Therapists and the S word

[Spikie]

Hi all

Just want to stress, I'm not in any danger (at the moment, you'll understand the caveat in a second). :) See, smiley face and everything!

Basically has anyone any experience/thoughts on mentioning the S word to a therapist? I've been... having issues recently, like I'm always somewhere on the scale of happiness but alately I've been lower down than I'd like, thoughts turning to being tired of it all, basically my thoughts have been worrying me in their nature and, though I have such thoughts from time to time they tend to be fleeting, while these are persistent and can now last hours.

I see a therapist every week or two and she and I talk things over, she helps. But I feel it is important I mention this to her, as I'm concerned for my safety (bad day + mind in that area + some trigger could be an issue I'm thinking), but I'm concerned in this day and age of professionals having to play it safe, 'I'm having more thoughts about something than I'm comfortable with, can we talk it over' will become some sort of panic for her, that she will be forced to take steps, declare me a danger to myself, things will escalate. To be honest I suspect that would make it worse, but I worry her hands will be tied ('he used the S word, I'm now obliged to call someone in').

I hope that makes sense... I don't need talking out of it, I just need to talk about it. But not if it will make her have to follow some 'worst case scenario' series of steps for health and safety reasons.

[MyNameIsTerry]

I think its a reasonable question Spikie.

Therapists are supposed to be under ongoing supervision so they have a more experienced therapist to discuss issues with.

They are obliged to report issues of self harm or harm to others and the potential of them, but I'm sure they are well trained in how to spot the difference between someone feeling the way we can do and someone who is really heading down that path. The BACP Ethical Framework explains this in their Confidentiality section where it can be breached if they believe you are at risk or others are at risk from you.

They must have to be aware of the Mental Health Act 1983 and their responsibility under it?

http://www.mind.org.uk/information-support/legal-rights/mental-health-act-the-mind-guide/compulsory-admission-to-hospital/#.VGxk9zSsWSo

When is it legal to section me?
If you are being sectioned under section 2, the Act says that two doctors, after examining you, must confirm that:

(a) you are suffering from “a mental disorder of a nature or degree that warrants detention in hospital for assessment” (or assessment followed by medical treatment) for at least a limited period; and
(b) you ought to be detained in the interests of your own health or safety, or with a view to the protection of others.

If you are being sectioned under section 3, the Act says that two doctors, after examining you, must confirm that:

(a) you are suffering from a “mental disorder of a nature or degree” that makes it appropriate for you to receive medical treatment in hospital; and
(b) “appropriate” medical treatment is available for you; and
(c) it is necessary to detain you for your own health or safety, or for the protection of others, that you receive such treatment and it cannot be provided unless you are detained under this section.


When I had CBT, I had to fill in the risk questionairre and I would always say I had thoughts about being better off dead, but said No to the question about whether you have considered the methods. Then there is the free format section where you can explaon your motivation for not taking any action and there is the 1-10 scale for probability of going ahead with it. I reckon they see this a lot, these mental health conditions can reduce us to desperation.

[Spikie]

Thank you very much, I felt trapped in that I know I should talk about it to her but I didn't want all the hassle I assumed would come of it.

I will try and impress upon her that it is unlikely I will act!

[wabbit1]

I had that discussion with my GP. I told him that sometimes I feel it's the only solution but I don't think I would ever go that far but it did scare me as when I get wound up I lose all sense of perspective. His response was there's nothing wrong with talking about it, your should be able to tell how much of a risk you are. Simply mentioning won't necessarily cause problems. Maybe if you had a plan of how you were going to do it they may be more concerned.

[MyNameIsTerry]

I had that discussion with my GP. I told him that sometimes I feel it's the only solution but I don't think I would ever go that far but it did scare me as when I get wound up I lose all sense of perspective. His response was there's nothing wrong with talking about it, your should be able to tell how much of a risk you are. Simply mentioning won't necessarily cause problems. Maybe if you had a plan of how you were going to do it they may be more concerned.

Yes, definately. In the risk assessment section I had in my CBT, which was a load of forms that are standard in therapy, they would ask whether you thought about it and then if you have determined how you were going to do it. The second question would counteract the first if you marked it No. If you marked it Yes, I think that would raise a red flag and the therapist would have to probe deeper to determine the level of risk and consider whether action is should be taken under The Mental Health Act 1983.

