SI - do you talk about it with your therapist?

[NarcKiddo]

SI can be a very prominent part of my being emotionally dysregulated. I have no active intentions and it very much feels like a 'get out of jail free' card. I think to myself 'well, if the worst happens I can always end it'.

I am currently dysregulated and I notice such thoughts coming up again. I am contemplating discussing them with my T but I am also scared to. I have a feeling (probably quite irrational) that if I even mention the S word she will be under some professional obligation to call the men in white coats and have me carted off somewhere I can't do anything. Which of course would remove my 'get out of jail free' card, plus would have all manner of real life ramifications that I completely do not want.

I think it would probably be more healthy if I could work through these thoughts with my T but I am scared to do so. Just wondering if anyone has any thoughts or experiences they care to share.

[Marcine]

Hi NK,
I know what you mean about the "get out of jail free card".

In my experience, competent therapists have an understanding of the line that exists between ideation and action plan. And are equipped to discuss these intense/delicate/human emotions.

A good therapist knows things are constantly changing, so would probably offer the reminder to always ask emergency services for help if you feel unsafe or in danger.

I hope the current dysregulation passes soon for you, NK, and that your therapist can hear you and be there for you in the ways you need.

I send love and support.

[SenseOrgan]

NarcKiddo
I'm sorry you're in a rough spot. The kind of escape hatch you talk about is also woven into my psyche. It used to be an everyday part of coping for me for a very long time. Ironically, it helped me to make it through extreme states. In the past I was a member of a support group specifically started around SI, which was a lifesaver for me. It was amazing to be able to talk about it freely, not dissimilar to the OOTS experience. Even with therapists it can be tricky. I get that. I think it really boils down to the relationship you have with them. I've told many therapist's about my SI. I think I was convinced I'd find the escape hatch sooner or later if I wanted to, even if they'd intervene against my will. It never got anywhere close to that. Not even when I suggested I likely needed to be admitted myself.

Anyways, this is the sort of thing that deserves to be discussed with a therapist, no? I think the way you phrased it here would be a good way to bring it up. A therapist would likely try to figure out how concrete/abstract the current SI is, upon which part of their assessment of current danger and need to intervene would be based. Bringing in the white coats for the abstract, or even a more concrete version isn't a reflex, I don't think. You'd have to be an acute danger to yourself for that, I reckon. Plus the coats are expensive, which is also something for therapists to consider.

If bringing up the subject now feels too risky, maybe you can consider doing that when this dark cloud has passed. I think it's rare for people with our sort of package not to deal with SI at all. Your therapist could hardly be surprised by it and perhaps considers this to be part of your coping already. Just my two cents. It's hard to assess from over here. You can send the dark cloud over here. We have about 30 cm of precipitation deficit from the exceptionally dry summer to make up for.

Much love 

[Kizzie]

Hi Narc Kiddo - So very sorry to hear you are having such a rough time of it and sending much care and support 

I had some really dark periods where SI was as you say my 'get out of jail free card.' I cold not bring myself to think seriously about a plan though because I knew what it would do to my H and S. It was just a strategy to get me through, but as I see it now it was a signal that things were really not good and I needed as much support and care as I could get. I didn't really see that then.

I think from what you have said before you have a good relationship with your T and that you trust them. As long as you don't have an actual plan I doubt they would take any action but I can see why that would be worrisome. Maybe check what's what for therapists in your location using an AI app?

I just want to say that I think you are one of the most caring and supportive members here at OOTS and I hate seeing you suffer like this. You always take time to help others and now it's time for you.  

Kizzie

[Desert Flower]

Dear Narckiddo, I'm so sorry to hear you're going through this. And I too know where you are. I think what you're doing, acknowledging it is there, is helpful and very brave.
What I did once, was talk to a S prevention website/app in an anonymous way and that helped me too. I'm sending you all the love and caring and good stuff you need! I hope you feel better soon. Big big hugs
 

[Blueberry]

NK, I'm sorry you're so dysregulated atm and that SI is prominent in you, even though you have no plans. Sending support.    too if you like, otherwise ignore.

SI can be pretty prominent for me too, although I've never had concrete plans and have almost always been able to say "I'm not going to do it, but it feels really awful to have this voice in me saying that S would be a good idea".

