This is the way therapists talk about your suicidality.

[Hunter]

This comment is taken from a subreddit geared toward mental health professionals. The original poster (a licensed masters level therapist) asks how to deal with a suicidal client. Here is a snippet of advice given by another therapist in response to someone pathologizing suicidality as overt manipulation. I'd love your initial reactions to it:

"But I hate the word "manipulative" in the context of understanding someone's manifestation of distress.

To me, "I'm going to kill myself" is not some calculated manipulation to get someone invested in you. It's a clumsy, blunt force statement to communicate the extent of your distress. "I'm so upset and hurting that I want you to know I am going to destroy myself." Which really may mean, "I need you to understand the stakes. I don't believe you will believe how shitty I am feeling unless I convey them to you in these terms. I want to know that it is important to you that I exist."

So it isn't about addressing manipulation. It's about saying, "Client, I believe you. I want you here. You don't need to make the stakes that high for me to be invested in you."

(Edit: selected different comment to be more focused on suicide)

 

[JustAboutDone]

I think my initial reaction is just ambivalence. They are just doing a job and have targets and objectives to achieve the same as every other job.

In some ways it's sad as lots of people look on a therapist as a "friend" but it's just a temporary working relationship.

 

[Hunter]

I think my initial reaction is just ambivalence. They are just doing a job and have targets and objectives to achieve the same as every other job.

In some ways it's sad as lots of people look on a therapist as a "friend" but it's just a temporary working relationship.

Sorry girl I changed the comment. Refresh and check it out again, I chose a different thread focused on suicide.

 

[CuriousAboutThis]

All about money in the end insurance money or whatever that is why I never liked the idea of talking to therapists or whatever only there to profit off your misery sure it may or may not help and they are there for a reason but in the end it seems like they can't even get rid of suicidal thoughts all they seem to do is either tell you everything you want to hear or the condescending approach "how does that make you feel"

 

[JustAboutDone]

Sorry girl I changed the comment. Refresh and check it out again, I chose a different thread focused on suicide.

Oooh you did that so quickly too :-)

 

[Hunter]

Oooh you did that so quickly too :-)

Yeah lol sorry about that. Just seemed more relevant to SS. I'll explain later why I posted this after I get more feedback.

 

[JustAboutDone]

It must be very tricky ground for a therapist working initially with a client who declares suicidal intentions. Until the therapist gets to know the client they don't know if this is regular behaviour for this individual or whether they are someone genuinely at the end of their tether.

Some people do use the concept of suicide to manipulate people. Heartbreaking, but true.

But essentially a therapist is still just a bog standard person doing a job. No difference from a person selling cigarettes in a shop. They have some training and follow some rules.

I do think there is some weird notion that therapists are like demi-gods or something. That they are all loving, all knowing, mother or father figures who will take away all our pain and find a miraculous solution to all our problems if only we believe. Nah. They are just like dentists.

 

[CuriousAboutThis]

It must be very tricky ground for a therapist working initially with a client who declares suicidal intentions. Until the therapist gets to know the client they don't know if this is regular behaviour for this individual or whether they are someone genuinely at the end of their tether.

Some people do use the concept of suicide to manipulate people. Heartbreaking, but true.

But essentially a therapist is still just a bog standard person doing a job. No difference from a person selling cigarettes in a shop. They have some training and follow some rules.

Shit I hope I don't do that because suicide to me isn't a sin it is either a last reality out of my mind and body of genetics being an American Indonesian haha and all that crap I just want purpose in life or simply want all my pain and suffering to go away not certain if I can do that I gave my potential CTB partner my cell phone number and address but still not certain if I can CTB.

 

[15dec]

For the most part this seems reasonable to me -therapists are people too and if they feel they're not helping a service user when they want to, it's only natural they would feel less competent or liked. The original poster seems to be coming from a good place, I'm assuming this from when the other therapist says "I know you think you are capable of helping them" so to me it seems likely that OP wanted genuine advice on how to connect with and understand their client so they can provide her with help.

What concerns me is the lack of empathy the other therapist displays, even towards OP. The comment they make about OP not being able to help others -especially considering that OP seems to have genuine concern for this service user- is certainly going to be disheartening for OP and could even contribute to the OP feeling incompetent. In my opinion the other therapist should have offered OP advice on how to connect with the service user and gain her trust over time.

She's not really benefitting from the way she is treating you. This may be the best way she knows how to interact with the world.

Obviously the main problem is how the other therapist is talking about the service user, with what seems to me like complete disregard of what the service user has been through, and of course not offering OP actual advice on how to deal with the service user's mental health and begin to gain her trust. In my opinion it's very likely that the service user has trouble trusting others and opening up, hence being a "difficult client" -which is by all means not her fault. However the other therapist seems to disregard what could have caused the service user to feel unable to cooperate (for lack of a better term) and to me, they seem to be blaming the service user for this.

