Tag: ssf

Incompetence and needs: A story of transference

by Midnight Demon, posted in Bipolar Disorder, blogging, chronic physical pain, depression, mood disorders, suicide

Incompetence and needs: A story of transference

My therapist read my Thanksgiving Eve blog and was basically horrified to find that she is inadequate for my needs. She wanted me, again, to see another therapist that was local as seeing someone in person on a regular basis might be more helpful to me. I nixed the idea because I don’t want to start over with someone new. She said it would be more as an adjunctive way. I don’t give a fuck, I am not setting out to see a new therapist. Then she brought up the whole CBT therapist idea. Nixed that too.

It got me thinking about what I need from my therapist. Frankly I don’t know. We have been struggling with my suicidality for so long that it just goes on without a resolution. It got me thinking about the CAMS philosophy and frankly, even though my therapist has been collaborative, she really hasn’t been. She acts more like a friend than a therapist at times. It has been driving me crazy since she took up the majority of the session with her guilt talk, whether it was directed towards me or her, I am not sure. She feels like she is failing me. Hence her incompetence.

There is more to solving suicidality than filling out the SSF forms. Again she brought up if she only knew how to get me to “open up” and write the answers she needs on the stupid forms, she will feel better. But that is not how it works. The SSF just provides you with problems that need solving so that you don’t end your life. The therapist and client are to work together to solve these issues so that life becomes more tolerable rather than intolerable, a “life worth living”. I’m never going to reach that stage of treatment because maybe I am too stubborn to give up my suicidality long enough to find a life worth living. I just go about my daily business of drinking coffee, writing this blog, taking care of my family and then dealing with a stupid therapist twice a week that drives me absolutely fucking insane with her idiocy.

Maybe we have been together too long and can’t see the forest for the trees. We are wrapped up in something and our path has gone so far astray that we just can meet anymore eye to eye. Maybe we are too close because my heart was really breaking today while she was droning on and on about seeing another therapist and how she was basically failing me. Yes, she is a pain in the ass. She is an idiot, but who isn’t really? I texted her that tomorrow will be our last session. I seriously doubt she will take me seriously. I don’t even know what no therapy will look like. I don’t want to know but what else can I do? Go on with a therapist that hates me on some level for calling her out?

Usually you bring up stuff and it gets dealt with and then you move on from it somehow, someway. A few years ago, we were at this impasse. The same issues were covered today. They haven’t moved on because they haven’t been dealt with. I know what needs to be done but I am just too much of a chicken shit. And there we have the needs piece again. I could list them and they would have NOTHING to do with the list from Shneidman. But I feel insecure and my therapist, even though she won’t admit it, does too. That was evident today and it was killing me inside. It broke my heart.

I know I have called my therapist a lot of names in this blog today, but I still believe she is right for me because we have a connection. Granted right now, that connection is a little frail but we are still tethered. The last time we talk about this, we went over Shneidman’s needs. He had 20 of them and I think I boiled them down to less than 10 that affected me, because part of his theory was that frustrated needs causes suicidal thinking. A lot has happened to me this year, more than any other year to date. Problem is that we just talk about shit in circles and we just go around and around because we are just on this merry-go-round that doesn’t have a stop.

People go to therapy for different reasons. I have a whole slew of them that are basically being neglected and possibly fueling my suicidality. I could list them but if you read my blog or my tweets every day you can probably figure out what the major ones are. I know my therapist can’t do shit about my physical pain, neither can my psychiatrist. I have trauma history, a death in my family that still hasn’t been quite dealt with, PTSD that I don’t think is managed, etc. just to name a few. I read blogs from fellow friends that suffer the same kinds of things that I struggle with yet they are dealing with differently. One of my blog friends has severe PTSD and has anxiety that tears her apart at times. My anxiety, though not a principle symptom, has becoming more of a problem lately because of my damn pain syndrome. It drives me to suicidal thinking. And there is no cut off valve when that level has been reached. So far I have managed but I still plan and strategize my suicidal plan because it comforts me to know I have a way out. I still don’t know what is going to happen this week. I know I have put off my plan but it’s back on again because, why the hell not if my therapist is pulling away from me, even though she says she is not.

In my head, I think I have spoiled my therapist. I bring her treats and indulge in her fantasy that I won’t kill myself. Maybe we both are trapped in that fantasy because I am still here either way you look at it. I have tried to bring her the reality my death will bring and even tried to say if I die, here is the help you need to find. I once brought her an article about it that she refused to read. She doesn’t think I will kill myself. Maybe that is what is keeping me going but it is also draining me to keep up this front week after week. I want to die very badly, to get away from myself because there are so many things I can’t stand about me. Being in pain every single day and night is also taxing me. Knowing the fact that my pain syndrome has changed course on me hasn’t helped matters. All I can do is what the voices tell me to do at the end of the day. So far I have ignored them, but one of these days, I will give in and things will finally be at peace. For me anyways.

