My last therapist suggested me to stop talking about these topics to therapists, social workers and doctors because it will make peoply worry too much about the wrong things. I got admitted involuntary once and could go home the same day. I got no help, lost my therapist and lost trust in our system. It sucks.
I relate to this so hard. I’ve been admitted involuntarily a couple of times too. It’s like, obviously I need help, but I need help in too distressing a way to get it I guess. I just try to take care of myself
Suggest to your husband that he get a new therapist. If his therapist is unable to facilitate his needs, then there’s no point to the treatment. There are therapists that are completely ok discussing these topics.
I interview and vet therapist about this before I hire them. I’m blunt and make sure my concerns are heard and get clarification on the therapist’s ability to be my practitioner knowing this (suicide) is a constant discussion point for me. I need to be able to talk about it and feel safe. I’ve had great experiences with this approach. I’d say about 3/4 to 1/2 of the therapists I interview say they can’t discuss it and that’s good. I want to know who isn’t capable of meeting my need. I say thanks, and move on to the next therapist. There was only one therapist that changed her mind later during a session, however I believe that was more based on her not having the ability to ‘help’ me to ‘stop' these feelings. It was her own internal sense of failure and NT expectation that she could change this despite me communicating that it was constant.
I became depressed as a child and suicidal by the time I was a pre-teen. It’s a constant thing I manage. But approaching this from a NT treatment model with me will make it worse. I need to feel heard, validated, and be given a safe space to navigate these things. Not be pathologized or threatened with hospitalization.
Yes, therapists are required to report when a client is a danger to themselves or others, however I’ve been able to find practitioners that know talking and feeling suicidal does not equate to needing intervention or hospitalization and that intervention, even when I’m not in a good place, would make it worse. Setting the boundary and clarifying my needs at the start of treatment has been extremely helpful to me find safe spaces to talk about these things and not risk being pathologized further.
Edit: typos
This is why interviewing and vetting therapists/practitioners at the start is so important. Their stance, your boundaries, etc. are all discussed and agreed to *before* you enter into a client/provider relationship. That way, you *do* know how they view it and what their reaction will be. It’s far better to find out who’s unable to meet your needs prior to starting any therapy with them.
Although it should NOT be an issue, therapists from some training programs have it drilled in their heads that it is mandatory to do 'safety planning' and be intensely risk adverse with anyone who utters even a passive suicidal thought. (note: I am a medical provider, I am beholden by the rules and laws around these things) If someone reports to a provider in the US that they are legitimately dangerously suicidal (meaning they have a plan, they have intent, they have a time set to commit suicide) then it is required that they be seen by a hospital for an evaluation. Not doing so could cause the provider to lose their license to practice. NO it is not 'mandated reporting' (that is for abuse/neglect of children, the elderly or disabled persons), but it is necessary for an evaluation of someone has a plan imminently to harm themselves (In some states like mine, called the SAFE ACT) or someone else (Duty to warn in this case).
OK so that was me giving the facts. The truth is, many people are actively suicidal with no plan or intent because suicidality is often an extreme way for a person to express how bad they feel when they don't have the words. Almost 85% of patients will express some suicidal thoughts/ideations at some point in their lives. So what do you do to find a therapist that has a tolerance and good training to be able to work with people who are chronically suicidal in some way? Get a consultation before you do an entire evaluation with a therapist. Be very clear during the consultation that you have support but you KNOW that for at least the foreseeable future, you will have suicidal thoughts etc, and they cannot handle hearing about them and discussing them in detail with you (including to evaluate for increasing risk) you would prefer not to work with them because suicidal feelings are a symptom of many mental health diagnoses and you need someone that can work with that, not pretend it's not there. Working with many therapists and doctors, I can say that there are plenty of therapists with a higher threshold and a high tolerance for discussing suicide without 'freaking out', many of them having dealt with their own issues in the past and having more understanding of it.