I have told therapists and doctors in the past, usually or possibly always adding "I'm not going to do it but...". My very good doctor (general practitioner, but he understood a lot of psycho stuff) got me a spot right away on one of the open wards of a very good psychiatric hospital. They didn't even mention the SI there, he must have told them that as soon as I got out of whatever all the pressure was at home (which included not having any psychotherapy never mind trauma therapy), the SI would disappear.

I don't think it's a get out of jail card for me, it's more like a huge, gigantic EF, with this voice from the past or from wherever (I used to have no idea where this voice came from, it was like an intrusive thing) hitting me out of the blue. So mostly doctors and therapists either didn't take my statement seriously or they did take it really seriously and knew that internally I was in dire straits, it felt like an emergency for me, I needed help there and then, but I didn't need help not doing S, I needed help out of a huge EF, that I didn't even know I was in because I didn't know about EFs back then. Like at those places where I sometimes do 3-4 days of intensive group therapy. One of the places didn't grasp my desperation. A few months later, a different place did. But they didn't say - "we can't deal with that here, you need to go to a psychiatric hospital". They said: "You need trauma therapy and we're starting that with you here and now. You'll be doing slightly different things to the rest of the group, but you'll be working just as hard". And so they began teaching me how to not go into overwhelm, and all sorts of things like that.

Something that has helped me in the past is reading on reddit/ trauma therapists, and that kind of subject because it gives me an insight into what therapists think about patients and particular patient problems. Reading that could be triggering of course, but for me it's been helpful. I can't remember off-hand but as a possible example one newish therapist might post on reddit something like "I always get these suicidal patients/clients, how do you other therapists deal with that?" and those other therapists might list how to tell whether S is a real risk for a particular client or whether it's maybe a cry for help that the client doesn't know how to express otherwise and how to deal with that, or maybe the client doesn't even know it's a cry for help, they have no idea what the blink this SI is for.

Another therapy method that has helped me in the past and would in the future too is for a therapist to work with the voice, basically Parts work. Your therapist would know whether or not that would help you.

I agree with Kizzie on checking AI or other Internet health regulations on what medical personnel in your area are required to do when somebody mentions S or SI. I would guess that they're not required to send you onto the closed ward or anywhere else unless there's a real danger of you severely harming yourself. Otherwise they'd be sectioning people right, left and centre for not much reason. Just financially, they won't want to be sending everybody who mentions S or SI inpatient. Inpatient even if just for a few days is super expensive. I'm sure they have duty of care to find out if you really need it.

I've always been helped by being able to speak it out loud, even to friends I know from previous inpatient stays, because they're much less likely to freak out than friends with no experience of indepth therapy. I feel it would be unfair to tell the latter group. You've opened up to us, I hope that's removed some of the pressure for you, pressure as in pressure cooker where the valve isn't functioning correctly.

Somebody else mentioned upthread that you trust your therapist. That's true mainly, isn't it? In that case, I would encourage you to speak to your T. They may even suspect already, who knows. I think if you come clean with it so to speak, that can only help. Otherwise it's like not telling your T you have a problem with alcohol or food or something. After a while, it's good to let them know about your 'crutches' and SI as a 'get out of jail card' is maybe a bit like a 'crutch'. Does that make sense? You don't need to respond. Just ignore if things I've written don't make any sense in your case.

[HannahOne]

NK, I'm glad you could share here, at least. As you can see, you're not alone.

Part of me is constantly suggesting it. I just kind of live with it as background noise and think to myself, "yes dear, I know, we'll most likely kill me in the morning," a la The Princess Bride movie. If it gets very intense or frequent I take it as a sign that my life is out of balance and I need to do more for myself or get myself out of a situation that is making me overwhelmed.

One important thing for a therapist in my experience is do you have a plan, and means, and intent. If you don't have those three things, then a therapist should deem you "safe" and not escalate. They should understand that you're finding these thoughts intrusive, bothersome, dystonic. Not that you are currently a risk to yourself. I think if you explain it as you did here, that you recognize it's actually a kind of safety behavior, that could be helpful context for the therapist.

They should not escalate--- but it's a big risk for me, so I am always careful. What I have done that's worked well is ask hypotheticals. Granted they immediately know I'm talking about myself, but the hypothetical gives us both space and time, avoids them making a quick decision or becoming alarmed. So I might say something like "Hypothetically, if you had a client who stated that they were having passive thoughts about su!cide, but they had no intent, means, or plan, it was just ideation, what would you do?"

