the reassurance that you are not alone and that someone cares that much, helps to diffuse the feelings of hopelessness and helplessness that the depression and weight of the world is bringing. It also helps to know that this difficulty will pass and the individual will get through this. It also helps to know that difficulties will pass and the individual will be able to move on. It is crucial that the individual knows this for tomorrow does not exist and the important thing is to get through today.
In Shneidman’s classic work, ¬Definition of Suicide, he states that “suicide should not be attempted while feeling suicidal” (1985, p. 139). The reason for this is because the thinking of the mind is focused solely like a never ending black tunnel. The constriction is so great; all you can think about is death and cessation. Time for them is in a warp full of pain and despair; there is no tomorrow. Their thinking is solely focused on what they need to do to ease their pain no matter what. Constriction is defined by Shneidman as the “honing in, the tightening down of the diaphragm of the mind. There is dichotomous thinking, a fixation on a single pain-free solution or death. Choices seem limited to two or one” (Shneidman, 1999).
Sometimes during this constriction, you are so overwhelmed by all that needs to be done you don’t know what to tackle first. This might be tasks at work, school, or just in general. Lists become an important tool that can help to prevent suicidal behavior. Dr. David Jobes at Catholic University created and designed a well focused, detailed, user-friendly form, called the Suicide Status Form (SSF, 2006). This form has three essential components that are initial, tracking, and outcome forms. Each section that both the client and clinician fill out to focus on the treatment plans, mental status at each office visit, treatment plan that the patient and clinician agrees to, and other relevant clinical material such as axis diagnoses for proper documentation. It essentially creates a written plan on getting better. The SSF is a very carefully made tool that clinicians can use to know how much pain, hopelessness, and likelihood the client may act on their feelings. This form is the best tool to know where the client is in their thought process because it clearly documents the distress they are feeling. The SSF also provides the client with a voice in their treatment rather than to have it dictated as the clinician seems fit, because after all “you do know best”. The client will feel more centered and relieved that someone is taking the time to listen to what is going on and work with them on what will work and what will not.
The next bridge is the crucial piece of what therapy is about:
Let him know that you know best
Cause after all you do know best
Try to slip past his defense
Without granting innocence
Lay down a list of what is wrong
The things you’ve told him all along
And pray to God he hears you
And I pray to God he hears you

According to Dr. Shneidman, “there are many pointless deaths, but never a needless suicide” (1995). Over his career, he has stated that the main element of suicide and suicidal thinking are frustrated needs. These are the “list of things that are wrong, things you’ve told him all along”.
In Shneidman’s Psychological pain assessment scale (1999), he lists twenty needs he feels are essential to the frustration one brings to think about suicide as an escape (for more detailed use of the scale, please see article). These needs are an adaptation of Henry Murray’s work, Explorations in Personality (1938).
The key to helping any suicidal person is to listen to what the person is saying. That is the most essential piece that any clinician can do. Jobes (2008) found in his clinical use of SSF’s one thing that was the level of the perturbation and stress involved with suicidal thinking as major correlate for suicidal behavior. This might be that pain becomes so jaded the person just doesn’t feel it and all they are left feeling is the urge to do something in the moment to relieve the pressure that is building up.
Learning new coping strategies may not be easy and some will work; others will not. In formulating this, it is up to the clinician to either “drive until you lose the road (client) or break with the ones you follow” (stick with what you know or try something different). O’Carroll (1996) did a survey of current assessments of suicide and found that not all clinicians (social workers, psychiatrists, psychologists, counselors) have the right definition of what it means to be suicidal. Each profession had their own beliefs and thoughts about what it means to be suicidal and propose a treatment for it. For a select few, some therapists even transferred the client to another clinician because of various reasons (David A. Jobes, 1995; David A. Jobes & Berman, 1993; David A. Jobes, Wong, Conrad, Drozd, & Neal-Walden, 2005; Joiner, Rudd, & Rajab, 1999; Joiner, Walker, Rudd, & Jobes, 1999; Meichenbaum, 2005; Michel, et al., 2002; Ramsay & Newman, 2005).
There is also David Rudd, et al (2006) Commitment to Treatment Statement (CTS). This is a formal written and verbal agreement, on paper, that the client is committing to live and as such, has decided to put suicide on hold to try and see if therapy can help achieve the goal of living rather than of dying. It is a novel way of thinking and is much better than the expense of the hospital (even though it might happen anyway) and the loss of life.
No one is an expert on suicide. There are predictive models that show the likelihood of risk factors that might cause a person to attempt. But these factors do not apply to everyone in the human race. Each suicide attempt or gesture is unique to that individual. There may be warning signs that go unnoticed until after an attempt or completed suicide. Psychological autopsies are valuable but they are too late to do much good to someone who is already dead. Their pain is no longer felt by them, just to those that knew them. You cannot save someone once they are dead. Nor can you learn much about the why and how they chose death to end their pain. As Dr. Shneidman points out, the best source of understanding suicide is through the “words of the suicidal person” (1996, p. 6).
In summary, these tools can be used in clinical practice. I know that most of these are not empirically based as of yet but does it matter to the client who is thinking these thoughts, is hurting so bad to want to end their life not to give it a try? You can “drive the until you lose the road, or break with the ones you follow”.