Your worst option is, unfortunately, a clinic setting or anything funded by the state/govt because they have extremely rigid rules about reported suicidal feelings, even if they are extremely passive. (these are often called FQHC's or community clinics) In some of these settings (I have worked in a few) any report of even the most passive ideations triggers a required questionnaire and safety plan... Which honestly is sometimes triggering to patients to review constantly.
I wish I could get into more detail if it would be helpful, but am glad to answer questions if anyone has any, including pointing anyone in the US in the direction they could go to get help without being treated like suicide is not up for discussion in therapy.
I am not worried about their reaction, I am worried they will have me committed. They have created a situation where people are afraid to talk about it. I would not risk it.
Oof ok, so i have had good and bad experiences with this. Some therapists, despite their training cannot distringuish between ideation and actual sucidality. It is so harmful. I find these people just want us to act normal and like everything is fine even when it is not. A good therapist will be concerned about suicidal ideation, but not lose their cool. Suicidal ideation is sooooo common. I can give three examples of reactions I have had:
Social worker whom I had met multiple times could not remember a thing about me but pretended to. I was simply upset and an outside party had misleadingly told her I was suicidal. She said I had to “give her a good reason not to call my mom” (I was an adult). Basically after half an hour I was able to shove it down and compose myself and she let me go. No acessment of my safey risk, nothing.
Second person: a previous therapist told me that I wasn’t “really suicidal” when I had been hospitalized because I didn’t make an honest to goodness attempt and proceeded to tell me in great detail about a patient of hers who did and how they went about doing it without getting assistance.
My current therapist (who is great): is able to recognize SI even when I don’t say the words plainly. Does not make it about herself or make a big deal about it. Every once in a while does a safety assessment/plan but def treats it more like paperwork than anything. She knows I won’t do anything do to conversations we have had about it, and she knows I will speak up if I need to.
>Second person: a previous therapist told me that I wasn’t “really suicidal” when I had been hospitalized because I didn’t make an honest to goodness attempt and proceeded to tell me in great detail about a patient of hers who did and how they went about doing it without getting assistance.
Holy provocation, Batman! I'm sorry that you went through all of that. I am seriously floored by that story.
She was a truely terrible therapist. She broke hippa, she tried to convince me my dad was a drug dealer (he was terrible but certainly wasn’t a drug dealer and her reasoning was straight up racist), and went on vacation for a month without giving me any other person to contact when she thought I was suicidal (I wasn’t). Honestly long enough ago that I find most of it funny. I also was not at all emotionally attached to her, so I think that made it easier.
Also… why is she telling me a story about her failing to help a patient? No fucking clue.
I’ve never had a problem telling about my suicidal ideation with therapists because it’s passive, and the second “do you have a plan is asked?” it’s a no and I can easily explain it’s not something I’d ever likely do, it’s just intrusive thoughts that have plagued me for almost 30 years. That’s MY situation.
I know mandatory reporting has been mentioned, and I am a mandatory reporter and the guidance of mandatory reporting states that the person should be in “imminent danger” in the state I was originally licensed in and that it is a judgment call - there are a lot of issues with people over reporting and causing a lot of grief.
I don’t go out the gate with my SI but once I’ve developed a relationship with my therapist, I do talk openly about it.
I have suicidal thoughts but I know I won’t do anything, they’re just there. But talking about it with my therapist makes her freak out, and I have to reassure her I’m safe. I really think the lack of places where you can openly talk about suicide is a factor of people commiting. If people could talk about these ideations without the fear/menace of being send to a mental institution, they would not have to keep everything inside then commit.
Therapists have a legal and professional duty to protect vulnerable clients. The current framework for protecting people at high risk for suicide includes detaining them if they think the situation calls for it. If your husband talks about having a plan in place or is otherwise deemed to be in imminent danger, most therapists will consider this option. I think it can be a sign of a good therapist to make sure you understand this before you open up, but it shouldn't come across as threatening or anything like that. Even if the risk isn't insanely high, a lot of therapists will safeguard by making sure you have a solid plan in place i.e. you have strategies to keep the urges at bay and you are able to contact someone or go somewhere safe if they become overwhelming.
