Discussion What do you think the therapist answers should be?

[Seiba]

I recently discovered a resource complication for suicide and the like. Within it are difficult questions for therapist to ask themselves. I'm interested in what the answers you would post would be. Alternatively, you can try to yourself in that position as as well. Try to keep in mind the legal and ethical standards they are held to, "just don't do anything because suicide is a right" isn't really an answer in this situation unless they want prison time and to have their entire life ruined alongside license lost.

Difficult Scenarios and Questions​

You've been working with a moderately depressed client for 4 months. You feel that you have a good rapport but the treatment plan doesn't seem to be doing much good. Between sessions you check your answering machine and find this message from the client: "I want to thank you for trying to help me, but now I realize that nothing will do me any good. I won't be seeing you or anyone else ever again. I've left home and won't be returning. I didn't leave any notes because there really isn't anything to say. Thank you again for trying to help. Goodbye." Your next client is scheduled to see you in 2 minutes and you have clients for the next 4 hours.

***​

1. What feelings do you experience?
2. What do you want to do?
3. What are your options?
4. What do you think you would do?
5. If there are things that you want to do but don't do, why do you reject these options?
6. What do you believe that your ethical and legal obligations are?
7. Are there any contradictions between your legal responsibilities and constraints and what you believe is ethical?
8. To what extent do you believe that your education and training have prepared you to deal with this situation?

*****​

You've been discussing a new HMO patient, whom you've seen for 3 outpatient sessions, with both your clinical supervisor and the chief of outpatient services. The chief of services strongly believes that the client is at substantial risk for suicide but the clinical supervisor believes just as strongly that there is no real risk. You are caught in the middle, trying to create a treatment plan that makes sense in light of the conflicting views of the 2 people to whom you report. One morning you arrive at work and are informed that your clinical supervisor has committed suicide.

***​

1. What do you feel?
2. Are there any feelings that are particularly difficult to identify, acknowledge, or articulate?
3. How, if at all, do you believe that this might influence your work with any of your patients?
4. Assume that at the first session you obtained the client's written informed consent for the work to be discussed with this particular clinical supervisor who has been counter-signing the client's chart notes. What, if anything, do you tell the client about the supervisor's suicide or the fact that the clinical work will now be discussed with a new supervisor?
5. To what extent has your graduate training and internship addressed issues of clinician's own suicidal ideation, impulses, or behaviors?

 

[WaaaghEnjoyer]

It'd be best for them to quit their job

 

[GenesAndEnvironment]

I recently discovered a resource complication for suicide and the like. Within it are difficult questions for therapist to ask themselves. I'm interested in what the answers you would post would be. Alternatively, you can try to yourself in that position as as well. Try to keep in mind the legal and ethical standards they are held to, "just don't do anything because suicide is a right" isn't really an answer in this situation unless they want prison time and to have their entire life ruined alongside license lost.

Difficult Scenarios and Questions​

You've been working with a moderately depressed client for 4 months. You feel that you have a good rapport but the treatment plan doesn't seem to be doing much good. Between sessions you check your answering machine and find this message from the client: "I want to thank you for trying to help me, but now I realize that nothing will do me any good. I won't be seeing you or anyone else ever again. I've left home and won't be returning. I didn't leave any notes because there really isn't anything to say. Thank you again for trying to help. Goodbye." Your next client is scheduled to see you in 2 minutes and you have clients for the next 4 hours.

***​

1. What feelings do you experience?
2. What do you want to do?
3. What are your options?
4. What do you think you would do?
5. If there are things that you want to do but don't do, why do you reject these options?
6. What do you believe that your ethical and legal obligations are?
7. Are there any contradictions between your legal responsibilities and constraints and what you believe is ethical?
8. To what extent do you believe that your education and training have prepared you to deal with this situation?

*****​

1. None.
2. Play hitman.
3. Bad question, does not compute.
4. Talk to the next patient.
5. Need money to buy suicide methods, can't get money by gaming.
6. None, to report it to the police (?).
7. Yes.
8. N/A.