Lyrics to How to Save a Life: By The Fray (2005)

Step one you say we need to talk
He walks you say sit down it’s just a talk
He smiles politely back at you
You stare politely right on through
Some sort of window to your right
As he goes left and you stay right
Between the lines of fear and blame
You begin to wonder why you came

CHORUS:
Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life

Let him know that you know best
Cause after all you do know best
Try to slip past his defense
Without granting innocence
Lay down a list of what is wrong
The things you’ve told him all along
And pray to God he hears you
And I pray to God he hears you

CHORUS:
Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life

As he begins to raise his voice
You lower yours and grant him one last choice
Drive until you lose the road
Or break with the ones you’ve followed
He will do one of two things
He will admit to everything
Or he’ll say he’s just not the same
And you’ll begin to wonder why you came

CHORUS:
Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life

CHORUS:
Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life
How to save a life
How to save a life

CHORUS:
Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life

CHORUS:
Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life
How to save a life

References:

Holden, R. R., Mehta, K., Cunningham, E., & McLeod, L. D. (2001). Development and preliminary validation of a scale of psychache. Canadian Journal of Behavioural Science, 33(4), 224-232.
Jobes, D. A. (1995). The challenge and the promise of clinical suicidology. Suicide and Life-Threatening Behavior, 25(4), 437-449.
Jobes, D. A. (2006). Managing suicidal risk: A collaborative approach. New York, NY: Guilford Press.
Jobes, D. A. (2008). CAMs workshop (lecture 41st American Association of Suicidology annual conference ed.).
Jobes, D. A., & Berman, A. L. (1993). Suicide and malpractice liability: Assessing and revising policies, procedures, and practice in outpatient settings. Professional Psychology: Research and Practice, 24(1), 91-99.
Jobes, D. A., Moore, M. M., & O’Connor, S. S. (2007). Working with Suicidal Clients Using the Collaborative Assessment and Management of Suicidality (CAMS). Journal of Mental Health Counseling, 29(4/October), 283-300.
Jobes, D. A., Wong, S. A., Conrad, A. K., Drozd, J. F., & Neal-Walden, T. (2005). The collaborative assessment and management of suicidality versus treatment as usual: A retrospective study with suicidal outpatients. Suicide and Life-Threatening Behavior, 35(5), 483-497.
Joiner, T. E., Rudd, M. D., & Rajab, M. H. (1999). Agreement Between Self-and Clinician-Rated Suicidal Symptoms in a Clinical Sample of Young Adults: Explaining Discrepancies. Journal of Counseling and Clinical Psychology, 67(2), 171-176.
Joiner, T. E., Walker, R. L., Rudd, M. D., & Jobes, D. A. (1999). Scientizing and Routinizing the Assessment of Suicidality in Outpatient Practice. Professional Psychology: Research and Practice, 30(5), 447-453.
Meichenbaum, D. (2005). 35 Years of Working with suicidal Patients: Lessons Learned. Canadian Psychology, 46(2), 64-72.
Michel, K., Maltsberger, J. T., Jobes, D. A., Orbach, I., Stadler, K., Dey, P., et al. (2002). Discovering the Truth in Attempted Suicide. American Journal of Psychotherapy, 56(3), 424-437.
Murray, H. A. (1938). Explorations in Personality. New York: Oxford University Press.
O’Carroll, P. W., Berman, A. L., Maris, R. W., Moscicki, E. K., Tanney, B. L., & Silverman, M. M. (1996). Beyond the Tower of Babel: A Nomenclature for Suicidology. Suicide and Life-Threatening Behavior, 26(3), 237-252.
Quinnett, P. G. (1987). Suicide: The forever decision. New York, NY: Continuum.
Ramsay, J. R., & Newman, C. F. (2005). After the Attempt: Maintaining the Therapeutic Alliance Following a Patient’s Suicide Attempt. Suicide and Life-Threatening Behavior, 35(4), 413-424.
Shneidman, E. (1985). Definition of Suicide (softcover ed.). Lanham, Maryland: Rowman & Littlefield Publishers, Inc.
Shneidman, E. (1995). Definition of Suicide: Jason Aronson.
Shneidman, E. S. (1985). Definition of Suicide: Aronson.
Shneidman, E. S. (1993). Suicide as psychache: A clinical approach to self-destructive behavior. Lanham, MD: Jason Aronson.
Shneidman, E. S. (1996). The Suicidal Mind: Oxford University Press.
Shneidman, E. S. (1999). The Psychological Pain Assessment Scale. Suicide and Life-Threatening Behavior, 29(4), 287-294.
Slade, I. (2005). How to save a Life Retrieved may 21, 2012

copyrighted 2012, collerone, G

Therapy and Therapists (psychological)

by Midnight Demon, posted in suicide attempt

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.