Weird dreams again and the SSF

I am having a horrible day. My day literally started at 0100. I slept for a few hours, from 2200 to 0100 and I was up for the night. I went back to sleep around dawn. Was up for a few hours and then tried to get back to sleep around 0800 or 0900. Fail. I finally gave up around 1130. In the times that I did sleep, I had another weird dream about children and elevators. It was winter time and we were going to take the children sledding but the elevator malfunctioned and we ended up at a hospital that was at an airport. I don’t know what that is about. Absolutely makes no sense. Other than me possibly wanting to get away either through an airport or a hospital admission. I don’t know.

I had therapy and we talked about the weird dream and me not sleeping. I told her I am getting to my wits end. The heat is not helping. I still have to clear a path for my bro in law to install the AC. Maybe I will do that after I write this blog. We also talked about my suicidality and the need to attempt suicide. I don’t know why I feel like this. I just feel like everybody will be better off without me. I just feel so low and useless. I know my sister needs me because I have to pick up my niece next week. She doesn’t have the after school program anymore. But I just hope my ankle doesn’t flare up other wise I will be in pain and I am not looking forward to that. I just wish I wasn’t in pain every single day. I have not had a “day off” from pain in weeks.

So because I am thinking of an attempt, my therapist is taking out the old SSF to assess where I am at. She will do this assessment tomorrow. The SSF (Suicide Status Form) is an assessment used to assess and evaluate suicidality. In addition to this assessment, it also lists goals of treatment that both the clinician and client agree upon. The beauty of this assessment is that it allows collaboration in the treatment of suicidality rather than have the clinician be the expert. And the assessment is easier for the clinician as it also lists all the necessary documentation you would need for a session such as Axis diagnosis, progress notes, and date of next appointment.

The SSF was developed by a suicidologist, my idol, Dr. David Jobes. He developed this assessment so that clients that were suicidal did not get “lost” in the system and were treated as equals in their treatment, rather than have treatment as usual. To learn more about this, check out his book on the subject, Managing Suicidal Risk. It is a great book and also teaches you how to score the assessment at the end of the book. There are also classes you can take. His assessment tool follows under his framework, CAMS, Collaborating and Assessing Management of Suicidality. I write a lot about his work on my blog because I can’t stress the importance of suicide prevention. And this is one tool to do that.

So my therapist is pulling out this assessment tool on me tomorrow. I am not happy about it. I know how to “cheat” on it as I am the one to bring it to her attention. She is not proficient in promoting it despite my several attempts for her to go to Jobes’s workshops. She feels, like many therapists, that her training is adequate (it’s not) and she does not want to be a suicidologist. I am not asking her to change her ways, just add to her skill set. Every time she brings it out, I cringe because I know she doesn’t use it all the way through and that pisses me off. I feel like it is a waste of time because it is not used properly.

how I manage being suicidal

It’s well past 2 in the morning. This may well be a Mr. Hyde blog as I am very tired but feel the need to write. Mr. Hyde likes to write things, very bad things and depressing things at this hour so this is a warning that this might be a suicidal blog.

I have been up the last few hours battling pain. My foot exploded around 11 pm (2300) and has now settled down some after putting on some gel and taking my pain meds. But then I got sick, I felt like I had to go throw up. So I laid down only it made it worse with reflux.

I wrote my psychiatrist a letter that I am hopelessly depressed and why bother with treatment of any kind as it is not helping me. I tried to get out of therapy with my therapist for today’s session and failed. I just don’t see the point. I am deeply depressed and if I could I would do something to end my life but I have no idea what I would do. Sure I have pills, but that might just make me sick and I hate to clean up vomit, if I survived. My luck, I probably will. I hate being in pain and can’t sleep. It drives me absolutely nuts.