[Spikie]

It didn't come up, she was so smiley when I saw her I couldn't get myself to tell her... stupid I know.

I think I need to bite the bullet (poor choice of words... lol) and talk to her about it, while I'm not intending to do anything at this moment I have certainly progressed to plans, though it was sort of 'tense tense tense sick of this don't want to go on how would I do it oh like that would be a good way all round relaxed relaxed relaxed'.

It was similar (for me) to self harming, it was meant to be a step towards the end but instead became all I really needed and made me not want to progress. But of course next time I get hit hard by the thoughts I already have a plan so that worries me. I think so long as I don't take steps towards carrying it out (not something I could just do, would take time to organise) I can write it off as idle 'escapist' fantasy.

I need something, some single thing, to focus on. ATM I am either working or studying, very little doing anything else, but I've lost enthusiasm for both. I need to set a goal (like ace the exam and let work be what it is), so I have some drive back.

Again just want to stress, not in danger, just been thinking too much about things. It'd be great if I could tell a friend/colleague about this so they could watch for me sinking too low and try and keep me at a better level, but I can't imagine that would be a good idea.

[MyNameIsTerry]

I've had thoughts when at my worst like "please just let me die" or "I wish this lorry would just fly off the road and end this" and I think thats all natural because we all have our limits. However, thats not planning its just being desperate for the current pain to end.

The therapist would be concerned if you had researched it e.g. using websites that explain how to do it or if you had made a plan of your own on how you would actually perform it.

One thing to consider is the ability of your therapist to help you. If they don't have all the facts, they won't be looking at helping you in all the ways they can. So, explain this and explain your concern over escalation by them and then they can explain how that works to put your mind at rest.

Something I've also learned over the years is that if your life is just all work, you are heading into the danger zone for depression because you are existing for other people. You need some balance. So, look for outlets for your emotions and activities that you enjoy, even if they are small ones right now. Anything including exercise is always a good one as well due to the additional physical & mental benefits that brings. I'm guessing you are at uni hence not having much time but if you can, get things in that can help you feel more confident and inspired.

Telling others depends on whether you think they will respond favourably because this is a complex area and most people don't know much about it. Its one of those things you have to experience to truly understand how it affects people. If you don't think you can do this, why not keep a Thought Diary so you can track your moods but also look at your red flags e.g. create a set of criterias that show you are sinking so that you can write your diary but also know where your mood is at. There are some specific tools for this that track mood swings that are useful which are used for bipolar people but because they just statistical methods e.g. dot charts, you can easily use them in any mood related disorder.

[Spikie]

Thank you for that, I think I need to get a hobby so I am doing things for me like you say.

Not at uni, just at our busy time at work and doing professional exams. Currently it's 7:00 - 19:30 work/commute, 19:30 - 20:30 study then an hour and a half where I can't be bothered to do anything, then sleep and repeat. Something has to give and I think it should be work (given they only pay 9:00-17:15), as I need to keep at studying.

I'll try and find a better balance.

[wabbit1]

Yes, I think you do need to give some more time to yourself. I also agree with MNIT that the therapist can't really help you if she doesn't know everything. I had to write down what I wanted to say when I confessed to the SH. I had planned on giving it to her but then I just read what it said.

I can relate to what you are saying. I started off contemplating SH thinking I would never do it but then I did. I'm starting to have the same thoughts about the other S word but I've never thought about how. I've often wished that something might happen that can take the option away from me, like a fatal crash.

It does scare me a bit. I've just been signed off work for a couple of weeks. Although it was providing a good escape I was starting to find it wasn't doing that and the constant up and down was exhausting. I had to promise the doc I would go down to my mum and dads house while I was off instead of staying on my own. I was trying to continue with work for my pupils and my colleagues and I realised yesterday that I wasn't doing anyone any good.

[MyNameIsTerry]

Being alone is a bad thing with all this wabbit1. I hung on at work until I couldn't take it anymore because I knew it would be more internalised due to all the sitting about thinking. Take a break but try to get some exercise and use distractions so you don't get into the sitting about & thinking trap.

I've never self harmed but I have thought about it a lot. From thinking about what I was feeling at the time it was all about a build up up of frustration from a trapped feeling and I found distractions & exercise would help move my mind onto something else for a while.

