Going to see doc this week

Can you talk about suicide now which is currently on your mind? Do you think the issues with your T have been solved if no?

He said occasionally is ok, just not every week. That's the only issue I have with him. Everything else is really good.

I still feel that is wrong. You should be able to talk about it as much as you need.

Is the reason he said that that you were making threats to kill yourself all the time? I don't remember if it was you or someone else (maybe on a completely different website) that was talking about this before. Their T felt like he was being taken emotionally hostage because they kept threatening suicide. I think the T felt that the expressions of SI were a manifestation of their BPD rather than actual ideation. Iirc, they ended up being terminated and referred to DBT. The more I think about it, the more I think the person who posted this was the therapist, not the client. So not you. And who knows about the client's side of that story.

I seem to recall you have BPD, though - maybe he's working off of the same sort of logic? Not saying that's right for him to do, just wondering where he got the bizarre idea that this is a topic that should be restricted.

It makes sense to me that a T might believe that talking consistently about suicide is destructive to an individual's well being. I also think that like in any relationship, the other party can ask the other to do something different or make it a dealbreaker of the relationship.

I don't believe in the unfettered right of a therapy client to do and say whatever they want in therapy, unless that is agreed upon by both client and therapist.

This isn’t me you’re thinking of. I do have BPD tho. His rationale is because if I’m that suicidal I need more help than he can provide me, which I understand. He is ethically doing the right thing.

But he's not doing the ethical thing as he defined it. He's just making it impossible for you to talk about. He knows you're suicidal, so why hasn't he referred you out? Pretending you're not suicidal doesn't seem like a very sound strategy to me for either of you.

This is much what I was thinking. Or does he not realize you're currently suicidal? It just seems like if you have to hide a major element of your mental health from your therapist, that can't be good for you.

Would you not be able to access whatever higher level of care he recommends? You should get whatever treatment you need for where you're at right now, mental health wise. I know plenty of therapists can work in an outpatient setting with people who have suicidal thoughts that only go so far. If he's not one of those therapists, or if your suicidal ideation is beyond what can be accommodated in a once-weekly outpatient setting, then the ethical thing would be to refer you, not to restrict what you can talk about. It can be hard to see if your thoughts are fuzzy, but if you need more than what he can give you once a week, then you should seek it out elsewhere if at all possible (2-3 times weekly with somebody else, intensive outpatient, etc).

I’m not always actively suicidal but I do struggle with chronic suicidal ideation. It’s part of BPD. I’m a full time student working part time with a mortgage, car payments, and other debt. I can’t afford $250/hr even once a week let alone 2-3x a week. I have to work with what I have and make it work for me. I have spent hours and hours researching and emailing other therapists. There are literally no options for me. It’s not for lack of trying. We actually just talked about this at my session yesterday. For now, I have other people I can lean on for support when the thoughts overwhelm me. If they get really, really bad I have resources (ie supportive friends, crisis line, etc). I’m doing the best I can with what I have.

HUGS Piggy Momma

We don’t have programs here like other countries. Everything is privatized. The health authority does offer outpatient treatment but when I was in hospital they would not refer me. They said I am far too high functioning to qualify for anything they offer. They released me with no direction or support or referrals. Trust me it is not due to a lack of effort on my part. This has been a several year journey trying to be able to access the right help.

I'm sorry, this all sounds really rough. I hope it gets easier at some point, maybe after your circumstances change.

Except unlike in most relationships, the therapist only gets to set dealbreakers that don't interfere with their professional responsibility. A therapist doesn't get to decide they don't want to talk about suicidality any any more than it would be acceptable for a cardiologist to decide they don't want to hear about chest pain.

I'm not going to argue with you, but none of us can tell whether (in this case) that this "dealbreaker" is interfering with professional responsibilities. A therapist can decide that suicidal ideation is not in fact a useful topic of conversation in the context of a person's life and other symptoms. Your analogy to a cardiologist and your absolutes do not make sense to me. I see it differently but I have no interest in changing your mind, and you cannot change mine.

I agree with the analogy.
But I would not hire a therapist who thought they got to tell me what I can or cannot talk about at all.

Quote:

Originally Posted by starfishing Except unlike in most relationships, the therapist only gets to set dealbreakers that don't interfere with their professional responsibility. A therapist doesn't get to decide they don't want to talk about suicidality any any more than it would be acceptable for a cardiologist to decide they don't want to hear about chest pain.

I think though, the professional responsibility might be to refer her out if he cant help her or doesnt want to talk about it.

The analogy is pretty straightforward. Suicidality and chest pain are both potentially serious symptoms, and it's a vital core responsibility of each profession to be aware of them appropriately and assess them when needed.

I'm not sure why you're not seeing it, but it's very clear from this thread that discouraging OP from talking about suicidality is interfering with that very basic professional responsibility--OP specifically said that her therapist has no idea how much difficulty she's really having right now, as a direct result of her being discouraged from talking about her suicidality.

I don't care about changing your mind, but I do find it worrisome that someone might read your comments as normalizing a therapist's irresponsible behavior.

And piggy momma, none of this is a reflection on you in any negative way. It definitely seems like you are doing the best you can in a difficult situation, and the way you're handling things with your therapist makes sense to me, given both his strengths and limitations. I hope you're doing okay and are doing whatever you need to in order to keep yourself safe.

A therapist who censors what a client is, or is not, 'allowed' to speak about is unacceptable.

Refer the client out if need be but this is not professional

He has nowhere to refer me to. He charges next to nothing and I can't afford the going rate. I don't qualify through the health authority and through work I can get five free sessions a year.

He is doing the best he can. We both are.