A fellow blogger is battling her demons too. Her psych team wants to hospitalize her because she is suicidal. I suggested an alternative, the SSF to help deal with suicidal thoughts and to come up with a treatment plan. I told her to get the Managing suicidal risk book. It is a good book, if you are trying to manage suicidality. I don’t know what I did with my copy of the book. I know it is somewhere in my room or in my office. I can never find it when I need it. I have the SSF (suicide status forms) all over the place but not the actual book. And, no, because of copyright rules, I cannot post the forms as much as I would absolutely love to. There is one online, used, but helpful just to give you an idea of what they look like. I think I might ask my therapist to use it tomorrow. Or use Holden’s psychache scale. And again, as much as I would love to post it, I cannot because of copyright rules. I just am so hopeless. Everything is dark and gray, and I don’t mean the weather. I feel like I have no future, no purpose in life. Sure I published a book and that is a huge accomplishment. But why am I being “punished” with this depression?? What have I done that is so wrong? I hate my life.

My ex blocked me on Facebook today. I am actually glad because I was getting uncomfortable with the questions she was asking. She wanted to get back together. That is not going to happen. I guess me telling her I just wanted an online relationship pissed her off. Oh well. First time I have been blocked by someone. But this is kind of good because I don’t need her drama in my life. Yes, it bothers me but only because I thought this time we could just be friends and I have no idea what set her off and I will never know. Oh well.

Tonight was the first time all week that I took all my meds that I was supposed to take. I think that is why my stomach is bothering me. I usually have something to eat when I take them but tonight, I didn’t eat anything. I just am not hungry. And feeling sick to your stomach doesn’t make you want to eat anything. And oh joy, I think I may have a UTI. I have been leaking the past few days, more so than usual. Oh the joys of CES. That has me down too, because who likes to piss their pants? I am so tired of dealing with wet underwear. And having to take a shower every time I leak. It sucks because I hate showering. I had a good shower tonight. The water was nice and hot and it relaxed me. It was the first time in a while I felt that way. But I couldn’t stay too long because I knew my foot would act up and it did. Damn foot! Always ruins things. But I did a lot of stairs today and walking so it is my fault it flared up. I wish I could chop it off. Least with the ghost pain, it will be a real reason why it hurts. I don’t have a clear reason why my ankle/foot hurts. They think it is tendonitis. I think it is just nerve damage and over usage from fatigue. My foot gets tired and then it needs to rest but I don’t know it so I keep using it and then it flares up on me late at night. I then write blogs like this because I have nothing better to do and I can’t sleep anyways. I wish I was dead than deal with this pain every night. My heart is so heavy with heartache. I really don’t know why I keep going on. But tomorrow I will call my PCP and hopefully not talk to the stupid nurse about my UTI symptoms because other than leaking, I have no burning or pain. I don’t feel it because of nerve damage down there. I just have had bladder spasms. But those have subsided. But now my urine reeks so I know something is going on. Fucking CES always has to throw a wrench in the works. Can’t always be a simple case. I still will need to give a urine sample and I hope I will be able to. That is always the tricky part. I have to make sure I drink a lot before the appointment. Otherwise, I might not go when they give me the cup to pee. Oh the joys of retention! I no longer get the signal to my brain when I am full. Usually, I have to start leaking and then the signal goes to my brain that I am full. Fucking CES. Wrecks your life forever. And people don’t get it when you tell them. I was telling my cousin tonight the story about how I got CEs and the surgeries I went through. He still didn’t get it. But oh well. Not his life to live.

A Special Blog Post

This is my 500th blog post. I wanted it to be memorable. And it will be, I hope, to me anyways.

I thought I would talk about David Jobes. He is my idol in the field of suicidology. I talk a lot about his work on my blog because I want to spread the word that there are treatment plans and assessment scales available for those who are suicidal. It took twenty-five years for this to happen. It might not catch on like DBT (Dialectical Behavior Therapy) did for borderline personality disorder but I am hoping that through my blog, someone has at least an inkling about it.

