Tag: psychotherapy

Ramblings 31

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

I didn’t do anything today, again. I didn’t go out. But I wrestled with the bed to change the sheets and put clean ones on. For some reason my dryer didn’t pick all the lin off of them so I had to use a lint remover stick to do the job. Three sheets later my bed was free of lint. I don’t know how sheets can be so linty. I was going to vacuum my bedroom floor but that seems to tiring now. I might do it tomorrow as I wait for my grocery delivery. Tomorrow is a busy day. I have the grocery delivery, then therapy and then I got to go in town to meet with my father’s doctors about his cancer. It’s a follow up appointment so hopefully he is ok and that will be the end of it, though I know we will be waiting for at least an hour.

I emailed my last blog post to my therapist, who actually read it before session. We talked a little about it but she was starting to get annoying as she was interpreting things different than I was and I hate that. She doesn’t always LISTEN to me when I talk, which can make sessions very frustrating. She is the only therapist I EVER had that didn’t listen. But she will listen when I tell her I am suicidal but then she goes off and asks if I hear voices, out of the blue. Drives me crazy.

I still feel depressed. I still want to die. It’s a never ending battle. Today I was wicked nauseous for no reason so eating was difficult to say the least. I just sipped ginger ale. I wish I ate like this every day, I would be thin in no time but I know tomorrow I will be better and I will eat like I normally do. Trying to cut calories have been difficult. I have limited my soda intake. I have maybe one a week, minus today where I was drinking to keep from throwing up. I only had two cans.

I told my therapist that I wanted to call her last night because I was having a hard time. But I also said I didn’t because I didn’t want to bother her. She said she would rather know than not know. I guess next time I will page her, but it was silly because I talked to her that morning and then I would be talking with her today. To talk in between would have been stupid, or needy and I didn’t want to be that way. I rather tough it out. I ended up calling a friend of mine and he makes me laugh. We also talked about the Sox season and how the Yankees team is going to be different this year because their veteran staff are on the DL. HAHAHAHA. I was watching an exhibition game the other day and I hardly recognized anyone. Seems like Rivera is on his own. But I respect him, though he is nasty at time at the plate. Pitchers like that you come to respect. Just like I respect Jeter. He is a hard worker and respectful of the game. I think that has gone away in baseball. Very few players have it anymore. Varitek, Wakefield, and Lowell had it but now they are retired. I miss them very much. I do hope that Varitek finds his way back to the Sox organization. I also hope that Martinez doesn’t play the part of a clown now that he is back. Special Assistant to the GM. I don’t know, I can go on about my opinion about the Sox but I will just stop here for now.

exciting article

by Midnight Demon, posted in depression, mental disorders, mental illness, mood disorders, psychache, psychosis, suicide, suicide attempt

Just read an interesting article about the Collaborating and Management of Suicidality (CAMS). I can’t believe this theory is 25 years old. It is gaining more acceptance as time goes on as more countries are using it as a treatment modality in suicidal people. It is a clinical intervention that is used as a collaboration between client and therapist in the treatment and care of a suicidal person. I find it one of the best out there and it is the best because it can be used across the disciplines in the mental health field.

I will be writing more about this. I write a lot about Jobes, the creator of CAMS and the SSF (suicide status form). He is the most brilliant person I have ever met. The fact that this is going to electronic way I think will be used across mediums and will be easier to deliver. Most clinicians have gone the electronic way but not all. This makes me want to go back to school and get my degree.

stigma and suicide

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

Stigma and suicidality
“Among the 10 leading causes of death in the U.S. most are claiming fewer lives each year but sadly suicide is on of the few that continues to rise. Depression and other diseases of the mind that contribute to suicide are real illnesses, not weaknesses. Not character flaws. People battling these illnesses deserve understanding and treatment afforded people with any other llness.” Robert Gabbia AFSP Executive Director.

There is a stigma out there that mental illnesses are not real. That if you just pull your boot straps up you will be ok and not suffer from depression. I have a friend in Canada, a place where the suicide rate is higher than the US because they are still in the dark about treating depression and other mental illnesses. Like Mr. Gabbhia states this is not a character flaw or a weakness. This is real. It takes character and strength to admit there is something wrong and to see help for it. And if you don’t succeed the first time try again until you do.