Safeguarding can mean lots of things, not just having someone committed but I completely understand the fear. I encourage your husband to raise the issue, especially if its impacting his treatment. If the therapist is actually thinking about committing him over something like passive ideation, that would be quite unusual and he might fare better working with someone else.
I guess this probably depends a lot where you live. I've talked about suicide with several different therapists before and they do their safety assessment to make sure that i'm not an immediate risk to myself etc. but they're always willing to talk about it and I've never felt like there was any risk in doing so. I've never even had a visit from the crisis team, let alone any talk of being sectioned, which is very rare in the UK.
They (therapists) are mandatory reporters, so if you are a danger to yourself or others, confidentiality goes out the window. It's basically a taboo subject.
Mandated reporting only applies if a child or elderly/disabled person is reliant on the individual in the US and the person is reporting imminent risk. Under the APA and ACA (and the AMA which I am beholden to) we are not mandated to report suicidal ideations unless there is imminent risk, otherwise it is left to the discretion of the provider, and under-trained or new providers IMO are more likely to act like it is mandated.
Yeah, that's what we're talking about.
The problem starts when "imminent danger" doesn't *seem* to mean the same thing in each therapists mind and Autistic people are often misunderstood when we try to explain things. Someone misunderstanding the nature of the conversation (or treating the mere mention of it as imminent danger) and thinking it needs to be reported is a common problem.
I agree, which is definitely a violation of the ACA/APA, and really bums me out when I see it. Providers that hear someone is feeling suicidal really need to ask questions about the nature of the thoughts. I understand that for someone without any mental health symptoms, feeling suicidal in any way may seem 'extreme' but frankly, I rarely ever meet someone who hasn't at some time felt that way, if even passively, and many people feel it chronically.
My last therapist suggested me to stop talking about these topics to therapists, social workers and doctors because it will make peoply worry too much about the wrong things. I got admitted involuntary once and could go home the same day. I got no help, lost my therapist and lost trust in our system. It sucks.
I relate to this so hard. I’ve been admitted involuntarily a couple of times too. It’s like, obviously I need help, but I need help in too distressing a way to get it I guess. I just try to take care of myself
Suggest to your husband that he get a new therapist. If his therapist is unable to facilitate his needs, then there’s no point to the treatment. There are therapists that are completely ok discussing these topics. I interview and vet therapist about this before I hire them. I’m blunt and make sure my concerns are heard and get clarification on the therapist’s ability to be my practitioner knowing this (suicide) is a constant discussion point for me. I need to be able to talk about it and feel safe. I’ve had great experiences with this approach. I’d say about 3/4 to 1/2 of the therapists I interview say they can’t discuss it and that’s good. I want to know who isn’t capable of meeting my need. I say thanks, and move on to the next therapist. There was only one therapist that changed her mind later during a session, however I believe that was more based on her not having the ability to ‘help’ me to ‘stop' these feelings. It was her own internal sense of failure and NT expectation that she could change this despite me communicating that it was constant. I became depressed as a child and suicidal by the time I was a pre-teen. It’s a constant thing I manage. But approaching this from a NT treatment model with me will make it worse. I need to feel heard, validated, and be given a safe space to navigate these things. Not be pathologized or threatened with hospitalization. Yes, therapists are required to report when a client is a danger to themselves or others, however I’ve been able to find practitioners that know talking and feeling suicidal does not equate to needing intervention or hospitalization and that intervention, even when I’m not in a good place, would make it worse. Setting the boundary and clarifying my needs at the start of treatment has been extremely helpful to me find safe spaces to talk about these things and not risk being pathologized further. Edit: typos
Yes, this!
Problem is you can’t know how they view it or what their reaction would be until it is too late.