I know those who are self harmers on here, hence know a lot more about this than I ever could, have said its about build ups of emotion. So, having creating outlets for your emotions could help e.g. drawing, painting, craftwork, writing, etc.

All the best.

[wabbit1]

It definitely comes from a build up of tension and stress. I do exercise a lot, half marathons and hill runs but that's no longer having the positive effect it was. I am now at my mum and dad's so have some company. I normally live on my own about 200 miles away. I will admit my thought process is starting to scare me a bit. I'll need to stop myself from chickening out of telling the psychologist on Friday.

How's it going for you Spikie? When do you see your therapist next?

[MyNameIsTerry]

Wabbit, do you think changing the type of exericse could help you? Our bodies adjust as you know and maybe you need to crosstrain to pull it out of its comfort zone? Perhaps variation would help so routines don't become stale? I know when things become stale for me, I tend to dip a bit.

[Spikie]

It definitely comes from a build up of tension and stress. I do exercise a lot, half marathons and hill runs but that's no longer having the positive effect it was. I am now at my mum and dad's so have some company. I normally live on my own about 200 miles away. I will admit my thought process is starting to scare me a bit. I'll need to stop myself from chickening out of telling the psychologist on Friday.

How's it going for you Spikie? When do you see your therapist next?

I see her Tuesday, am determined to talk about it!

I used to run, but haven't in months. I need to make time for it, or something similar (did a push up with my wife on my back to prove I could yesterday, does that count :) ).

[MyNameIsTerry]

I see her Tuesday, am determined to talk about it!

I used to run, but haven't in months. I need to make time for it, or something similar (did a push up with my wife on my back to prove I could yesterday, does that count :) ).

Yes, as do ones with the wife underneath :blush::D

[Spikie]

Just in case anyone is interested.

Met with my lady, she could tell I had something big to say which helped (I'd taken a note but didn't need it then as I found I could say it while staring at a plant in the corner). I told her in a totally honest way exactly how I was feeling, how long it had gone on, that it was coming and going but the coming stage was just uncomfortably long, that I wasn't in immediate danger (I stressed that a lot) and the concern was more that I felt I was on the road to being in danger. She took it all in and we talked it over.

I told her I had been concerned that I would cause her massive issues by was saying, or that I was setting 'overkill' (ha!) procedures in motion which were currently not needed. She laid out what she would do (speak to her supervisor, perhaps with someone else in an anonymous way) and I was fine with that.

She asked me if I would come to her if I were to move forward with my 'plans' and I said the me that is here would as that me wants to continue, albeit not happily, but I was concerned that if I was in the frame of mind that meant I was taking steps I would no longer want to come to her. I told her all I could say was that if I felt I was getting close to that step I would come see her while I still retained some rational thought process and she outlined what would happen then (I forget the terms, but specialists would descend on me and there would be processes and hoops to go through and I would lose some autonomy as to medication and what I do with my days). I accept that and hope that if I get to the stage where that is needed I can still want to bring that on myself.

She let me leave anyway, so I think I convinced her I'm not a danger to myself (in fact I know I did otherwise things would have happened). She has suggested I visit my doctor to consider medication again (see topic on other board), which I said I would do but don't hold high hopes for actually accepting medication (me and anti-depressants have a history).

Oh, and she kept trying to get me to say how my planned suicide would go, I think I might have made it sound too enjoyable as she looked worried (but that's why I was there, my thoughts had gone from 'violent death' to 'how can I do this in a peaceful and calm way that minimises issues to others'?). She kept saying 'but what about...' (... the person who finds you, the effect it will have on your family etc...) and I again think I worried her by the fact I had pre-prepared answers.

So that's my story so far. I might start a blog again as that helped a little before, or just a good old fashioned diary.

[MyNameIsTerry]

Well done Spikie, its often better to discuss things than keep ruminating or worrying about them.

These people are trained to handle all this and I found that mine would be talking to her supervisor on a regular basis anyway and she explained it was simply to ensure standards & patient care.

You could tie in your blog/diary with your therapist so she can see what you thought processes are and surely this would also demonstrate that you are taking more positive steps?

[wabbit1]

Well done Spikie. Also thanks for sharing. I've got a psychologist appointment on Friday. It's the first one after being 'discharged' a month ago - that went well :/. It's the same woman I saw before so we're not starting from scratch but I'm still really anxious.