If I didn’t try and try again, I probably wouldn’t be here today. I probably would have taken my life. I have seen over 10 therapists over the course of my treatment for my mental illness. My current therapist I have been with for the past twelve years and it has been the a huge difference. With the stability of treatment providers I don’t go to the hospital as much and with the value of trust between us, I can state my suicidal feelings without being held against my will in some treatment facility. I am open about how I feel with my therapist but it took a long time to get to where I was. It took about 3-4 years to really trust her and for her to trust me.

I say that it takes trust between us because most therapist are under the believe that all people that have suicidal thoughts should be hospitalized immediately if they cannot be held to safety contracts, which are worthless. Therapist think this is the way to go but it is not. It just takes the legality of it all away from the therapist and really does not put trust in the relationship. Nor does it build an alliance with the therapist because the client is always in fear of being put into the hospital for fear of stating their true feelings. Is that how therapy is supposed to go? Again you have the stigma that if you talk about suicide, you will cause suicide. That is a common myth that everyone still believes is true except for those that actually deal with it. Like me and other suicidologists around the country. Those that deal with suicide are afraid of being sued but there are measures that can be taken so that it is not as frightening as it is. I am not saying that the person with a loaded gun or is in eminent danger and threatening suicide should not be hospitalized and that that gun or other means NOT be taken away. I am saying for those that are chronically suicidal be given a chance that doesn’t include the hospital all the time. In the course of my therapy over the past twelve years I have been hospitalized 4-6 times, compared to twice a year for the previous ten years.

For resources on dealing with suicide:
http://www.suicidology.org the American Association of Suicidology.

Jobes, D. A. (2006). Managing suicidal risk: A collaborative approach. New York, NY: Guilford Press.
Michel, K., & Jobes, D. A. (2011). Building a therapeutic alliance with the suicidal patient. Washington, DC: American Psychological Association; US.

comparisons of psychological pain scales

by Midnight Demon, posted in Chronic pain, mental disorders, mental illness, mood disorders, psychache, suicide, suicide attempt

Suicide attempts are the leading reason why people go to see a mental health professional. What does it mean after an attempt and will the person get the help they need. There are many assessments on risks but few deal with the psychological pain that is attached to the attempt. In my research I have found three clinicians that have developed assessments to help deal with this issue. They are Dr. David Jobes from Catholic University of America, Dr. Israel Orbach in Israel, and Dr. Ronald Holden from Queen’s university in Canada.

Dr. David Jobes wrote and developed what is known as a suicide status form and believes that by collaborating with the client, you can decrease the suicidality (Jobes, 2006; Jobes & Drozd, 2004; Michel & Jobes, 2011). The form consists of three parts: initial, tracking, and outcome. The initial form has the initial evaluation of suicidality, followed by a treatment plan agreed upon by both client and clinician, and then clinical notes such as axis I diagnosis, mood status and session outcome (follow up appt, discharge, or hospitalization). The tracking and outcome are similar in nature. Tracking follows the suicidality. This is used until suicidality is resolved. I base his study on research articles and the two books he has written on the subject.

Dr. Ronald Holden was able to validate his scale of psychache that has helped to focus treatment on psychological pain. This is a 13 item scale rated on a Likert rating of 1-5. The total number of points is 65. The higher the psychache, the higher risk of suicide. The first 9 items deal with the psychological underpinning of what is causing suicidal thinking. The last 4 items deal with the likelihood that this person will act on it. His work I base on his research article.

Israel Orbach (Orbach, Mandrusiak, Gilboa-Schectman, & Sirota, 2003; Orbach, Mikulincer, Sirota, & Gilboa-Schectman, 2003) also has a mental pain scale but has 44 items and cannot be used, in this author’s opinion, in the clinical setting but does have some merit in the initial evaluation of psychological pain. The overall score is intricate and complex as it breaks down the 44 items into quartiles. The study was very small, less than 50 participants and was broken down into two parts. I base his study on his research article.