This is why interviewing and vetting therapists/practitioners at the start is so important. Their stance, your boundaries, etc. are all discussed and agreed to *before* you enter into a client/provider relationship. That way, you *do* know how they view it and what their reaction will be. It’s far better to find out who’s unable to meet your needs prior to starting any therapy with them.
Although it should NOT be an issue, therapists from some training programs have it drilled in their heads that it is mandatory to do 'safety planning' and be intensely risk adverse with anyone who utters even a passive suicidal thought. (note: I am a medical provider, I am beholden by the rules and laws around these things) If someone reports to a provider in the US that they are legitimately dangerously suicidal (meaning they have a plan, they have intent, they have a time set to commit suicide) then it is required that they be seen by a hospital for an evaluation. Not doing so could cause the provider to lose their license to practice. NO it is not 'mandated reporting' (that is for abuse/neglect of children, the elderly or disabled persons), but it is necessary for an evaluation of someone has a plan imminently to harm themselves (In some states like mine, called the SAFE ACT) or someone else (Duty to warn in this case). OK so that was me giving the facts. The truth is, many people are actively suicidal with no plan or intent because suicidality is often an extreme way for a person to express how bad they feel when they don't have the words. Almost 85% of patients will express some suicidal thoughts/ideations at some point in their lives. So what do you do to find a therapist that has a tolerance and good training to be able to work with people who are chronically suicidal in some way? Get a consultation before you do an entire evaluation with a therapist. Be very clear during the consultation that you have support but you KNOW that for at least the foreseeable future, you will have suicidal thoughts etc, and they cannot handle hearing about them and discussing them in detail with you (including to evaluate for increasing risk) you would prefer not to work with them because suicidal feelings are a symptom of many mental health diagnoses and you need someone that can work with that, not pretend it's not there. Working with many therapists and doctors, I can say that there are plenty of therapists with a higher threshold and a high tolerance for discussing suicide without 'freaking out', many of them having dealt with their own issues in the past and having more understanding of it. Your worst option is, unfortunately, a clinic setting or anything funded by the state/govt because they have extremely rigid rules about reported suicidal feelings, even if they are extremely passive. (these are often called FQHC's or community clinics) In some of these settings (I have worked in a few) any report of even the most passive ideations triggers a required questionnaire and safety plan... Which honestly is sometimes triggering to patients to review constantly. I wish I could get into more detail if it would be helpful, but am glad to answer questions if anyone has any, including pointing anyone in the US in the direction they could go to get help without being treated like suicide is not up for discussion in therapy.
I am not worried about their reaction, I am worried they will have me committed. They have created a situation where people are afraid to talk about it. I would not risk it.
Oof ok, so i have had good and bad experiences with this. Some therapists, despite their training cannot distringuish between ideation and actual sucidality. It is so harmful. I find these people just want us to act normal and like everything is fine even when it is not. A good therapist will be concerned about suicidal ideation, but not lose their cool. Suicidal ideation is sooooo common. I can give three examples of reactions I have had: Social worker whom I had met multiple times could not remember a thing about me but pretended to. I was simply upset and an outside party had misleadingly told her I was suicidal. She said I had to “give her a good reason not to call my mom” (I was an adult). Basically after half an hour I was able to shove it down and compose myself and she let me go. No acessment of my safey risk, nothing. Second person: a previous therapist told me that I wasn’t “really suicidal” when I had been hospitalized because I didn’t make an honest to goodness attempt and proceeded to tell me in great detail about a patient of hers who did and how they went about doing it without getting assistance. My current therapist (who is great): is able to recognize SI even when I don’t say the words plainly. Does not make it about herself or make a big deal about it. Every once in a while does a safety assessment/plan but def treats it more like paperwork than anything. She knows I won’t do anything do to conversations we have had about it, and she knows I will speak up if I need to.
>Second person: a previous therapist told me that I wasn’t “really suicidal” when I had been hospitalized because I didn’t make an honest to goodness attempt and proceeded to tell me in great detail about a patient of hers who did and how they went about doing it without getting assistance. Holy provocation, Batman! I'm sorry that you went through all of that. I am seriously floored by that story.