Twitter Rant: CAMS and Suicide

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

I wrote this at 0400 today. excuse the hashtags

Twitter rant CAMS and Suicide

I wonder if there will ever come a day when there isn’t a hierarchical relationship between client and clinician in the matters of #suicide. That clinician and client work together to deal with #suicide and all that it portends, without judgement, stigma, or fear. These are the musings I have at this hour. Anyone can be trained for suicide prevention but do they go with that training or own prejudices. I have seen that changing clinicians’ minds about how they deal with #suicide training doesn’t change their perception of it. The old stigma of “they’re going to do it anyways” so why bother helping them is prevalent. If it doesn’t change their perception of #suicide, why then bother spending hundreds of dollars for training if you aren’t going to use it?? Case in point, at the Menninger clinic, they had a CAMS study where the authors noted the clinicians resistance to this easy framework. Again, it was hierarchical, the clinician knows best, the client knows nothing, This truly needs to change if we are to prevent #suicides. CAMS was designed to work with all disciplines (SW, PhD, PsyD, MD, etc.) Yet these clinicians had their biases & stigma preventing an open mind. CAMS is unlike any other theory, is quick to learn, and has less paperwork. Along with the SSF, it really help deal with #suicidal clients. I might be biased for CAMS only because it saved my life and I think it is the most superior #suicide assessment out there. Here is my blog about #CAMS. #CAMS is also NOT a replacement or new treatment but a theory that working collaboratively helps someone who is #suicidal. my musings started when a therapist was complaining about the use of the CBT paperwork and stayed away from it in her practice. As a patient, I can totally understand why the CBT paperwork is so daunting. I never liked it and don’t think it is helpful but others have found it helpful. And you have the CBT nuts that swear by it. I just wonder if it is because that is all that they were trained to be like DBT therapists. You don’t have to change disciplines to work with #CAMS, after the assessments, the client will need that discipline for treatment. I still would love to replicate the study in the Boston area about therapists and their attitudes toward suicide and training. Final thoughts are that #suicide training is under utilized in this country and not mandated. when is that going to change??

talking therapies and other things

by Midnight Demon, posted in depression, mood disorders

A fellow blogger asked about talking therapies and it got me thinking that I never really wrote about this before. I have been through most psychotherapies, but mostly to do with psychodynamic. I never was one for DBT (dialectical behavioral therapy) or CBT (Cognitive behavioral therapy). I wanted to get better quick and these therapies, you had to do homework and stuff. It just made me more depressed. I know some people have sworn by them and have been helped by them. I know they work because I have seen the studies on them. Most recently, CBT is making waves with veterans who have suicidal thoughts. They use what is called Brief CBT and it helps the soldiers faster than “treatment as usual”. Treatment as usual is just a term used to describe what is standard care for someone. There are some specifics about it but I can’t remember them off the top of my head at the moment.

For suicidal patients, I still believe the standard of care should be CAMS, Collaborating, Assessment, and Managing of Suicide. It is a framework that has been shown to work best with suicidal people and its assessment, the SSF (Suicide Status Form) is very useful in getting to the bottom of a suicide crisis. People don’t know more about CAMS because they rather rely on their own method of treating someone who is suicidal, which is the “standard of care” but it doesn’t work. If you are suicidal, you agree you aren’t going to kill yourself and if you can’t agree with that, you are placed in the hospital. CAMS allows for outpatient treatment to occur and only takes about fifteen minutes in a 50 minute session to work on. I have written about CAMS. You can search for it in my archives.

I didn’t sleep well last night. I was just tossing and turning most of the time. I couldn’t get comfortable. I was hot, cold, cold, hot. I just didn’t get it. I finally took my meds around 0230 this morning and then was up till around 0530. I didn’t have supper and I wasn’t hungry. My appetite has been minimal these days. Going to my father’s place was a chore and left me more tired than I was before I left my house. I was only there for about ten minutes. He is a pain in the ass as he hasn’t been taking his water pill and then wonders why he is swollen. Pisses me off.

Now I am home and feel like I should nap. Except I don’t want to nap. I am wicked cold and need something to warm me up. I would have coffee but I don’t want the jitters. I still am not over my little caffeine overdose from the other day. Never again will I drink back to back cups of coffee. It was too much for my system. I felt great but not in the long run. It wasn’t intentional. I just wanted to stay up as I had again didn’t sleep too well. Think I might have tea next time.

What We Ain’t Got

by Midnight Demon, posted in Bipolar Disorder, chronic physical pain, depression

What We Ain’t Got

This song was ruminating in my head today. I hope you will take the time to watch it. It’s by Jake Owen.

I stayed up later than I should have last night but that wasn’t the plan. I was hurting because my ankle was jerking, literally. I then woke up around 0530 because of pain. I can’t run away from it. It’s dragging me down like there is no tomorrow. They say that if you have your health, you have everything. I once had it and somehow I lost it through no fault of my own.

The song talks about regret. And how we all want what we ain’t got. It’s a sad song but it touches me. Makes me think.

I have been sleeping on and off today. I just am so tired. I think it is because I got my menses today. I am going to try and shower today. I didn’t shower yesterday because I didn’t feel like it. But I did brush my teeth. I have been trying to brush my teeth more often. Some days it works, and others it doesn’t.

I no longer have paper for my printer. I used it all when I printed the SSF (suicide status form). It’s the latest version and I wanted to check it out.

Damn it. My foot is doing the jerking again. Going to have to take some medicine to quite it down. Guess editing it out for today. I was going to call the doc today and tell him about this but it’s too late to call now. I’ll try tomorrow.