*****​

You've been discussing a new HMO patient, whom you've seen for 3 outpatient sessions, with both your clinical supervisor and the chief of outpatient services. The chief of services strongly believes that the client is at substantial risk for suicide but the clinical supervisor believes just as strongly that there is no real risk. You are caught in the middle, trying to create a treatment plan that makes sense in light of the conflicting views of the 2 people to whom you report. One morning you arrive at work and are informed that your clinical supervisor has committed suicide.

***​

1. What do you feel?
2. Are there any feelings that are particularly difficult to identify, acknowledge, or articulate?
3. How, if at all, do you believe that this might influence your work with any of your patients?
4. Assume that at the first session you obtained the client's written informed consent for the work to be discussed with this particular clinical supervisor who has been counter-signing the client's chart notes. What, if anything, do you tell the client about the supervisor's suicide or the fact that the clinical work will now be discussed with a new supervisor?
5. To what extent has your graduate training and internship addressed issues of clinician's own suicidal ideation, impulses, or behaviors?

1. Slightly hungry but no appetite.
2. Yes?
3. No strong influence, hopefully.
4. Tell the truth, idk.
5. Bruh, I'm not a therapist.

 

[quakociaptockh2]

Therapists live in a weird world. Everything would be much simpler if they tried being a human once.

 

[Seiba]

Therapists live in a weird world. Everything would be much simpler if they tried being a human once.

I think a decent portion of them are pretty human all things considered. Regardless, it seems the thread isn't of much interest but maybe the thing talking about suicide will be. It goes over a lot of things such as being hospitalized being largely bad for BPD, therapist giving criticism to therapist who are poorly trained in suicide and the like. I'll also link an example below, I think partly this is caused by societal aspects of suicide where it expected to be prevented at all cost and more so from trained people. Regardless of any therapist feel bad or not I obviously still support the right to die fundamentally, but I find the rhetoric of them only wanting money or needing to quit their job and never work in that field again a bit much. Therapist are not highly paid, and depending on setting like community health can be overworked with hundred to hundreds of clients a week (for comparison a healthy amount is around 20-30 a week) Sorry if the thread wasn't of much interest, in retrospect a bit in the kspope page where it goes over what therapist should be willing to do to care for suicidal such as more than phone calls, and having members compare their experiences with idealized versions of that over the reality they experience. A biased sample because of the nature of a suicide forum -- those happy with therapist aren't going to be talking on a forum too much but it could be interesting regardless. It was my first thread so maybe I'll make a better one in the future.

Link to webpage here if anyone would like to lurk it: https://kspope.com/suicide/index.php


Assessing and responding to suicidal risk is a source of extraordinary stress for many therapists. This part of our work focuses all the troublesome issues that run through this book: questions of the therapist's influence, competence, efficacy, fallibility, over- or under-involvement, responsibility, and ability to make life-or-death decisions. Litman's study (1965) of over 200 clinicians soon after their patients had committed suicide found the experience to have had an almost nightmarish quality. They felt intense grief, loss, and sometimes depression as anyone—professional or nonprofessional—might at the death of someone they cared about. But as therapist they also felt guilt, inadequacy, self-blame, and fears that they would be sued, investigated, or vilified in the media. A study of short-term and permanent effects of patient's suicide on the therapist led Goldstein and Buongiorno (1984) to recommend providing support groups for surviving therapists.

Mangurian and her colleagues (2009) wrote that the "suicide of a patient is arguably the most traumatic event that can occur during a psychiatrist's professional life" (p. 278). Reviewing the research, Séguin, Bordeleau, Drouin, Castelli-Dransart, and Giasson (2014) noted how a patient's suicide can affect the therapists' practice, especially when working with other patients around suicidal issues. Support from friends, colleagues, and—if needed—a therapist can serve a protective function and lower the risk of negative effects on the therapist's practice (Gulfi, Dransart, Heeb, & Gutjahr, 2015).

Solo practitioners may be even more vulnerable than their colleagues who practice in groups and clinics with their natural support systems. Trainees may be among the most vulnerable. Kleespies, Smith, and Becker (1990) found that "trainees with patient suicides reported stress levels equivalent to that found in patient samples with bereavement and higher than that found with professional clinicians who had patient suicides" (p. 257). They recommend that all training programs create a plan to help trainees with client suicide:

 

[everydayiloveyou]

For the first scenario, that client is 100% gonna get 911 called on them and get sectioned, no doubt about it. It's a traumatic and awful thing to do to someone, but there's an obvious risk and strong intent. It'd be wrong for anyone to hear that from somebody and not do anything.

