For those wondering, here is what a future blog post of CAMS is about. I will be writing more about this and the SSF in greater detail.
Tag: suicide
One Great Mystery
One Great Mystery
“One Great Mystery” is a new song off Lady Antebellum’s new album, 747. It’s lyrics has struck a cord with me as I don’t know what I did to make my therapist “fall for me”. Tonight I am reminded of the time, many years ago, that I first encountered her stubbornness. I was in another suicidal depression and I so wanted to get rid of her. I felt like therapy was worthless because I was feeling such things. I was so into my suicidal mind that I was planning for my death and yet I wanted to make sure she was taken cared of. So the journal that I subscribed to had an article in it on therapists survivor group. She wouldn’t even accept the paper I was handing her, she couldn’t accept my eminent death, much less going to see a therapist for her grief. She really didn’t want me to die. Yet with every fiber of my being, I wanted to. I just couldn’t face life. It hurt too much. I was tired, extremely tired of fighting the battle of depression month after month, day in and day out. It is exhausting just putting a smile on your face when all you want to do is hide from the world. Yet somehow, some way, she got me through that episode. It was difficult work. I was almost as stubborn as she is. I had to consistently keep in contact with her via text message about how I was doing. I would write her the most awful of text messages. But it was a way to let her know I was still around. Long as I sent her a text, it meant I was still fighting this battle I so wanted to end.
During one horrific suicidal place that lasted for about three long weeks, I asked her if she would tell me that she loved me. I needed to hear that if I was to survive. So toward the end of session she would say it, and it would always surprise me. I was taken aback that she complied. Who does that?? And I could tell in her voice she was sincere. I knew that I had to keep on doing this thing called living. It’s like the song by Garth Brooks, “learning to live again”. One of the lines is “learning to live again is killing me”. And it was. I can’t describe the battle of death vs life that was going inside of me. I so wanted to die but I had my goofy therapist wanting me to live. My “kids” that needed me for their various things. And my sisters who need a person to vent to. When I was working, it was always responsibility to my job, though I planned on killing myself at work because I hated the place. Even though they tried to promote they were for taking care of your pain, they really didn’t. If I didn’t have a caring PCP, I would be screwed. I know that I would have ended my life years ago had my PCP turn me down for opioid therapy.
My therapist knew this. She and my psychiatrist know that my physical pain drives my suicidal tendencies to the limit. And when I don’t have a break, I get into a very depressive state that is hard to get out. Luckily, with my last hospitalization I was put on an antidepressant. If I wasn’t on it, I doubt it would have lifted my depression and suicidal thoughts.
But my therapist is great, as much as I call her a bozo and a PITA (pain in the ass). I know I wouldn’t be here without her persistent nature.
Birthday in Review
Birthday in review
This time last year, I was thinking of taking my life. I was sure I was going end things. My book was done and I didn’t care if it got published or not. But I had commitments to keep. I had to keep my relationship with my writing partner. I had to keep going for my therapist’s sake. And by the time this day came, I really didn’t want to take my life. I wanted to see my book published. I wanted to see if I could lose weight (I would gain and lose for most of the year).
The relationship I have with my therapist is unconventional. Today, I finally saw her after months of not seeing her. She dressed my 3 ft bear with a birthday hat and a card. The card was a goofy one, as show in this post. But the words that she wrote really touched me. She called me exceptional, something I have never heard before. Unlike my father who said that I smelled. I didn’t shower today and don’t plan on it. I did way too much today and my ankle is thanking me kindly. And I still have my party to attend.
My therapist is someone who is very extraordinary. She goes beyond the limits of any therapist I have ever had before. I have had 12 before her so I know. She has always been there for me, at my worst times and is usually available for the extra session or two when I really need it or when I don’t want it. Though she is terrified of losing me when I bring up the “S” word, we work through her issues as well as mine. I finally had the idea of using a code word to tell her when she has become tense. There is a baseball on her desk that she keeps there. She knows I am a baseball freak so the word baseball would not in itself clue her in that I noticed a change in her demeanor. So I came up with “baseball on your desk” as the code word. In that process, my hope is that she gets ‘grounded’ and figures out that I can tell she is tense so I can be more comfortable being open to my dark feelings. It’s a process. I don’t know if it is going to work, but we’ll see.
This year has been tough. Not every month was a good month. I got hospitalized again this year because I was close to ending my life, again. I don’t think I will ever be free of wanting to end my life, and I know that one day I will succeed. But right now, it’s not on my mind. I just am letting the day be and hope to god that I don’t crap my pants today because of this damn cough I got. I am not living, I just am being a part of this thing called life, which I hate. I still don’t want to “be” anymore. But like I said before, I have commitments to people that I take seriously. I have responsibilities to my family, whether it is helping to pay for bills or watching my niece when my sister needs me to (and I am able to). I have “grown up” the past year, though it wasn’t an easy thing to do. I am learning to live on a fixed income, which isn’t easy.
