Help How do I stop avoiding the topic of suicide in therapy?

[siouxsie]

As the title says…
I've been in therapy for about 1 1/2 years now. My psychiatrist is great and I trust him 100%. It took me ages to mention suicidal thoughts. But I did and he handled it well (as in no threats of involuntary admitting me, just checking I was safe). For the couple of months i've been feeling awful again. Came close to ctb about 5 times. Twice I was stopped by my husband, the other three times I got myself out of the impulse by cutting. I just can't seem to bring it up in therapy again and I don't know why. I want to get better so I obviously have to speak up but I can't. Today when asked about any self harm since my last session, I said I did. When asked if I thought about alternatives first I said that in that case self harm was my safer option, I hoped he would pick up on it, but he didn't. I guess the main reason why I can't just sit there and go "I was going to impulsively OD because I was just so done with all this shit, but managed to just cut myself instead" I probably shame, not wanting him to be worried and not wanting him to be disappointed. Yes, my rational mind knows he won't be disappointed and it's nothing to be ashamed about but my borderline mind is constantly ashamed, worried about others more than myself and convinced I'm a disappointment to pretty much everyone in this world including myself.
Any advice on how to just get it out there next time? I wrote that sentence down like a million times, practiced saying it out loud, yet I can't get it out when I'm in his office. I feel like I can't just go in there and answer his "how are you feeling today" with a blunt "I'm doing ok today but was going to ctb 3 days ago". I always keep waiting for the perfect timing, but then get sidetracked on other issues until close to the end of a session. And mentioning things like that right before time is up doesn't seem like a good thing to do.
Any advice would be really helpful. This isn't going to change unless I give him a chance at helping me. But it needs to change. I'm not worried about getting admitted. I would go voluntarily if asked, but I doubt he would suggest it cause there's enough mutual trust between the two of us. So it's even more stupid of me to keep hiding

 

[Life_and_Death]

what about giving him a note? just something like "this has been hard for me to tell you but i want to tell you so this is the way i found the best because verbally hasnt been working"

thats typically what i do. ill write it out or text it then have them read it. the reading part and waiting is stressful, but i personally find it a little easier.

 

[cruelexistence]

Something that may or may not work is write a letter to your therapist about it, but don't send it. Then, when you feel the time is right, hand it to them. Or maybe carry it with you to every session, and then when you finnaly want to be open, it's as easy as handing over a letter.

Not flawless by any means, but I always found that doing something like this has worked with others before.

what about giving him a note? just something like "this has been hard for me to tell you but i want to tell you so this is the way i found the best because verbally hasnt been working"

thats typically what i do. ill write it out or text it then have them read it. the reading part and waiting is stressful, but i personally find it a little easier.

Lol, I thought of the same thing. Good advice.

 

[LaVieEnRose]

I feel like I can't just go in there and answer his "how are you feeling today" with a blunt "I'm doing ok today but was going to crab 3 days ago". I always keep waiting for the perfect timing, but then get sidetracked on other issues until close to the end of a session. And mentioning things like that right before time is up doesn't seem like a good thing to do.

Yes, you can. This isn't an ordinary social situation where you have to worry about tactful timing. You have the right to go about your therapy the way it works best for you and if just revealing this information right there out of the blue is what works for you, then so be it. Though you're right it's probably best not to reveal it at the very end, though that might not be a problem if there are no "safety" concerns.

 

[arnxxx]

Just throw it out there: 'I want to talk about suicidal thoughts'

If you really can't the note option seems good

 

[Ash]

I'm about to email my GP surgery with some information they probably need but I've been withholding. I've spent the whole day failing to pick up the phone but writing it down and not witnessing their reaction seems a lot more manageable from my perspective. But I have, in the past, started sessions by blurting out "there's something you need to know but I can't make myself tell you so you need to push". Always works.

 

[siouxsie]

Yes, you can. This isn't an ordinary social situation where you have to worry about tactful timing. You have the right to go about your therapy the way it works best for you and if just revealing this information right there out of the blue is what works for you, then so be it. Though you're right it's probably best not to reveal it at the very end, though that might not be a problem if there are no "safety" concerns.

It's probably not a problem to mention it at the very end safety wise, but then we wouldn't be able to explore it much until the next session. So I guess I really should try to just blurt it out right at the beginning so there's 50 minutes to actually talk about it.