These combined formed my contention that psychological pain is a causal factor in suicidal thinking.

Suicide status form:
This is a collaborative effort between client and therapist in understanding the reason why a person is suicidal. These forms, initial, tracking, and outcome, provide a base for which to form a treatment plan for working on decreasing suicidality. It was built on the theories of multiple clinicians in the field of suicidality. These clinicians are Shneidman (Shneidman, 1993), who focused on psychological pain, Beck, who focused on cognitive treatment of depression, Baumeister (Baumeister, 1990), escape theory in suicide as escape from self, Linehan (Linehan, Goodstein, Lars Nielson, & Chiles, 1983), reasons for living when you want to die, and Jobes (Jobes, 1995), tracking suicidality.

Dr. Jobes has developed an assessment tool and mangement for suicidality. This management includes the suicide status form (SSF) and uniquely tailors the treatment around individual needs. This is based on the client’s direct input into their treatment. This collaboration takes away the therapist as expert and puts the client in charge of treatment. This also makes things more comfortable and meaningful. Dr. Jobes believes that by tracking the course of treatment, there may be better outcomes and those that are suicidal do not go by the way side, meaning get lost in the system or are ignored after their treatment ends. In his seminal work (Jobes, 1995), he found that nearly half of those that reported to be stressed and suicidal responded to treatment. The other half either dropped out of treatment, got hospitalized, or remained chronically suicidal. This propelled him to develop the SSF to keep track of the suicidal clients and their outcome.

OMMP: Orbach and Mikulinger Mental Pain Scale.
This scale is a 44 item assessment that measures mental pain on nine factors ranging from irreversibility, loss of control, narcissist wounds, emotional flooding, freezing, self-estrangement, confusion, social distancing, and emptiness. These factors are what contributes to mental pain as explained by the authors (see Orbach et al, 2003). Items are scored on a Likert scale of 1-5. In my opinion, given the complexity of this assessment, it cannot be used for clinical use but does hold a valuable research tool.

Holden scale.
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, and psychological pain one feels. Each items are ranked on a 1-5 point scale ranging from never to always agree, neither, or from strongly disagree to strongly agree (Holden, Mehta, Cunningham, & McLeod, 2001). Scores are from thirteen to sixty-five. This scale is easy to use and can be used clinically, with the permission of the author to reproduce it. What I like about this scale is that it is user friendly, scores can be added quickly, and the tracking of suicide can be seen. With higher results, suicide is more likely to occur. The lower the score, the lower the risk of suicide.

These three assessments are comparatively the same but are just called different things. The main point of suicide ideation is to find out what is driving the person to think about suicide and to try and prevent it from happening. Ideally these scales should be used in the first session and the Holden and/or SSF used thereafter.

Baumeister, R. (1990). Suicide as Escape From Self. Psychological Review, 97(1), 90-113.
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., & Drozd, J. F. (2004). The CAMS approach to working with suicidal patients. Journal of Contemporary Psychotherapy, 34(1), 73-85.
Linehan, M., Goodstein, J., Lars Nielson, S., & Chiles, J. (1983). Reasons for Staying Alive When You Are Thinking of Killing Yourself: The Reasons for Living Inventory. Journal of Consulting and Clinical Psychology, 51(2), 276-286.
Michel, K., & Jobes, D. A. (2011). Building a therapeutic alliance with the suicidal patient. Washington, DC: American Psychological Association; US.
Orbach, I., Mandrusiak, M., Gilboa-Schectman, E., & Sirota, P. (2003). Mental Pain and Its Relationship to Suicidality and Life Meaning. Suicide and Life-Threatening Behavior, 33(3), 231-241.
Orbach, I., Mikulincer, M., Sirota, P., & Gilboa-Schectman, E. (2003). Mental Pain: A Multidimensional Operationalization and Definition. Suicide and Life-Threatening Behavior, 33(3), 219-230.
Shneidman, E. S. (1993). Suicide as psychache: A clinical approach to self-destructive behavior. Lanham, MD: Jason Aronson.

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