From there I can gauge their response and decide how to answer any questions they have. If I don't feel assured that the therapist understands that I am experiencing SI and not a su!cidal crisis I could downplay, backpedal and deny. Or sign their safety plan or whatever it takes to make them comfortable.

My therapists have always understood that I want to talk about these thoughts, and have never escalated. One in three decades wanted to make a safety plan.

I hope you can get the support you need!

[NarcKiddo]

Thank you, everyone. I did in the end work through some of it with AI. Of course I got initially jammed with nothing but hotline numbers but eventually I managed to persuade it I wanted to discuss how to approach my therapist and then I was able to work through some things with it.

It seems that in my case it is very much a comfort blanket type thing. And my littles have long, long experience of their comfort blankets being taken away by M. Right back to when I was four and she finally took my pacifier, but we'd had months, maybe years of threats before it finally happened and it was totally dysfunctional. So my littles are scared that my T in conjunction with adult NK will confiscate this comfort blanket. The 'get out of jail free' card  visual has also proved useful because, as HannahOne has commented, it is essentially a sign that I am out of balance or overwhelmed. Basically parts are wildly waving this card at me to get my attention - so forbidding them to do that would be a bad thing. At least that is my current thinking.

I do trust my T, but not all of my parts do. Particularly Teen NK who has dissociated me out of therapy more than once.

Now that I have framed this as a comfort blanket thing I feel more comfortable with the thoughts and more able to regard them as a cry for help from the littles. I am sure I will bring this to therapy at some point but I am working on it myself for a while. Once I bring it to therapy I think it will be clear to all parties that it is no more than a thought. If I allow myself to think the thought and examine it then the thought should pass, like an emotion, but if I suppress it then the littles may feel forced to up the ante and nobody wants that. It is not a 'bad thought' that needs to be banished and never spoken of.

 

[HannahOne]

NK, your idea of seeing the thoughts as a safety blanket and also as a cry for help from the littles makes so much sense to me. Behavior is communication, as they say in child therapy. If the littles or Teen NK is waving this flag, they are trying to communicate something. As you say, you will notice and examine the thoughts and situations to help the littles, or whatever part of you is signaling need for help or comfort. That's taking care of you! 

[dollyvee]

NK, I'm sorry to hear that you're experiencing SI. At times in the past, I feel like it I did have these thoughts come about, but, they have gone now. When I think back, I feel like they came up in times of no resolution, or damned if you do, damned if you don't bind that I found myself in in a NPD family. Perhaps you notice a certain event that triggers these feelings, or can trace it back to an event that preceded the rumination?

Also, it might not be appropriate here, so please disregard if it offends, but have you looked into any mold that might be hidden in your home? Dr Showmaker lists suicidal thoughts as a symptom of mold illness, and I know someone who had those thoughts every time they would go back to their flat with mold, and then have them disappear when they would leave again. Also, given your lung function that will not get better, it could be an interesting correlation.

Sending you support,
dolly

[TheBigBlue]

NK, I'm sorry you're going through such a rough patch. I hope some of the dysregulation has eased a little by now. What you wrote really resonates with me, especially the control part.

From my own experience, yes, I would talk to your therapist about it.

With my CBT therapist I eased into it very gradually. I first asked questions: What does it mean if I tell you this? What would happen next? What would make you concerned? As I understood how she assesses different levels of risk, I became much more comfortable talking openly.

We did make a safety plan, but importantly, it isn't stigmatizing or synonymous with "I'm in crisis." Opening the plan doesn't automatically mean I'm at the highest level, rather it helps us identify where I actually am and what support fits that level.

When I went through a rougher patch earlier this year, my T and I agreed that I would dispose of excess medication that had accumulated over the years by taking it to the pharmacy. I did it, but I noticed surprisingly strong resistance in my body to giving it up. I could tell my T about that too, and we could understand and unshame the feeling as being about loss of control rather than treating the feeling itself as evidence that I wanted to act on anything.

I've also learned that being able to talk openly with a therapist about SI can itself be protective, because I'm not carrying it completely alone.

That said, the terrain with my second therapist was a bit rougher initially. I noticed a change in how she communicated when the subject came up - her voice hardened a bit and my hypervigilant antenna picked it up, which made parts of me wary, until I understood better what was happening and we could talk about that dynamic too.

And despite all this, I still really dislike speaking out the term "SI." Therefore, both my Ts now use my ridiculous euphemism, "Voldemort," with me instead. Apparently even He-Who-Must-Not-Be-Named can be talked about.