I wonder if that's something that happens often, I'm pro-choice but I would never tell anyone I was gonna ctb, especially not my psych!! In this day and age, you cannot expect people to take that kind of news in stride. You either die alone with things carefully planned out in private, or you get caught in the middle/before the act and you will get sectioned, stay alive, and deal with all the consequences of it after.

For the second scenario, I feel like the expected/"right" answer is that the client does not need to know about the supervisor's suicide, and that it's normal to be on guard now that a suicide has just occured. Probably if the client has any similar behaviors to the supervisor, everyone will be more wary. Maybe that's an example of transference or projection, blah blah blah.

I can imagine a therapist saying "first things first, the supervisor you consented to last time has passed so I need your consent to move your file to someone else." I wouldn't ask for details myself in that scenario, but maybe this particular client would. I bet most therapists would reveal the cause of death if asked and then discuss with the client how it makes them feel, since the convo can give insight to the client's own suicidal ideation (or, simply give them context to why their therapist might take a break or seem sad/distracted/concerned in session)

 

[Seiba]

For the first scenario, that client is 100% gonna get 911 called on them and get sectioned, no doubt about it. It's a traumatic and awful thing to do to someone, but there's an obvious risk and strong intent. It'd be wrong for anyone to hear that from somebody and not do anything.

I wonder if that's something that happens often, I'm pro-choice but I would never tell anyone I was gonna ctb, especially not my psych!! In this day and age, you cannot expect people to take that kind of news in stride. You either die alone with things carefully planned out in private, or you get caught in the middle/before the act and you will get sectioned, stay alive, and deal with all the consequences of it after.

For the second scenario, I feel like the expected/"right" answer is that the client does not need to know about the supervisor's suicide, and that it's normal to be on guard now that a suicide has just occured. Probably if the client has any similar behaviors to the supervisor, everyone will be more wary. Maybe that's an example of transference or projection, blah blah blah.

I can imagine a therapist saying "first things first, the supervisor you consented to last time has passed so I need your consent to move your file to someone else." I wouldn't ask for details myself in that scenario, but maybe this particular client would. I bet most therapists would reveal the cause of death if asked and then discuss with the client how it makes them feel, since the convo can give insight to the client's own suicidal ideation (or, simply give them context to why their therapist might take a break or seem sad/distracted/concerned in session)

Thank you for the post and effort you put in it. I agree with you in regards it's best to keep in secret from them if one desires to leave. Only case where it might be a okay idea (depends on therapist) is if one is ambivalent about leaving and not currently planning -- perhaps then the therapist might have more information equipped to help. I imagine there's a difference in therapist eyes between typical non enjoyment and non enjoyment so bad you are considering leaving, among other things. Perhaps it is naivety or indulgence on my end, but I think I would tell them but stress that I want to work with them on it for a bit. I obviously wouldn't tell them if I changed my mind and decided fully on leaving though.

 

[quakociaptockh2]

I mean: therapists don't have some reactions that would be completely obvious for a normal human.

Psychological training is not learning. Rather, it's unlearning. Unlearning common sense.

Suppose you see a child sitting on a road and crying.

What would a normal person do?

Comfort the child, ask what's up, try to solve the situation, whatever.

What would a therapist do?

- Ask himself what he feels regarding the child crying.
- Does he have any obligation to help the child?
- Go ahead and approach the child. Ask it to remember all the things in life that made it cry.
- Tell the supervisor about the situation but avoid any conclusions.

Normal people have some intuitive reactions in certain situations. Therapists unlearn that and replace it with overanalyzing and this characteristic avoidance, probably meant to protect from any responsibility. That's the consequence of psychological training.

