Psychache scale

hello,

I am probably breaking the rules but this is my version of the Holden psychache scale that he used in this paper Development and preliminary validation of a scale of psychache.
By Holden, Ronald R.,Mehta, Karishma,Cunningham, E. Jane,McLeod, Lindsay D.
Canadian Journal of Behavioural Science / Revue canadienne des sciences du comportement, Vol 33(4), Oct 2001, 224-232

I modified it from the original to suit my needs. You can get the original scale by getting the article. Here is also a blog I wrote on the research article (click here)

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About suicide hotlines: My thoughts

About suicide hotlines: My thoughts

some hotlines: Crisis text line 741741, National Suicide hotline 1-800-273-8255, Trans Lifeline 877-565-8860, Trevor Project for LNGTQ 866-488-7386

After a 9 year old that came out as gay to his friend and then killed himself, there has been an increase in sending out the suicide hotline numbers. While I know that sending out and calling does help people, there are other that feel too hopeless and alone, maybe feeling ashamed, maybe feeling no one will understand, and therefore won’t reach out.

One thing that is often said in hindsight of a suicide is why? Why didn’t I see the signs? But knowing the signs are not enough. Often when confronted, people with suicidal thoughts or maybe even planning a suicide, will deny it. It is a sensitive issue. A private issue. I know when my best friend told me at the age of 11 to seek help, my response was “I am not crazy”. With stigma, it is hard to approach someone who is suicidal. Often, there is the thought, no way this person is thinking of suicide, not my child, friend, co-worker, etc. They may deny it and say they don’t because it is against their religion or maybe the person who asks, frightens their friend or family member for fear of being stopped or if they do say yes, the person who asks responds with “don’t do something stupid” or “I will kill you if you do this”, which further alienates the suffering person. I’ve had this experience from two different people. I’ve never understood this logic. I still don’t.

My point of all this is people who are depressed ad suicidal need to feel safe in order to talk openly about their feelings. Often calling a hotline takes a lot of effort to even pick up the phone or dial the number. It is so scary because they are afraid they will be turned away and that holds people back. Or maybe they have phone anxiety like me. The Crisis Text Line is super for those people. But it is still scary to admit they are having suicidal feelings. They don’t know what will happen when they call or text.

In this case of this little boy who apparently was bullied, I don’t know if he would have had access to a phone to reach out and seek help. We often think those under the age of 10 cannot think about suicide but the numbers are growing. I know when I was eight I started having suicidal thoughts and made my first attempt at age 10. I didn’t tell anyone about this besides my best friend. He was probably sick of me talking about it so told me to reach out and then I shut down. I stopped talking about it but the thoughts were still there. When I was 12 I did reach out to Samaritans. I talked to a nice British speaking lady. I was very scared to call. I never had another good experience calling a hotline again. I was often rushed off the phone once I mentioned that I was suicidal.

World Mental Health Day

This is going to be negative but I don’t care as it is my lived experience: I’ve been in therapy since I was 15 because I self-harmed. Seen a wide range of therapists from social workers to psychologists to psychiatrists. Most have ended treatment with me for various reasons. I am now on therapist number 14. First 6 months I didn’t think I was going to stay with him. He is a psychologist with supposed experience with trauma and suicidal ideation. He took me on knowing this. Now since the MeToo, I’ve been having intrusive memories. I tell him about it and he shrugs. Seriously? Why am I seeing you if you don’t know how to deal with trauma when you said you had training? I feel like the system has let me down, yet again.

Before I even saw him, I must have talked to at least 5 different therapists. None would take me on because of my suicidal history. I thought I could shove it aside and just have this guy because he returned my call and wanted to work with me. Now it is a year later and I am finding it so difficult to deal with him. I am once again looking for therapists and I am wondering why. I live in a large city. There shouldn’t be just 1 therapist in my 5 mile radius that deals with suicidal histories. Suicide is its own can of worms. I understand from a suicidologist standpoint. Not everyone is cut out to deal, it isn’t taught in school yada yada. I get it. But where is the compassion in therapy? Are too many good therapists burned out? Am I ever going to find someone to help me through suicidal crisis and chronic pain and all the other shit I deal with? Or is that too much because I don’t follow god or help myself?

About Therapists

About therapists

I have been thinking about writing this for a while, just an overview about the many therapists I have had from all different degrees and orientations. I started off seeing a school counselor. She was getting her degree in counseling, though I am not sure if it was as a school counselor or a social worker. We only saw each other for a few months and then when school started again, I started seeing a social worker that worked at another school. She was good. Had the idea that I shouldn’t use drugs or alcohol. We had a “safety contract”, which my first 10 or so did. It mostly said I wouldn’t kill myself until the next meeting and if I did feel like acting to go to the emergency room or call 911. I only saw her for about 10 months. She left and I saw someone new, a person who was also seeking their degree. I basically feel like she took advantage of me and was only interested in collecting my insurance. Nothing got worked on. I was hospitalized every three months, the last one was when I came out as “gay”. Transgender was never talked about with any therapist until the one I saw prior to my current therapist.