His work is CAMS: the Collaborating Assessment and Managing of Suicide. It is a framework that allows the suicidal patient/client to work with the therapist in his or her treatment plan. By working together, therapist and client, it is hoped that suicidal thinking will decrease enough so a completed suicide is avoided. This does not mean that the suicidal thinking will go away completely. Nor does it totally prevent a suicide. During one of his talks, he spoke of a clinician in Texas that followed the CAMS and the assessment tool, SSF (suicide Status Form) to the letter with one of his suicidal clients. The client ended up killing himself. The clinician did everything that he could. But sometimes, there is still the risk.

The SSF is a seven page form that uses an initial, tracking, and outcome form to monitor and assess suicidality. It is based on the work of several clinicians. I won’t go into great detail about this because you can find out more in Dr. Jobes’s book, Managing Suicidal Risk. The link it to the Amazon website where you can purchase it. I would love to post the SSF one day but I would be violating copyrights, though in the book you can make copies of the form. I just can’t do it electronically, yet.

The wonderful thing about this form is that it is a self report about the client’s thinking about suicide and also has clinical information in the end so that both client and clinician fill it out to assess and document the suicide risk. It doesn’t take more than 10-15 minutes to fill it out (might take longer if the person has trouble understanding reading and writing English or has a disability that prevents that from happening, such as dyslexia). It is individualized for the client and that is a huge thing Jobes tries to do. It is not a fit all in one box, so to speak. It should broaden the thinking of the client and clinician to help bring together and work together to prevent the client from committing suicide. In the SSF, it talks about reasons for living and dying, assess psychological pain, hopelessness, the need to escape, and also asks the question, what would make you not kill yourself? I have used this form in my therapy sessions and that is the first question my therapist asks me when I am in the throws of a suicidal crisis, which happens more times than not for various reasons.
Mostly it has been my word that has kept me alive and I do hate myself for it at times. I have told my therapist that I would keep myself safe and I have, though sometimes, I overmedicate to do so.

Background information of Jobes is that he is a professor at the Catholic University of America and also has a private practice in the Washington, D.C. He has written in at least a half dozen books (some of which I own, if I could afford it I would own all) and countless research articles relating to his work and also to the field of suicidology. He not only write about his work but also about the legality and ethical matters of dealing with a suicidal client.

coffee and therapists

Went out for coffee today. I didn’t feel like it but I forced myself to. I gave myself an incentive, that if I went I would get something sweet. I usually just get my coffee and maybe a sandwich, if I am hungry. But today I really wanted something sweet so didn’t need that much incentive to get a coffee cake. I like that the baristas are getting my order down pat. I don’t order anything fancy, just my favorite flavor, which is now Kati Kati, grande size but in a venti cup. This is so I have plenty of room for the half and half. I also put in several packets of sugar. I need my coffee sweet, which is why I usually don’t get something sweet.

I did accomplish something today and that was finishing the book why do people die by suicide by Thomas Joiner. I had an autographed copy but lost it on the train the first week I read it. Much to my sadness. The book was good and I learned a few things that I hope I retain. He is a cognitive therapist so he focused on that during the strategies for dealing with suicidality. I really liked the book because it not only dealt with personal experience (his dad died by suicide while in grad school), he also listed empirical data to back up what he was talking about. I am a research geek so I tend to like stuff like that. He also used terms that put people that couldn’t understand the technical stuff into words that people could understand, like how neurotransmitters interact. It was a very interesting book. I also bought another book that he wrote called Myths of Suicide, which I hope to read after I finish reading Lincoln’s Melancholy.