The other therapist also regards therapy as a "business", which it certainly can be. My issue with this is that they seem so fixated on the business side of therapy they're forgetting that the most important part -and that's the clients. Working in health and social care means you put your service users first: you are there to help and support them. From reading this snippet, it certainly seems to me that the other therapist is more concerned about making as much money out of their clients as possible with very little empathy and concern for their wellbeing and comfort.

TL;DR: OP seems to genuinely want to help their client but the other therapist has a lack of empathy and seems much more concerned about making a profit and carrying on with "business"

 

[Hunter]

For the most part this seems reasonable to me -therapists are people too and if they feel they're not helping a service user when they want to, it's only natural they would feel less competent or liked. The original poster seems to be coming from a good place, I'm assuming this from when the other therapist says "I know you think you are capable of helping them" so to me it seems likely that OP wanted genuine advice on how to connect with and understand their client so they can provide her with help.

What concerns me is the lack of empathy the other therapist displays, even towards OP. The comment they make about OP not being able to help others -especially considering that OP seems to have genuine concern for this service user- is certainly going to be disheartening for OP and could even contribute to the OP feeling incompetent. In my opinion the other therapist should have offered OP advice on how to connect with the service user and gain her trust over time.


Obviously the main problem is how the other therapist is talking about the service user, with what seems to me like complete disregard of what the service user has been through, and of course not offering OP actual advice on how to deal with the service user's mental health and begin to gain her trust. In my opinion it's very likely that the service user has trouble trusting others and opening up, hence being a "difficult client" -which is by all means not her fault. However the other therapist seems to disregard what could have caused the service user to feel unable to cooperate (for lack of a better term) and to me, they seem to be blaming the service user for this.

The other therapist also regards therapy as a "business", which it certainly can be. My issue with this is that they seem so fixated on the business side of therapy they're forgetting that the most important part -and that's the clients. Working in health and social care means you put your service users first: you are there to help and support them. From reading this snippet, it certainly seems to me that the other therapist is more concerned about making as much money out of their clients as possible with very little empathy and concern for their wellbeing and comfort.

TL;DR: OP seems to genuinely want to help their client but the other therapist has a lack of empathy and seems much more concerned about making a profit and carrying on with "business"

I'm very sorry but I switched out the comment I pulled from this subreddit because it wasn't as relevant to suicide. Thanks for this thoughtful feedback.

 

[Hopeless_soul]

Maybe I'm too pessimistic, but to me, it seems an exercise of indoctrination. Obviously, there are well-intentioned therapists, but very few.

 

[Hunter]

Maybe I'm too pessimistic, but to me, it seems an exercise of indoctrination. Obviously, there are well-intentioned therapists, but very few.

What kind of indoctrination specifically? What is the commenter saying specifically about a client who is open about their desire to die?

 

[Hopeless_soul]

What is the commenter saying specifically about a client who is open about their desire to die?

I would say the therapist is conditioning the client's feeling to a stereotypical vision of a suicidal person.

What kind of indoctrination specifically?

It seems like he is teaching him to respond in a particular manner with all his clients. That's dangerous. Because patients are different from one another. Having a specific magic discourse to treat them all the same is unfair.

 

[Hunter]

My honest thoughts about this comment is not as anti-therapy as some. I know many who have found therapy to be incredibly useful in seeking new behavior/thinking patterns but your expectations of the practitioner you're working with has to be severely adjusted if you're to continue any sort of psychotherapy. They are, after all, people and informed primarily by other people in their profession and will only be as useful as the theoretical training and models they're informed by. So if their entire field is adamantly opposed to a client's choice to end their life to the point of revoking their clinical licenses for supposed "neglect," they will follow suit.

Some therapists are quite skilled in understanding and conceptualizing suicidality. In this commenter's case, she displays a level of awareness that's slightly above the typical assumption "people who threaten suicide are trying to manipulate you".... but when you take a closer look at the second part, it's clear she still thinks clients who who talk about wanting to die are trying to test how much their therapists "care." She also seems to think clients want the therapist to affirm their worth and tell them they want the client alive. These are, unwittingly, more assumptions - and not too far from the idea of manipulation, i.e. "I am talking about suicide because I want to elicit you to express something caring."

If I ever express that I want to die I am not seeking the other person to tell me how much they want me alive. I find that to be yet another unhelpful set of empty words that have less to do with me and more to do with their perceived value of my life. I am telling them because I am trying to make clear that I am suffering to the point that I no longer find life worth living and that's it.

I wish these professionals would stop reading malicious/attention seeking intent where there is none, and even with this carefully worded statement, I detect it.

 

[Redt2go]

Today my therapist said let's get things back on track before you become suicidal and give up on life.

 

[Hopeless_soul]

Today my therapist said let's get things back on track before you become suicidal and give up on life.

What a prikc.

 

[Hunter]

Today my therapist said let's get things back on track before you become suicidal and give up on life.

Sorry to be cliche but "how did that make you feel?"

 

[Redt2go]

I found it kind of funny is all. Like haha I've been suicidal since forever. Then I felt slightly bad for not telling them. But I don't think I'll tell them I'm suicidal because I don't want help and I've already decided that I don't want life anymore.