No Suicide Agreement in Therapy

My therapist has asked me to agree to a no suicide contract for the duration of our work together due to my frequent intense suicidal thoughts.
This has made me feel really awful. I have interpreted it as him being completely unaccepting about those kinds of feelings and it has made me feel even more shameful and guilty about having them than I did previously. When they do occur I then feel even more useless because I am not supposed to be thinking like that and I feel guilty and that then can increase the intensity of acting on the thoughts. I'm scared to tell him if I am suicidal because I feel he might just dismiss it and just tell me again I need to make an agreement not to do anything.
Am I overreacting? Has anyone else ever been asked to agree to this and how did you feel about it?

Nope. We talk about my sui feelings.
The only thing she did request when I began with her was that if I started drinking/using again, to tell her because therapy wouldn't work if I did that.
But signing contracts. Nah.

I've never had to do that but it would make me feel awful. I would definitely feel as though I wasn't allowed to talk about those feelings in there, which seems to defeat the object of what therapy is supposed to be - a safe place in which to discuss difficult feelings. I can understand your T being concerned about you going ahead with it and also being the subject of a lawsuit, but really, the primary concern should be that you can talk openly about how you feel. And anyway, how does a contract even work in practice? Anyone could go ahead and do it anyway?? Or it is to legally protect T??

I really couldn't work with a T who placed that sort of agreement on me. It would feel too much like a no go area and I need to feel I can talk about anything with a T, no matter what their discomfort may be.

Those sorts of things are nonsense and patently manipulative

My T pushes for this every year. He always wants a one year contract but I always negotiate down to a few months at a time.

Just because you sign a NS contract does not mean you cannot have those thoughts or feelings. It does not mean you can't talk about it in session. It is just a contract saying you won't actually go through with it for that length of time.

I have gone round and round about this with my T. I have been SUI since childhood. He knows I can't stop the thoughts and he doesn't really expect me too. He did say once that he couldn't continue to go on doing therapy with me if I wasn't able to put in a commitment. There were a few different reasons he gave but 1) he says clients that have that as a way out do not work as hard at improving during therapy. The only way to get better is to commit to the program. (whatever). 2) He said he cannot go on as a human worrying every week if I am going to stay alive. In the end I signed the damn thing just to get him to shut up. I still talk about it when things are bad and I have to fill out a DBT diary card which tracks my SUI feelings on a daily basis. He knows a contract is not going to make it all go away and he always wants me to be truthful and make him aware of my thoughts. Personally, I think it is just something to cover their butt although he says he would still be held responsible either way.

My contract is coming up again at the end of this month. I am not looking forward to that again. I'm sure he is not either. Ask your T to discuss it a bit further. I doubt he expects your urges will stop just because you sign a contract. Also, feel free to negotiate the terms. I didn't always win during my negotiations but I at least worked the timeframe down a bit.

I have heard of therapists doing this, but if they are good they can tell the difference between what is just thoughts and what is going to lead to action.

Thanks for the replies. He brought this up right at the end of our last session and when I tried to express how it made me feel he cut me off and just said there was no judgement from him about having the feelings, but we had run out of time and he needed some kind of boundary in place. I'm annoyed that he left it until the last moment to mention it as when he had briefly talked about it before I have expressed my dissatisfaction at making an agreement, so he knew it was going to cause me to react.

I've been asked to contract for safety many times with previous Ts and pdocs. I feel like it's a way to protect themselves. Usually mine is in the case of SH which hasn't worked out for me in the past. My current T allows me to talk about my thoughts, and just tells me to call him if I need to if I feel like I'm going to act on them.

Is the contract saying you cant talk about the feelings and thoughts or that you will not attempt SU? That is a big difference. I think the contract is useless but wonder what he means?

No and I would never see a T who asked for such a contract, or one that would refuse to talk about such things. When they demand things like that, they often twist it as it is for the safety of the client - IMO it is the opposite. I understand their fear but... It involves dealing with one of the most important (and common) aspects of mental health, which should be in the essence of their profession. Also, how does such a contract work, how is it a contract? Suicide and SH are not illegal or involve some sort of obligation to anyone else - if a contract could prevent them effectively, we would not need mental health services to help.

Makes going to therapy pointless for me as that's the sole reason I go. I have asked her to treat me as if I am terminally ill. I may not have a visible diagnosis of a disease or be receiving treatment like chemotherapy but for me, my MI and suicide are the same thing.

From what you write, I understand "no suicide contract" to mean you are not going to take action *not* that you are not allowed to express such thoughts or feelings.

Talk to him about it rather than assuming he will be "completely unaccepting about those kinds of feeling". I would be very surprised if a T were to implement a blanket ban re suicidal thoughts or feelings. They would not be a very effective T.

You might even discuss with him about strategies or coping IF you were to have such feelings.