As I had state insurance, therapists were coming and going. By the 10th one, I was tired of them leaving so I left the system for private as I then had private insurance. Only problem was that this therapist didn’t take my insurance. When I switched in 2001, we saw each other for a month before my disc blew and then I didn’t see her again for another three months. We kept in touch by phone. It was a lot to go through. I didn’t talk about my psych issues as I just had my physical health jeopardized. We worked together for sixteen years. All throughout, I was suicidal. But I had the odd hospitalization because we worked on stabilizing using frequent contact. We saw each other sometimes three times a week when I was bad. Then we saw each other twice a week. She moved offices until she moved 30 miles away from Boston. It was tough because I didn’t have a car. I did but it broke down. We just had phone therapy. This went on for about five years. I would get a zipcar once a month to see her but that took some planning around my pain and weather.

The suicidal ideation I had made my therapist nervous. We tried different things, but she never consistently held me to them. I chided away from it because I knew what she was looking for or rather had an idea. I knew it wasn’t going to change. During the last year of therapy we had, we were constantly fighting over my suicidality. She just wasn’t listening to me anymore. I couldn’t explain why I was suicidal. I just mentioned it and she would “hog” the rest of the session with her endless talk, which I just took as her anxiety. It was interfering. I found out she was seeking consultation over me and I felt threatened by that. Eventually we just called it quits. I didn’t see anyone for few months. I had to collect myself. She gave me a few therapists but they weren’t taking on new clients.
Enter my current therapist. He had called back within a few hours of me leaving a message and we had set a time up with in a few days. He sent me his paperwork and other insurance stuff. All throughout seeing the previous therapist, we had tried different suicidal safety planning and scales and whatnots. This guy was not for it. I think the less paperwork, the better. And it bugs me! He just wants to talk things out. For the first six months I didn’t know if this was going to work out. But I had no where else to go. I was tired of searching for therapists only to be told no when I revealed I had a suicidal history. He wasn’t afraid of me talking about suicide and I ease up. Even when I told him I had a plan, he didn’t freak out on me. He understood why I felt that way and we talked it out. It decreased my feelings so I didn’t feel like no one was on my side. I often felt better after sessions but there were a few where I was more frustrated. I texted him a few times and got supportive responses, something my previous therapist did not do, at all. She only responded if we had to change appointment times.

I have been seeing this guy for 16 months. I still find it totally weird that we have an understanding of why I am suicidal yet there is no plan in place, so to speak. He is okay if I live and okay if I die, as long as I don’t do it in his office. He hasn’t taught me things I don’t already know. He would like me to be more social, but that is kind of hard with my physical pain. I like being alone anyway as noise can irritate me, like it is today. Hell, just being in Starbucks when their music is loud is enough to have me leave after I finish eating or when I am ready to write. He doesn’t try to pin things down and my biggest annoyance is when he says we will work on something but doesn’t go further than that. And then when I bring it up next session (I have to bring things up, he won’t), it still doesn’t go anywhere. But I have had that happen with the last therapist I saw, too. She would say we need to work on this and we never did.

I don’t mean to write this to defer you from seeking therapy, that isn’t my goal. I just wanted to write about my experiences with therapists and how they react to suicidal thoughts. Everyone is different. And maybe you started seeing a therapist and then the suicide thoughts started happening. The therapist freaks out and you are then forced to see someone else. Or you attempted and now the therapist doesn’t want to work with you anymore. That is sad and unfortunate but I know it does happen. Suicide is like an elephant (or hippo as someone called it that the other day) in the room that you both know is there but don’t want to face. Or maybe your therapist is trained and does work with you on the issues as long as there is a safety plan in place first with contact numbers and you collaborate on what will work and what will not work. The focus has to be on YOU not the therapist’s comfort level. While my therapist does that and gives me the time to try and work things out as well as support me in any way he can, I still sometimes feel like he just doesn’t get it or dropped the ball on an issue that is never going to see light of day again. I know they are busy people. They have lives outside the office. They see so many patients per day and then deal with the wonderful insurance that can or cannot accept their claims. I don’t know. I am not making excuses for them but if you have a therapist that cares about you and takes your suicidal thoughts seriously, works with you on keeping you safe, and the chronicity of the matter, great. I just am still trying to work with someone and cope with a therapist that says you can kill yourself as long as it isn’t in my office.