Being honest about how bad things are

*this post contains triggers for sh and si*

I recently had my first face to face appointment with a psychologist.

Im not really sure how it went to be honest. I was so nervous, I could hardly look at them, couldn't keep still and they somehow knew something happened to me in the past but I told them I couldnÂ’t talk about it (at the initial intake I told them I was struggling with anxiety which is a huge problem for me right now). I am pleased I went in because when I arrived I really had second thoughts and had a bit of a panic.

I had intentions to let them know I was feeling pretty bad and suicidal but in the end I wasnÂ’t able to. Partly because I was so overwhelmed and partly because the feelings had passed.

I tend to have passing thoughts regularly but then I have days where itÂ’s so overwhelming that I feel so close to the edge. The only thing that seems to help is self harming.

I had to fill in a form about how I was feeling at the during the session but I felt so put on the spot (and I hate these forms anyway) that I made things seem better than they are (not a great move I know).

I have my next appointment soon and because I had another two days of really struggling with the thoughts and not doing it I want to try again to tell them. IÂ’m just not sure what to say(I might try writing it down), IÂ’m so scared they will tell me I should go to hospital because this would be my worst nightmare.

I also want to ask them some questions before so I know where I stand but I wondered if anyone here might know the answer to these questions?

Are they able to speak to my family about things (suicide, self harm etc) without my consent if IÂ’m an adult?

If I have a plan (I know how, where etc), the means but only the intent during the really hard times (they happen randomly and if I did it it would be more on impulse) are they likely to do anything?

What happened when you told your therapist you felt suicidal? How did they help you?

I hope you will communicate how you are feeling and be honest about your thoughts with your therapist. The bottom line is that it sounds like you need some help, but without you being straight with them about your thoughts and plans, they are working without all the information.

"Are they able to speak to my family about things (suicide, self harm etc) without my consent if I'm an adult?" -- Did you sign a release giving them permission to do so? If you did, yes. If you did not, expect that they will ask you to let them speak to someone who can perhaps at least be there for you rather than you being alone, etc. You do not have to say yes; however, if they feel you are at risk of hurting yourself and you won't voluntarily follow measures for your own safety, they can procure intervention for you via legal means if needed. That's why it can actually be helpful if you do have someone they can perhaps speak to that can help keep you safe while you are in a bad state. You just have to know if there is someone in your life willing to be that support for you if you need it.

"If I have a plan, the means but on the intent during the really hard times are they likely to do anything?" -- I hear you saying you aren't in immediate danger, but if you hit a bad spot, you could take actions to harm yourself. That's where your therapist might come up with a safety plan so that rather than acting, you agree to contact them or a crisis line or go to the ER. That's a difficult judgment call that the therapist will have to make based on his/her assessment of your level of danger.

"What happened when you told your therapist you felt suicidal? How did they help you?" -- Much depended on whether I was just "feeling suicidal" vs. I was having serious suicidal ideation vs. I had a plan vs. I had a plan and the means to carry it out, etc. There are levels of danger depending on many factors. My therapist and pdoc knew me very well, and we took a great deal of time talking through those various levels, my danger signs, etc., and we had a plan of action to work with based on where I was on the scale of danger.

Sometimes it was simply a feeling (very common) and just talking about it openly, perhaps checking in with my pdoc if I needed a med adjustment, etc. was all that was called for.

Sometimes my therapist had me check in daily, if not in person, at least by phone. Just having that touch point daily could keep me safe while things settled down.

And sometimes I was in real danger . . . and I knew it . . . we all knew it. And yes, hospitalization was really the best alternative for my safety. I always went voluntarily, and I never regretted it. I'm still here. There are worse things than hospitalization.

ETA: I see you are in the UK, so I am not sure how closely aligned the rules about this are between the U.S and the U.K. I'm sure someone here probably knows.

They may ask if you have a safe person to go home to. I am not sure if they are required to contact them especially since your si thoughts are fleeting. I would definitely talk to them though because they may be able to get you out of the rut. Also they can give you a plan of action to take when your si thoughts arent fleeting.

For me, my therapist and I have been working very closely with me for almost a year now. He encourages me to talk about any thoughts I have, and we talk about if they're fleeting thoughts or stronger urges to act on it. I'm similar to you that SH is kind of that stop gap to SI, but it's also been very dangerous for me. So we talk about that too, like what I have the urge to do and how I can stay safe. I have been lucky that this current T allows me to call him on the weekends and even last week he told me to call him in the middle of the night if I feel unsafe. He hasn't asked to talk to anyone in my family, since I'm an adult and haven't gave my permission to talk to anyone else besides other health care providers. We haven't hit that point in session about whether I should be admitted or not since I see him 5 days a week and that seems to help.