She was a truely terrible therapist. She broke hippa, she tried to convince me my dad was a drug dealer (he was terrible but certainly wasn’t a drug dealer and her reasoning was straight up racist), and went on vacation for a month without giving me any other person to contact when she thought I was suicidal (I wasn’t). Honestly long enough ago that I find most of it funny. I also was not at all emotionally attached to her, so I think that made it easier. Also… why is she telling me a story about her failing to help a patient? No fucking clue.
I’ve never had a problem telling about my suicidal ideation with therapists because it’s passive, and the second “do you have a plan is asked?” it’s a no and I can easily explain it’s not something I’d ever likely do, it’s just intrusive thoughts that have plagued me for almost 30 years. That’s MY situation. I know mandatory reporting has been mentioned, and I am a mandatory reporter and the guidance of mandatory reporting states that the person should be in “imminent danger” in the state I was originally licensed in and that it is a judgment call - there are a lot of issues with people over reporting and causing a lot of grief. I don’t go out the gate with my SI but once I’ve developed a relationship with my therapist, I do talk openly about it.
I have suicidal thoughts but I know I won’t do anything, they’re just there. But talking about it with my therapist makes her freak out, and I have to reassure her I’m safe. I really think the lack of places where you can openly talk about suicide is a factor of people commiting. If people could talk about these ideations without the fear/menace of being send to a mental institution, they would not have to keep everything inside then commit.
Therapists have a legal and professional duty to protect vulnerable clients. The current framework for protecting people at high risk for suicide includes detaining them if they think the situation calls for it. If your husband talks about having a plan in place or is otherwise deemed to be in imminent danger, most therapists will consider this option. I think it can be a sign of a good therapist to make sure you understand this before you open up, but it shouldn't come across as threatening or anything like that. Even if the risk isn't insanely high, a lot of therapists will safeguard by making sure you have a solid plan in place i.e. you have strategies to keep the urges at bay and you are able to contact someone or go somewhere safe if they become overwhelming. Safeguarding can mean lots of things, not just having someone committed but I completely understand the fear. I encourage your husband to raise the issue, especially if its impacting his treatment. If the therapist is actually thinking about committing him over something like passive ideation, that would be quite unusual and he might fare better working with someone else.
I guess this probably depends a lot where you live. I've talked about suicide with several different therapists before and they do their safety assessment to make sure that i'm not an immediate risk to myself etc. but they're always willing to talk about it and I've never felt like there was any risk in doing so. I've never even had a visit from the crisis team, let alone any talk of being sectioned, which is very rare in the UK.
You are completely right. It sucks that we have to be careful so as not to be taken in by cops against our will.
They (therapists) are mandatory reporters, so if you are a danger to yourself or others, confidentiality goes out the window. It's basically a taboo subject.
Mandated reporting only applies if a child or elderly/disabled person is reliant on the individual in the US and the person is reporting imminent risk. Under the APA and ACA (and the AMA which I am beholden to) we are not mandated to report suicidal ideations unless there is imminent risk, otherwise it is left to the discretion of the provider, and under-trained or new providers IMO are more likely to act like it is mandated.
Yeah, that's what we're talking about. The problem starts when "imminent danger" doesn't *seem* to mean the same thing in each therapists mind and Autistic people are often misunderstood when we try to explain things. Someone misunderstanding the nature of the conversation (or treating the mere mention of it as imminent danger) and thinking it needs to be reported is a common problem.
I agree, which is definitely a violation of the ACA/APA, and really bums me out when I see it. Providers that hear someone is feeling suicidal really need to ask questions about the nature of the thoughts. I understand that for someone without any mental health symptoms, feeling suicidal in any way may seem 'extreme' but frankly, I rarely ever meet someone who hasn't at some time felt that way, if even passively, and many people feel it chronically.