And as most of you suggested writing it out I think I will write it down and then hand the note to him if I can't get it out next session.
Thanks everyone, I'll keep you updated, but my next session isn't until in 16 days. Which leads me to the next question. I used to go weekly, then he switched to biweekly, which was fine by me then, but now as I'm not feeling great lately, weekly seems better. If I bring up being actively suicidal, will he be likely to get me back on a weekly schedule? Do y'all know? Like is there a rule for therapy frequency or is that a trust based thing? Keeping myself safe for 2 weeks is though, but then again, saying something like "I don't think I can keep myself safe for that amount of time" makes me think that rather than having session frequency chances would make me end up hospitalized. I would be fine with it if that's what he suggests as I trust he knows what's best, but would obviously prefer not to.

 

[Little_Suzy]

Yes, you should tell your therapist about the pain your mental illness is causing you. When therapy felt incomplete, I emailed my psychologist to request another session.

Talking about active suicide may lead to a suicide interview. Before answering the assessment, tell him you want a safe space to discuss your mental illness-related suicidal thoughts.

I say, "I understand your duty, but I want to let you know that I am fine; I don't want to hurt myself, and if I speak with you, I need to know you are not going to call the cops." His likely response is, "If you report an imminent threat to others or yourself, I must take it seriously."

Involuntary admission requires you to state that you intend to hurt yourself or others. I recommend that you only admit self-harm attempts and dates. Avoid sharing any details about the acts. If asked, explain that you no longer intend to harm yourself and don't want to violate his 'duty.'

During therapy, think about how to move forward. Tell him you need help processing the awful feelings caused by your suicidal thoughts. Talk about your support system. Your husband helps you stay safe, and he will call 911 if you need medical help.

 

[siouxsie]

Yes, you should tell your therapist about the pain your mental illness is causing you. When therapy felt incomplete, I emailed my psychologist to request another session.

Talking about active suicide may lead to a suicide interview. Before answering the assessment, tell him you want a safe space to discuss your mental illness-related suicidal thoughts.

I say, "I understand your duty, but I want to let you know that I am fine; I don't want to hurt myself, and if I speak with you, I need to know you are not going to call the cops." His likely response is, "If you report an imminent threat to others or yourself, I must take it seriously."

Involuntary admission requires you to state that you intend to hurt yourself or others. I recommend that you only admit self-harm attempts and dates. Avoid sharing any details about the acts. If asked, explain that you no longer intend to harm yourself and don't want to violate his 'duty.'

During therapy, think about how to move forward. Tell him you need help processing the awful feelings caused by your suicidal thoughts. Talk about your support system. Your husband helps you stay safe, and he will call 911 if you need medical help.

We did talk about it once but now I'm struggling to bring it up again. I'm a med student so he knows I'm aware of his duties but he also knows I have the knowledge to ctb successfully. He knows I'm not actively planning on it. But having borderline personality I'm likely to act on impulse. Back then I told him I didn't have the means to act on it on impulse. Like not enough meds, can't cut past the pain of cutting my wrist and don't want to hang. He then proceeded to ask how I would prefer to do it. I straight out told him if I did plan on doing it it would be SN. But that I can't really obtain any. He handled that well. Before I left he reminded me that I need to remember that my impulses are only temporary. I said I know.
So even though that went really smoothly, I still struggle to bring it up again. I do want to tell him that I tried partial suspension twice, was about to pop a close to lethal dose of a substance three times, all in the span of a month. But i just cant get it out. The husband thing wont work. He knows about our difficulties. My husband once called him, shortly after I started therapy. He told my husband to call 911, my husband didn't. It was my husband who found me trying partial hanging and trying to pop those pills. While with the pills he did say he was gonna call 911 which lead to me running away, when he found me trying partial he just yelled at me and walked out of the room, leaving me there with my rope. So the husband backup isn't gonna work.
I don't mind being admitted if he thinks it's best. I just feel too ashamed to talk about those near-attempts. Just writing this post makes me feel ridiculous.

 

[Linda]

Sounds like you have a good therapist. If that is the case, your best option is probably to be completely honest with him. He isn't psychic, and he won't know what is going on in your head if you don't tell him. If he doesn't know what is going on in your head, he won't be able to help you effectively. Just talk to him openly, the way you would talk to people here. I doubt that anything you say would come as a complete surprise to him. He will have heard it all before, from other people.