Thanks for taking the time to reply.

I will hopefully be able to talk to them about it at my next appointment. I do agree that they wonÂ’t be able to help if they donÂ’t have all the information I didnÂ’t go in with the intention of not telling them it just sort of happed but I know it doesnÂ’t help me in the long run.

I have never signed any agreement and the only things they said wouldnÂ’t be confidential is if myself or someone else is in danger. ItÂ’s complicated and I donÂ’t want my family to know how bad it is sometimes (I donÂ’t want to worry them).

I have social anxiety and the thought of a hospital/going to a&e or even phoning a crisis line is really hard. I havenÂ’t been able to reach out over the last times when it has been bad but they have eventually eased off.

Thank you for sharing your experience too. It sounds like your team knows you very well and is able to know what you need and help you which is great! My relationship withy my therapist is very new so IÂ’m a bit nervous but hopefully it will work out for the best

Yes, IÂ’m in the UK so IÂ’m not sure if things might be slightly different.

Thanks for replying.

I live on my own and really don’t want to stress out family members or make them worry if I can deal with it myself by seeking help from the therapist it’s just a little difficult because it’s the start of the treatment and sessions aren’t regular.

I will be trying to open up about it at my next appointment and hopefully they will be able to suggest some things that might help.

Thanks for replying.

ItÂ’s hard isnÂ’t it? I know sh isnÂ’t the answer but it seems to be the only thing that helps relieve the si but I do want to stop relying on that and try to find other ways through it hopefully with the help of my therapist.

Wow your t sounds amazing! I think itÂ’s great you can call him if youÂ’re struggling because you know you can trust him and youÂ’re not having to explain everything to someone else for example on a crisis line. In the UK I donÂ’t think itÂ’s very common for NHS therapists to work with people so closely and offer help outside of sessions. I think my therapist will advise me to call a crisis line which I would find pretty impossible due to my social anxiety but I understand there are limits to the help they can offer too.

(Apologies for being wordy)

It is totally reasonable to spend as much time as you want discussing all of these questions as hypotheticals with any therapist. They won’t be surprised or act like you’re worrying over nothing. I have brought it up repeatedly with my T even though I’ve been with her for over 3 years.

I can tell you that most Ts are not looking to lock you up just for SUI. Thoughts are common - even very consistent thoughts. Also, Ts are in the business of helping people! They know if the minute you share those thoughts they have you locked up, you’ll never trust them again and even if you come back to them after the IP stay, you won’t trust them with that critical, dangerous information again.

That said, if you indicate you have a plan and the means… things get tougher. It depends on the method and their judgement of your ability/willingness to follow a mutually agreed upon safety plan.

Three examples, that I hope are informative despite being vague:

1. I have talked about methods that are highly effective but require a lot of planning and forethought/preparation, and which I do not have the means for. T and pdoc are concerned, but we can move forward.
2. On the other hand, for a method that would be highly effective, could be done impulsively, and I had the means for… my T and pdoc had me give them what I would have used.
3. I have talked about crashing my car, but they have not told me to stop driving - my T did have me get someone else drive me to the hospital once when that had been a predominant plan.

I don’t know what gun laws are where you live, but if you have access to any firearms they will likely want you to arrange to have that access removed (e.g., guns out of the home and have someone else hold the key to the gun safe who’s aware of your illness, etc.)

The T will likely ask you to “contract for safety.” That means promise to not end your life, or promise to take certain steps before you do - like calling them or 999 or a crisis service. You don’t have to promise “never”, you can put a time limit on it. This is a negotiation, not an ultimatum. I usually do something like agreeing I will attend my next appointment with one of my providers, or agree to a mid-week check-in or something.

My experience is all in the USA, so some of the legal stuff might be a little different - but I expect the assessment and the conversations you will have with the T will be similar.

I have been hospitalized, but only after discussing it with my T/pdoc. It’s not something they just spring on you - you’ll know it’s coming. You may be able to have a conversation about other ways you can stay safe and talk them out of it.

In the US, it is generally in your best interests to go voluntarily, rather than have it be forced on you. It varies by hospital, but often voluntary status can afford you a few more comforts/“privileges”, and you will be viewed as more of a partner in your medical treatment, which changes how the doctors talk to you. Note that if you're there involuntarily in most cases you can still refuse treatment (e.g. meds or other treatments like TMS and ECT), although refusing all treatment will likely extend the length of your stay.