I became more active on Twitter and met people close and afar. I have been involved in chat groups, something that I have missed since the early days of the internet. I follow my childhood idol, Wil Wheaton and his wife, Anne. I have learned just how geeky Wil is and how much his wife adores animals. Just recently, she rescued a pup called Lucy. She is only 10 weeks old and was malnourished. Anne found a good home for her and the pup is doing quite well. It brightens my day when I see a PUPDATE text on my phone (I have mobile notifications for both Wil and Anne as well as a few other members of the STTNG cast). Twitter has brought me to socialize on social media in ways I never thought possible and to expand my network, making new friends every day. Most of my Twitter buddies are therapists as I try to spread information about lived experience and my thoughts about suicide prevention. But I also have buddies that I follow for baseball and my beloved Buckeyes and Huskers. I follow them to keep abreast of new information. I don’t read newspapers so Facebook and Twitter are my news info. I just recently made 300 followers. I hope this time next year I have 400.
What also has been a life saver for me is my writing on this blog. I do it whenever I feel like it or when I have to express my feelings in a safe way. I doubt I would still be here without the blogger world support. A few months ago, I asked if I should keep the blog or shut it down after my hospitalization because I was getting negative feedback. The response was an overwhelming yes. I guess it is true that a few bad apples can spoil a good thing. I have tried to avoid these apples but they creep up every now and then. One blogger comment basically was begging me to kill myself. I have noticed that when my blogs are at the worst, is the only time s/he “likes” my posts.
I can write more, but I have a party to attend…my own! So if you are reading this and are struggling, hold on, there is hope!
selected reading for CAMS
Copyright 2014, Midnight Demon p 10-11. All rights reserved. Collerone, G
David Jobes is my idol. I really love his works and he is a great suicidologist. He really gets what it means to be suicidal and better than that, he wants to help suicidal people. Most clinicians do not want to deal with suicidality with a ten foot pole. They are afraid of the risks involved, from liability to malpractice to ethical concerns. Dr. Jobes has written about all of this and with a passion created a clinical framework to deal with this population. The framework is called CAMS (Collaborating Assessment, and Managing of Suicide). It is a philosophical yet empirical theory that has helped thousands of suicidal people get out of their suicidal thinking and on with their lives. CAMS was developed specifically to modify clinician behaviors in how they initially identify, engage, assess, conceptualize, treatment plan, and manage suicidal outpatients. It is a brilliant concept that is much needed in outpatient therapy as inpatient treatments have gone by the way side and insurance companies have dictated more on treatment than clinical matters. The heart of CAMS is the emphasis on a strong therapeutic alliance where counselor and client work closely together to develop a shared understanding of what brings the client to think about suicide. CAMS is similar to the Aeschi model, where the clinician is open to hearing the clients story of why they are suicidal. It is a patient oriented model rather than a physician oriented model.
These CAMS model has an assessment tool called the Suicide Status Form (SSF) and it is used to assess, treatment plan, and track suicidal patients. The cool thing about this assessment is that it multi-faceted and is not restricted to one mode of therapy or type of clinician. It can be used across all disciplines and types of therapists (DBT, CBT, psychodynamic, etc.) As long as there is a willingness to adhere to the principles of putting the client first, that is the first step in the right direction.
The SSF is a seven page assessment tool that is used to initiate, track and follow the outcome of suicidality. It was created so people who are suicidal are not lost to follow up. More can be said about this in Jobes’s book, Managing Suicide Risk.
I have used the SSF in my therapy. But I have to confess that my therapist and I never followed through completely with it. We would use the initial and the tracking forms but never quite got to the outcome phase of the assessment. Because I felt like it was my idea, and she wasn’t into changing her style of treatment, it was difficult to follow through. But that is okay because I am still here regardless. We mostly use the SSF to assess my psychological pain, reasons for living/dying, and the level of my suicidality.
I will repeatedly talk about the works of Jobes, Shneidman, and the Aeschi model throughout this book. It is because I think there is not enough awareness of this in the world of psychiatry, psychotherapy and psychology. And there is even less in the training of therapists and future psychiatrists. It really is a shame that not enough awareness of suicide is mentioned in the course of graduate college training and it is often left up to the students to figure it all out on their own, if at all. Usually it isn’t until a suicide or attempted suicide happens that people have hindsight and that isn’t always 20/20.
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