Second thing they unlearn is the intuitive drive to adhere to logic. Normal people try to be logically consistent. If you point some logical flaws in reasoning of a normal person, he will try to rectify it. That's completely normal for normal people, and that's exactly what cognitive dissonance is for. Cognitive dissonance is an unpleasant feeling urging the person to fix logical errors in his worldview.
Therapists, on the other hand, learn to tolerate cognitive dissonance, or rather ignore it. They can't be "convinced", because it assumes some logical reasoning.

Example: You come to a therapist and say. "I want to eat ice cream, but I'm allergic to milk. What to do?"

The therapist says:
"You want to eat ice cream? Go buy yourself an ice cream."
"You are allergic to milk? Avoid foods with milk."
Case closed.

They don't see the contradiction in their saying, or rather they ignore it, they learn to tolerate inconsistence.

Psychological training is some totally weird manipulation done on the minds of young people.

 

[WaaaghEnjoyer]

I think a decent portion of them are pretty human all things considered. Regardless, it seems the thread isn't of much interest but maybe the thing talking about suicide will be. It goes over a lot of things such as being hospitalized being largely bad for BPD, therapist giving criticism to therapist who are poorly trained in suicide and the like. I'll also link an example below, I think partly this is caused by societal aspects of suicide where it expected to be prevented at all cost and more so from trained people. Regardless of any therapist feel bad or not I obviously still support the right to die fundamentally, but I find the rhetoric of them only wanting money or needing to quit their job and never work in that field again a bit much. Therapist are not highly paid, and depending on setting like community health can be overworked with hundred to hundreds of clients a week (for comparison a healthy amount is around 20-30 a week) Sorry if the thread wasn't of much interest, in retrospect a bit in the kspope page where it goes over what therapist should be willing to do to care for suicidal such as more than phone calls, and having members compare their experiences with idealized versions of that over the reality they experience. A biased sample because of the nature of a suicide forum -- those happy with therapist aren't going to be talking on a forum too much but it could be interesting regardless. It was my first thread so maybe I'll make a better one in the future.

Link to webpage here if anyone would like to lurk it: https://kspope.com/suicide/index.php


Assessing and responding to suicidal risk is a source of extraordinary stress for many therapists. This part of our work focuses all the troublesome issues that run through this book: questions of the therapist's influence, competence, efficacy, fallibility, over- or under-involvement, responsibility, and ability to make life-or-death decisions. Litman's study (1965) of over 200 clinicians soon after their patients had committed suicide found the experience to have had an almost nightmarish quality. They felt intense grief, loss, and sometimes depression as anyone—professional or nonprofessional—might at the death of someone they cared about. But as therapist they also felt guilt, inadequacy, self-blame, and fears that they would be sued, investigated, or vilified in the media. A study of short-term and permanent effects of patient's suicide on the therapist led Goldstein and Buongiorno (1984) to recommend providing support groups for surviving therapists.

Mangurian and her colleagues (2009) wrote that the "suicide of a patient is arguably the most traumatic event that can occur during a psychiatrist's professional life" (p. 278). Reviewing the research, Séguin, Bordeleau, Drouin, Castelli-Dransart, and Giasson (2014) noted how a patient's suicide can affect the therapists' practice, especially when working with other patients around suicidal issues. Support from friends, colleagues, and—if needed—a therapist can serve a protective function and lower the risk of negative effects on the therapist's practice (Gulfi, Dransart, Heeb, & Gutjahr, 2015).

Solo practitioners may be even more vulnerable than their colleagues who practice in groups and clinics with their natural support systems. Trainees may be among the most vulnerable. Kleespies, Smith, and Becker (1990) found that "trainees with patient suicides reported stress levels equivalent to that found in patient samples with bereavement and higher than that found with professional clinicians who had patient suicides" (p. 257). They recommend that all training programs create a plan to help trainees with client suicide:

I don't see how a therapist could ever become depressed. Maybe they should just start being happy again, and look at the bright side of life.

And if their job isn't paid a lot and stressful, that's a valid reason to switch jobs. They should pull themselves up by the bootstraps, learn something else and get hired in a different field.

 

[Seiba]

I don't see how a therapist could ever become depressed. Maybe they should just start being happy again, and look at the bright side of life.

And if their job isn't paid a lot and stressful, that's a valid reason to switch jobs. They should pull themselves up by the bootstraps, learn something else and get hired in a different field.