In either case, you’ll end up on a psych ward in the hospital and won’t be allowed to leave until the doctors there feel you’re safe (if you are there as a “voluntary” patient and try to leave AMA, the hospital will have you flipped to involuntary status).

Even if you are involuntarily admitted to hospital, the T is not given carte blanche to tell anyone or everyone everything you've told them. They can tell people who can help you (e.g. doctors, paramedics, nurses) specifics that relate to your treatment/why they deem you unsafe. The T might encourage you to call a trusted friend or family member, and if you do and you allow your T to talk to them at all, you can limit what they say. It might be something like "so-and-so is having a hard time and we have agreed they need evaluation at the hospital, would you be willing to drive them?" It is highly unusual for a T to talk to non-treatment professionals (ie. your family/friends) without you present or at least discussing exactly what they'll say.

---

Talking with my T about SUI has been helpful without landing me IP. It helps to have someone I can share explicit details with. It helps to have someone hear my pain. It helps because sometimes she can help me see there are things I could try before ending things.

Feel free to PM me if you want.

When I was struggling more with SI, it took a while for me to bring it up. My T had me promise to call the on-call number if I had an impulsive urge to act on SI even though we hadn't really talked about the extent of the SI going on at the time. Later we were able to talk about it significantly more. She was clear that sending me to IP was the last thing she wanted to do and that if she could manage it, there would be many steps we would take before that became necessary. As it is now, she knows my standing plan. She kind of knows I have means - she doesn't know the extent of the means I have . Over the 3 yrs I've been seeing her the SI has pretty much gone away. My intrusive violent thoughts have also lost their powers (which is good and bad). I miss some of the comfort that the SI and violent thoughts provided. I still have the means, just in case. At times, I have thought about giving them to T. I'm not there yet and may never be there.

I found it helpful to feel safe and to share what was going on around my SI and when it would come to the forefront again, as it would cycle for me. There were also times where out of the blue she'd ask me if I was safe. Using the word safe allowed us to have a way of measuring where I was with things.

Most recently, I shared with her that I was afraid of doing a recreational activity that had high risk because I thought I might take that opportunity to passively suicide - as the death could then be seen as an accident. We didn't talk about it, didn't get to it. Hmm guess I need to loop back to her about that.

I tried telling the first one how bad I felt (not si), but she was always dismissive so I stopped bothering with her and thus stopped upsetting myself further by trying to get that one to listen or understand me. I told the second one and she was not dismissive but really it made no difference. There was nothing either of them did that even remotely was useful to me.

To be honest, I think they will probably be very concerned if you tell them that you are most likely to act on impulse, and also that you won't be able to reach out when the SI gets really bad due to your social anxiety. That puts you at a significantly higher risk than someone who can agree to safety plan and who would not be impulsive about acting.

I can't predict what your therapist will do. I do hope you are honest. The one I see has not hospitalized due to SI, but only because I contracted for safety. If I had not agreed to a safety plan, I absolutely believe she would have initiated an involuntary hospitalization (she said as much). If I told her I was suicidal and might just act on impulse without reaching out to anybody, it would be a huge risk for her to not take any measures to ensure my safety. If I were to act on the SI after telling her these things, she would be liable in the same way that a medical provider would be for ignoring symptoms of a fatal condition.

I think talking about things hypothetically might be useful actually so I can see how he would respond.

I would be happy to do a safety plan (right now I feel okay) so I would do it and say yes of course I will stick to it and that’s me being honest when I feel okay. I’m just not sure I would be able to stick to it when the feelings get overwhelming like they do as it’s like having tunnel vision when it happens.

Thank you for sharing some potential scenarios and outcomes that was helpful to read. I don’t have access to a gun so that’s not a concern.

I have been in hospital once before voluntarily but the staff were horrible. One of them told me if I sh again whilst in there they would kick me out which I thought was ridiculous.

I’m hoping like you that I might find it useful to tell him about it and that talking about it might take the power away from it.

Thanks for replying and for the offer to pm you, I appreciate it.

Thanks for replying.

I’m hoping if I can talk to him which I intend to that he will be able to offer some suggestions that I haven’t thought of yet.

It’s good to hear you thoughts have pretty much gone away. I hope I can get to that point too with some help and time.

I think mine does the same (cycles) and it seems to be at the weekend when it’s particularly bad although I’m not sure why this is.

I would definitely bring up your thoughts around the activity you will be doing. It sounds like your t has been a great help and support over the years and you can trust her with how you feel. I hope I can get to that stage with the person I’m seeing at some point.

I’m sorry that your first t was dismissive and she didn’t help. It’s a shame you haven’t found talking about it helpful, can you maybe bring it up again and see if revisiting it helps?