That's dumb. How is that supposed to work? I don't think there is any evidence that says that people who sign contracts are less likely to attempt. My last DBT therapist said that I was supposed to "take suicide off the table." I don't even know what that means, so I just said OK because I didn't want to talk about it right then. My other therapist said that she really hoped I wouldn't decide to do it, and she'd be there to talk if I thought I was getting closer, and she has been. That was way more helpful. I would have been much more likely to talk to her if it got bad than the DBT therapist.

That said, I have been willing to make a safety plan because I know my thoughts can get kind of nuts when I'm depressed. So if it gets to the point where I recognize that I am starting to make a concrete plan I talk to someone...call the suicide hotline, talk to my husband, call my therapist, talk to a friend, etc. before acting on anything. I have used it a few times, and that seems to work. Maybe ask your therapist if he would be willing to compromise on something like that. Has there ever been a suicidal patient who thinks to him or herself, "oh I was going to do it, but I know I signed a contract so now I won't"? Sometimes when they say stuff like "research says," I ask for a citation, but I'm kind of a pain in the *** client.

I think my T makes me sign one because he knows lying is a huge personal value of mine. He also knows that I will not tell him if I am getting serious and I will not follow any safety plan. He is also big on working on skills to manage emotions. Everything in sessions has to be focused toward progress and by keeping my SUI options open I will not work as hard on practicing skills to improve my distress tolerance. Although honesty is my highest value, I have to admit he finally broke me and I signed the stupid paper anyway and told myself it is just a paper to make him happy and get off my back, it means nothing to me.

No T however should not allow a client to avoid talking about intentions. I do not think your T is taking SUI discussion off the table. He is probably just scared for your safety as I know mine is.

Suicide is a complex problem. Thoughts to action...it can escalate rapidly for people and especially during a crisis situation. There’s no way to accurately predict the outcome for each client.

It sounds like this is a contract to not ACT on your thoughts. I don't think it is a restriction on talking about your thoughts.

That said, contracts weren't meaningful to me. My pdoc tried to use one at first (sort of a hospital thing), but I basically told him I would sign it and not feel obligated to follow it, so he didn't push it.

I think there is a segment of clients that do respond to this kind of contract and it is enough to perhaps at least slow down their impulsivity long enough to contact someone for help. I'm also guessing therapists are quite aware the contracts aren't useful for every client.

Just talk to him about it.

I have a safety plan with my Ts, but not a no SUI/SH contract.

I can see how it might be useful for some people, but overall it seems silly because of the irrelevance of the consequences for breaking the contract.

humans have many thoughts, and some times thoughts do just pop up.

I remember one or two professionals telling me that, when humans are stressed it's not uncommon for unpleasant thoughts to pop up. And it doesn't make the person any thing but human. What therapy was, for me at least, was to cope better with those thoughts and help find management aspects that followed usually after thoughts.

Is this contract part of the safety plan packet? Or is a stand alone contract?

I ask because
I have had past therapist (all of them I can recall actually) ask I do their "safety plan" and with that, there is usually a page that states it's a contract, I've had a few that ask me to fill the page again later
. Basic it stated, that if I going to harm myself or to the point of going through an attempt that I agree to contact emergency//reach out.

Sure, I'll sign, and these days with a note written by my signature that states I'll try best in the future to comply... and i explain when handing it in that some times I've been spontaneous and things happen, and i can forget in moments of such agreement; but that I'd try my best.


For me, it's because I will try but I also know myself enough that I may forget in a moment.
*(or with a few I mentioned how hard it is for me to reach out, and after they got to know me more they understood why partially at least)).*

There were a couple verbal sessions with one t that she would ask I would promise- no self harm or using after our meet and to call/reach out ... again, I would honestly in that moment of speaking, I'd try If it got that bad, but again- with knowing myself and being honest, couldn't do a 100% promise and explained it didn't feel right for me to say I'd 100% do it.

The document wasn't to state that I wouldn't think or repress the thoughts, or "*poof* thoughts gone" but that I would reach out if in danger of harm.

To me, it's nonsense if a t or professional is asking that a patient to not think or talk about self harm or suicidal thoughts((or other thoughts for some as well)) when a patient is trying to get help and those aspects tie into the treatment being seeked....
or so I am understanding with this situation.. I maybe misunderstanding, and if so apologizes.

Therapy, while it isn't a walk in the park, if it's assisting with more negative self associations - like the Shame and guilt mentioned- t or a professional should be aware and patient should make a decision if the program is a good fit for them... because we all individual and not the same psychology program or outline works for every patient... because we're all beautifully different.

Sorry if this a ramble to some, but thoughts on the subject that is just another view, i guess.
---

Also, if this helps any, from PC
The Suicidal Client: Contracting for Safety

"A laugh is worth a hundred groans in any market." Charles Lamb
http://www.youtube.com/watch?v=da7StUzVh3s

No but my T said I'm to call her before acting on any SUI feelings. But I didn't have to sign anything.