 

[StillBreathing]

what about giving him a note? just something like "this has been hard for me to tell you but i want to tell you so this is the way i found the best because verbally hasnt been working"

thats typically what i do. ill write it out or text it then have them read it. the reading part and waiting is stressful, but i personally find it a little easier.

I have done this and it worked very well. Write down all your feelings and what you want to say on a piece of paper. Bring it to your next session and let the doctor read it if you still want him to know. It can be very hard to put into words the feeling you had when you were at your very low. Writing it down can be a much easier way to relay the information so he can help you better.

 

[Ash]

The idea of writing it down then giving it to him is excellent. Sounds like you've got a therapist you really get on with and who understands you, so make the most of it. If you're a med student you'll know how important personality is when it comes to getting to the heart of things to ensure the best treatment or management. And don't be afraid to use humour if it helps you communicate. Xx

(Edited to clean up my own lack of communication )

 

[Jorms_McGander]

As the title says…
I've been in therapy for about 1 1/2 years now. My psychiatrist is great and I trust him 100%. It took me ages to mention suicidal thoughts. But I did and he handled it well (as in no threats of involuntary admitting me, just checking I was safe). For the couple of months i've been feeling awful again. Came close to ctb about 5 times. Twice I was stopped by my husband, the other three times I got myself out of the impulse by cutting. I just can't seem to bring it up in therapy again and I don't know why. I want to get better so I obviously have to speak up but I can't. Today when asked about any self harm since my last session, I said I did. When asked if I thought about alternatives first I said that in that case self harm was my safer option, I hoped he would pick up on it, but he didn't. I guess the main reason why I can't just sit there and go "I was going to impulsively OD because I was just so done with all this shit, but managed to just cut myself instead" I probably shame, not wanting him to be worried and not wanting him to be disappointed. Yes, my rational mind knows he won't be disappointed and it's nothing to be ashamed about but my borderline mind is constantly ashamed, worried about others more than myself and convinced I'm a disappointment to pretty much everyone in this world including myself.
Any advice on how to just get it out there next time? I wrote that sentence down like a million times, practiced saying it out loud, yet I can't get it out when I'm in his office. I feel like I can't just go in there and answer his "how are you feeling today" with a blunt "I'm doing ok today but was going to ctb 3 days ago". I always keep waiting for the perfect timing, but then get sidetracked on other issues until close to the end of a session. And mentioning things like that right before time is up doesn't seem like a good thing to do.
Any advice would be really helpful. This isn't going to change unless I give him a chance at helping me. But it needs to change. I'm not worried about getting admitted. I would go voluntarily if asked, but I doubt he would suggest it cause there's enough mutual trust between the two of us. So it's even more stupid of me to keep hiding

Ayyy BPD bud. Your therapist is DBT right? Just be honest. You're not going to be able to hang on to your OD meds the same way you would. You gotta openly discuss symptoms and the therapist is going to work with you to keep you safe by making coping plans with you and by helping you stay safe by removing the most dangerous things from your immediate possession.

In my years I've given up four helium tanks, a kilo of bitter apricot kernels, two ropes, all my chef knives, belts, like seriously everything.

And once while committed I took a nurse around my room when she asked how I'm doing and I said here's a ligature I can get, here's a sharp object I can make, here's an attachment point to suspend myself--just every possible way to hurt myself I had been coming up with and she said yeah. We can't keep you safe in here really.

She could--padded room. It was a test, sort of. It always is. Cuz I would have gone into the solitary room if I hurt myself. But just telling her every dangerous thought on my mind wasn't enough in that context for an intervention.

Even there, my biggest "fuck you I'm gonna tell you how bad it is" didn't get me into a padded room

So, don't be afraid. Your therapist will work with you, not against you.

 

[AnAnonymousCrow]

Just throw it out there: 'I want to talk about suicidal thoughts'

If you really can't the note option seems good

This is good advice. I struggle with some form of a personality disorder. I have multiple people in my head who talk to me. Sometimes we're friends, but other times, they punish me by reducing my ability to think. If you really want to talk about suicide, try to direct the conversation so it builds up to it. Then, throw it out there. Let yourself be emotionally driven to keep progressing the conversation to a point when you'll feel comfortable about talking about suicide. Then, blurt it out. That way, in case you aren't able to say it, or you hesitate, your psychiatrist might be able to read between the lines and figure out what you meant to say. That's would I would do. Whatever you do, I hope it's to your benefit, and that you only get better. Wishing you well.