Pretty easy to see how anyone can become depressed, and I wonder how it would feel to have your problems oversimplified to that degree.

 

[WaaaghEnjoyer]

Pretty easy to see how anyone can become depressed, and I wonder how it would feel to have your problems oversimplified to that degree.

I am unable to respond yet I will continue to consider therapists as reptilian infiltrators working on behalf of the aliens to destabilize the human civilization.

 

[Seiba]

I am unable to respond yet I will continue to consider therapists as reptilian infiltrators working on behalf of the aliens to destabilize the human civilization.

Reptilians is too much credit, let's go with rats.

 

[everydayiloveyou]

Thank you for the post and effort you put in it. I agree with you in regards it's best to keep in secret from them if one desires to leave. Only case where it might be a okay idea (depends on therapist) is if one is ambivalent about leaving and not currently planning -- perhaps then the therapist might have more information equipped to help. I imagine there's a difference in therapist eyes between typical non enjoyment and non enjoyment so bad you are considering leaving, among other things. Perhaps it is naivety or indulgence on my end, but I think I would tell them but stress that I want to work with them on it for a bit. I obviously wouldn't tell them if I changed my mind and decided fully on leaving though.

If you've never self-harmed or had a suicide attempt, you can most likely tell your therapist about ideation and plans with no worries. I've done so and to date I've never been sectioned. It's when they can reasonably suspect that you'll be a danger to yourself in the near future that they will need to do their jobs as mandated reporters and section you. Basically, don't say what your plan is, emphasize that it's "years out" or "goes away pretty soon" to lessen the urgency, and do not ever mention gathering supplies, preparing final arrangements, writing notes, etc. I guess it's easier said than done but you just need to give them reason to believe that you aren't impulsive or calculating about this sorta thing.

It's important that they know you are having ideation, and how often/recently it occurs. It affects the kinds of meds they can prescribe, your differential diagnosis, and your treatment. Your approach would be pretty good since the therapist would know you have suicidal ideation and anhedonia, and expressing that you are hopeful means you'll probably be compliant with treatment and willing to be open and honest. I always feel kinda bad omitting the fact that I go on SS and do in fact have preparations and a detailed plan, but the alternative is to be sectioned. I think some people do need that (like the client in the first scenario) but a majority of the time it's a wholly traumatizing experience. And in the USA, you will leave with debt and a complete loss of trust with your therapist, which can destroy the therapeutic relationship and prevent you from seeking help in the future during better times. I wish there was some alternative but the world isn't ready for anything but hotlines staffed by clueless people and psych wards right now.

 

[Seiba]

If you've never self-harmed or had a suicide attempt, you can most likely tell your therapist about ideation and plans with no worries. I've done so and to date I've never been sectioned. It's when they can reasonably suspect that you'll be a danger to yourself in the near future that they will need to do their jobs as mandated reporters and section you. Basically, don't say what your plan is, emphasize that it's "years out" or "goes away pretty soon" to lessen the urgency, and do not ever mention gathering supplies, preparing final arrangements, writing notes, etc. I guess it's easier said than done but you just need to give them reason to believe that you aren't impulsive or calculating about this sorta thing.

It's important that they know you are having ideation, and how often/recently it occurs. It affects the kinds of meds they can prescribe, your differential diagnosis, and your treatment. Your approach would be pretty good since the therapist would know you have suicidal ideation and anhedonia, and expressing that you are hopeful means you'll probably be compliant with treatment and willing to be open and honest. I always feel kinda bad omitting the fact that I go on SS and do in fact have preparations and a detailed plan, but the alternative is to be sectioned. I think some people do need that (like the client in the first scenario) but a majority of the time it's a wholly traumatizing experience. And in the USA, you will leave with debt and a complete loss of trust with your therapist, which can destroy the therapeutic relationship and prevent you from seeking help in the future during better times. I wish there was some alternative but the world isn't ready for anything but hotlines staffed by clueless people and psych wards right now.