I do worry that I might not find it helpful either as I then wonder where that leaves me but hopefully I will find some part of talking about it helpful.

Thank you for replying.

I really worry about sounding like I’m trying to put roadblocks in the way of any help but I really do struggle to reach out for help when things are bad. I hate talking on the phone and especially to people I don’t know plus I would worry about a police car turning up so a crisis number i really wouldn’t want to call.

The impulse thing is annoying. Like right now I feel okay it’s when I get overwhelmed that I really struggle then the thoughts get so intense that it’s hard to see a time past them. The thing is I can’t predict if/when it’s going to get bad.

I could agree to a safety plan (although I’m not really sure they use them in the UK) now when I’m feeling okay. I just don’t know if it would have any effect in the moment when Im deep in the negative thoughts.

I’m glad you were able to contract to safety and I understand my t has a duty of care I just really don’t know what I want or expect from him. If he could help make the thoughts go away then great but I’m not sure that’s a realistic expectation.

Louella, I’m from Canada, so there may be some differences but...

1.) If you write down ( I’ve done that, you have a great idea!) what you are hesitant to say, it’s definitely easier. It was easier for me, anyway, when I felt too scared to say something verbally. Definitely try that.

2.) In my case, if I’m anxious about something, I know from experience that facing my fears is never as bad as what I imagined. For example, if I am supposed to go somewhere but start having second thoughts ( or 3rd, 4th, 5th, etc!)... I remind myself that I’ve done uncomfortable things before, and nothing bad happened to me. Doctor appointments, going to a busy place for a lunch date, meeting new people, etc... When I go, I feel better for going.

3.) I also plan for contingencies... I.E.: go with someone supportive; I can always say I have to leave at x time/early if it’s a party or outing; I can have a friend call or text about “an emergency” or needing a ride, etc so I have the option to leave early... So when you are telling your T about your SI, s/he can help you come up with contingency plans.

That is when you can explain you would rather not notify family. Do you have a friend you can count on, or does your T know of any caseworkers/social workers or other resources or people who could accompany you to the ER?

Your T is an excellent resource to help you find a good support system.

Hope this helps! *huggles*

So I told t what was going on (I just kind of blurted it all out at the start) but honestly it wasn’t very helpful. I told him how I was feeling that the thoughts are hard to ignore when they’re bad and I want to He asked what stops me and I said I’m not sure.

He asked if they needed to be worried to which I said no (talking to one person is hard enough). I said sometimes it makes me worry though.

I mentioned I was a bit preoccupied about it looking it up online etc and t said it’s okay to be curious etc. He asked if I would speak to family about it but I said no I didn’t want to worry them (plus it would make it less of an option but I didn’t say this). I said how I think it’s unfair that people are expected to carry on for the sake of other people and it wasn’t fair.

He asked if I needed help staying safe and again I said no and kind of shrugged.

Then the conversation moved on to something else but I don’t remember how it shifted away from the subject.

I’m glad he didn’t overreact but I guess I was a little surprised by his response, he didn’t offer any suggestions to help or ask about a plan or if I had the means etc. Yesterday the feelings were back really bad again and it’s so annoying I just wish they’d go away.

I’m not sure if it will come up again next time but I don’t think it will unless I was to mention it again which is doubtful now really.

Just thought I would update for anyone who had replied. Thanks again for replying it helped give me the courage to say it.

I'm sorry your T wasn't more helpful responsive to your talking about the thoughts. It was brave of you to share them. The good thing is, now that you've brought up the topic once, it should be easier to bring up again next time you're feeling the thoughts. You could try bringing it up again next session and say you feel you need to talk about them more.

Thank you I just feel like it wasn’t worth mentioning anything really. I don’t know thought, I’ll see if he says anything next time about it or if the subject is forgotten.

I guess I was hoping he would have some suggestions on how to stop the thoughts but maybe that’s only something I can sort. I’m only a few sessions in and still feel really lost in the process and a bit unsure I guess of the purpose of therapy, if i feel it’s going to actually help and still building trust etc. He keeps asking me if I want to talk about the trauma thing from my past (really don’t) and he doesn’t push it too much but I kind of feel under pressure to pick up the pace (although maybe that’s just in my head and overanalysing his offering to talk about it).

Sorry your t doesn’t take things as seriously as you would like sometimes. Its hard when it feels like the just gloss over a topic you think is important. It’s good you can keep talking about how you feel and I do prefer my t isn’t getting upset or taking it personally. I agree that he was probably trying to normalise it. I wish I could remember exactly what he said I would love to record our sessions but there’s just no way I could ask about that.