My reading voices are back, thank god. I can’t seem to focus unless they are there. I got a comment from my psychotic while reading blog and this person said that she only hears her voice while reading. I find that so interesting. I never hear my own voice. Unless my voice is male sounding, which I don’t think it is, not yet anyways. But then I do have enlarged ventricles in my brain that cause the voices. Not as large as those found in schizophrenia but enough to have a radiologist comment on it. I had the MRI the first time I was hospitalized when I was sixteen. They ran a bunch of tests on me the whole time I was there, from cortisol suppression studies to psychological tests such as the inkblot. I remember how much paperwork I had to do for the MMPI, the Minnesota Multiple Personality Inventory. I hated that. I did that more than once over my lifetime for various studies I was involved in. It is a LONG inventory. I am glad it is not used in clinical practice, unless you go specifically for psychological testing. It would make for a long afternoon or morning.

I have been feeling self-harm urges the past few days. I don’t know why that is. I just have the urge but usually distracting myself or listening to music helps. I have not cut in years and I like it stay that way, though I still have my “kit”. Even though I don’t use it, I still find it comforting to have it around. I also have been getting urges to overdose but these quickly pass as I just can’t do it in my house. Symptoms of my illness.

The dreaded nerve pain has come again. I really tried not to stand too long while waiting for the bus today to get my coffee. I tried not to jiggle my foot in a way that I know would upset it later. But I did do stretching exercises while I was on the phone with my therapist so maybe that is why it is angry at me. I never know what will make it upset. It’s like an untemperate, abusive person. You just never know what will set it off. The cold. The heat. Wearing socks. Not wearing socks. Moving it this way versus that. It’s a never ending battle. I am so sick of it. I am tired of hurting. And nothing helps curb the pain. My pain meds can only do so much, which is knock me out most of the time so I can sleep. But that is only for a few hours. Once the meds wear off, I am screwed. I wake up and sometimes it take a little but to register that I am awake before the pain starts. Other times it is because I am in pain that I wake up. My sleep has not been good the past week. I keep waking up between 0230-430 in the morning. No matter what time I go to sleep, I always wake up during those hours. If I fall asleep before ten, I am always up four hours later. I can’t stand it. I usually play my games or check twitter. If I am bullshit, I might write another blog or journal if I don’t feel like opening my laptop. Sometimes, I try reading and usually that works to put me back to sleep, unless I am in roaring pain. Then I just stay up until the pain meds kick in to knock me out again while withering in agony.

This week’s AAS blog is about finding a therapist that won’t run away or panic at the mention of suicidal thoughts. I want to laugh and say, have you read my therapist blog? I have had ten therapists run away from me soon as I mention that I have had suicidal thoughts in the past or been hospitalized because of them. Course I am hospitalized frequently so that doesn’t help my case. I have been hospitalized at least eight times since 2008. My last hospitalization was last June. So it has been a year but if these damn voices don’t stop, I might have to go back in. The voices and being suicidal doesn’t mix too well. But getting back to therapists, they can be tricky. I kept on being referred to another therapist, who would then refer me to yet another therapist. Before I knew it, I had ten within a month’s time. I finally gave up and stuck it out with my current therapist, even though I don’t see her in person frequently. I think I will see her next week. I will try and get my sister’s car.

I know why therapists don’t want to take on suicidal clients. They don’t want to be liable. They fear malpractice. They even fear losing the client. But I believe that despite this, with the right treatment, therapists can see suicidal clients. It just takes a little bit of courage and trust, a lot of it. Not only on the therapist’s part, but also the client. The client also needs to have a trust in the therapist that they aren’t going to be dumped in the hospital every single fricken time they get suicidal. The therapies out there that help are by David Jobes, CAMS and by using his suicide status form. Also using the Aeschi model helps. Knowing why the client wants to kill themselves says a lot. By not allowing the client to share his story, he gives his therapist a reason to distrust him. I do hope that there comes a day when graduate schools are mandated to have some kind of suicide preventions/treatment protocols in their curriculums. It shouldn’t be up to the therapist’s own style of interviewing that should be dependent on their suicide knowledge. That and the use of no-suicide contracts should be discontinued as long as something like CAMS is in place or the QPR by Paul Quinnett. I forget what QPR stands for but it is a useful resource.