I had a previous attempt years ago so I think it would be fine on my end, but a recent one or one during a therapy I could see omitting. The medical situation in general around America and suicide is pretty sad. I used be resentful over the fact I could be charged and imprisoned at my expense. Sorry to hear omitting your browsing of SS to them made you feel bad, from my perspective you deserve no shame or bad feelings over it. It's a sad reality our deaths have to be private if we wish to truly leave. I've heard of hotlines and the traumatizing it can cause so it can be rather nuanced situation if it will help or really damage someone which is why I will always understand someone avoiding the medical health system in general.

 

[everydayiloveyou]

I mean: therapists don't have some reactions that would be completely obvious for a normal human.

Psychological training is not learning. Rather, it's unlearning. Unlearning common sense.

Suppose you see a child sitting on a road and crying.

What would a normal person do?

Comfort the child, ask what's up, try to solve the situation, whatever.

What would a therapist do?

- Ask himself what he feels regarding the child crying.
- Does he have any obligation to help the child?
- Go ahead and approach the child. Ask it to remember all the things in life that made it cry.
- Tell the supervisor about the situation but avoid any conclusions.

Normal people have some intuitive reactions in certain situations. Therapists unlearn that and replace it with overanalyzing and this characteristic avoidance, probably meant to protect from any responsibility. That's the consequence of psychological training.

Second thing they unlearn is the intuitive drive to adhere to logic. Normal people try to be logically consistent. If you point some logical flaws in reasoning of a normal person, he will try to rectify it. That's completely normal for normal people, and that's exactly what cognitive dissonance is for. Cognitive dissonance is an unpleasant feeling urging the person to fix logical errors in his worldview.
Therapists, on the other hand, learn to tolerate cognitive dissonance, or rather ignore it. They can't be "convinced", because it assumes some logical reasoning.

Example: You come to a therapist and say. "I want to eat ice cream, but I'm allergic to milk. What to do?"

The therapist says:
"You want to eat ice cream? Go buy yourself an ice cream."
"You are allergic to milk? Avoid foods with milk."
Case closed.

They don't see the contradiction in their saying, or rather they ignore it, they learn to tolerate inconsistence.

Psychological training is some totally weird manipulation done on the minds of young people.

This sounds more like psychoanalysis than the evidence-based therapies like CBT and DBT. I agree though that the psychoanalytical approach is nonsense and goes pretty much exactly how you described lol

The CBT therapist would nod when you say you're allergic to milk and want ice cream, plan 10 sessions, and in each one they will painstakingly work through your desire to eat ice cream. Why do you feel you need to eat it? Which distortion is causing you to feel like you *need* to eat ice cream? How can you accept the fact that you can't eat ice cream? What kinds of alternative thoughts can you have instead of "I want to eat ice cream?" Maybe, "it's ok if I can't eat ice cream, it's not even that good," or, "even if people make fun of me for not being able to eat ice cream, and the cafeterias only serve ice cream, that doesn't mean I'm missing out. I'm still valid"

Though if the therapist was in your shoes, they'd try some ice cream and keep an Epipen handy, and see what happens. But they can't tell you they agree with that because it's unethical.

 

[ClairyFairy]

Assessing and responding to suicidal risk is a source of extraordinary stress for many therapists. This part of our work focuses all the troublesome issues that run through this book: questions of the therapist's influence, competence, efficacy, fallibility, over- or under-involvement, responsibility, and ability to make life-or-death decisions. Litman's study (1965) of over 200 clinicians soon after their patients had committed suicide found the experience to have had an almost nightmarish quality. They felt intense grief, loss, and sometimes depression as anyone—professional or nonprofessional—might at the death of someone they cared about. But as therapist they also felt guilt, inadequacy, self-blame,

Mangurian and her colleagues (2009) wrote that the "suicide of a patient is arguably the most traumatic event that can occur during a psychiatrist's professional life"

Not a therapist or psychiatrist but my gp told me I used to give her sleepless nights and she was terrified I'd actually succeed one day. I thought she was being dramatic. These professionals know so much more than anyone else in my life. I suppose it would affect them. To be fair though I thought they'd have a few ctb on them.

Also I thought this was really interesting.

No. 1 would get the cops.

No. 2 damn that supervisior. I'd be glad I went with the 1st guy ;)