Tag Archives: therapist coping with client suicide

Putting Feelings Into Words

Posted by What It Takes To Be Me in Anger, Anxiety, Attachment, Boundaries, Countertransference, Expressing Emotion, Psychology, Psychotherapy, Psychotherapy with A, Rejection, Suicidal Ideation, Suicide, The Therapeutic Relationship, Transference and tagged with , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

I am not someone who commonly contacts my therapist between sessions; the resentment I always felt towards those of my father’s clients who did so has heavily enhanced my desire to not be That Client. In fact, I have only done so twice before. Once after a friend of mine killed herself right before a final session before a break, and once, earlier this year, after a session where I was simply overcome with anxiety about having broken A. and feeling sure that I had finally become too much for her, because something in session had made it seem she wasn’t really coping. But, following the session I described in my previous post, in which A. had told me that she couldn’t work with me under the threat of suicide I made a very conscious decision to write her. Below is that email.

 

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Dear A.,

It’s late Saturday evening and I find myself feeling like my head is still spinning from trying to make sense of what happened in our last session. I decided already yesterday that I would sit down and try to write down my thoughts over the next few days and send them to you on Sunday; I felt it wouldn’t be a very wise thing to do, sending off a rash email before I have had time to sit with all of this for a little bit. Also, I figure sending it on Sunday gives you two days to think about what I’m saying, should you want me to come for session on Wednesday, so it’s fair on you too.

This is what you said on Friday: ‘I can’t work with you under the threat of suicide’. This is what I heard you saying: ‘I won’t work with you if your level of distress passes a certain point. It’s now got to that stage, and I can’t handle it.’ If I allow my mind to wander a step further it would go something like this: ‘This is too much, too scary, and I don’t want the responsibility. She has become too much for me. I’m out of my depth and I don’t know what to do. I want out, but I don’t want to be the one to end therapy, so I’ll give her a ‘choice’ which is almost impossible to go along with. ‘

I know you said in session that you didn’t know how I might react to what you had to say, but you’re an intelligent person, and it seems reasonable to assume that you must have realised both that this would have a really big impact on me, and have thought of at least one or two scenarios of how I might interpret it. Considering how fear of being ‘too much’ for people and the constant worry about breaking people have been major themes running through the last four years of therapy, it doesn’t take a particularly big leap of the imagination to see that this statement of yours would be experienced as direct proof that I have once again managed to become too much for someone..

Like I said to you in session, this does feel incredibly unfair. In the last four years I have been trying to open up, to stop holding back and to overcome this fear of breaking people – to trust that you can cope, even – and now that I have taken this step, you tell me you can’t work with me. When I have asked you ‘Are you OK? Can you cope [with what I bring to session]?’ you’ve consistently opted to not answer, and then suddenly you give me what you present as a choice, but which to me feels increasingly more and more like a black or white ultimatum. ‘Either you stop being suicidal, or therapy stops’.

I do understand that you are in a very difficult situation and I can easily imagine how very stressful it must be to work with me, especially when I’m dipping like this, I really can. However, I’m not sure exactly what prompted you to make the decision to give me this ultimatum now, because I honestly can’t recall having said anything in the previous session that I haven’t said before. I remember saying that ‘it feels like everyone knows how this is going to end’, but that is something I have said many times in the past.

Were I to venture a guess I would say that it may have been my arriving late for the first session after the break that was the trigger. The fact that you commented on it, makes me think that this was possibly (and, if so, understandably) quite frightening for you, seeing as I had previously made it clear that if I ever don’t show up for a session you’d have good reason to think I’ve taken drastic action. I’m not sure if you believed me when I said that the reason for my lateness was that I used a different route (since I was staying at Drayton Park), and I simply miscalculated how long it would take to get to your place, but that really is the truth. I wouldn’t be so cruel as to be late on purpose solely to test how you’d react, and I would never play games like that with you; I have too much respect both for you as a person and for the work that we do, to do that.

I have to admit that I feel upset about your decision to tell me this on a Friday, knowing that it’s the longest possible time before the next session. I also cannot for the life of me understand why you would wait until after I had been discharged from Drayton Park to have this discussion with me, rather than doing it while I was still there, taking advantage of the fact that I wouldn’t be going home to try to deal with this on my own, but would have people around me who could offer support. This seems especially strange, seeing as I told you that my stay at Drayton Park had been extended until Monday because I knew that the first session back might leave me feeling vulnerable and unstable, since things between you and I had seemed rocky before you went on leave.

As I said before, I can absolutely understand that it must be really hard to deal with me, and it may well have left you feeling you couldn’t cope working under those circumstances, but surely there must have been other ways of doing this? Rather than, for example, making it clear that ‘If you tell me that you are intending to kill yourself, I will have to contact your GP/crisis team/have you sectioned etc..’ (thereby taking some steam off of you), you went straight to ‘If you’re suicidal, I can’t work with you’.

I have no problem with you looking after yourself; if you feel you can’t work with me when things are like this, then – absolutely – you should raise that point. Of course a therapist both needs to and should look after herself, I take no issue with that at all. But, what I do feel has been done quite poorly is the fact that you drop this bomb in my lap without doing anything at all to ensure that I am as safe as possible with it. You could have said ‘If you don’t feel you can make a promise to not kill yourself, I’m really sorry, but I won’t be able to work with you. It would be impossible to do this work. I know this will probably feel like a rejection and I am sorry about that. It’s not my intention to leave you feeling that you have become too much for me, but I do realise that it may have this effect. I may be able to refer you to a colleague, if that is something you would want.’ Or even something so simple as to pick up the phone, call the crisis team, who you knew I was still under, to let them know that you have just had a really difficult conversation with me and you want them to be aware of this as I may need extra support over the weekend.

I really don’t want our work together to end like this, and I certainly don’t want the take away message after four years to be that I’m too much even for the professionals, and that is what it would be, should we terminate therapy at this point. I know you would soon find someone else to take my slot, you’d move on and I would eventually fade and end up being a learning experience for you. I, on the other hand, would be left with the incredibly painful knowledge that I am too much even for professionals, and, really, if even my therapist can’t cope with me, what hope is there..?

I know that some of the things I am writing in this email will inevitably come across as wholly unfair, and I recognise that my assumptions of what is going on for you may well be entirely wrong, but at the end of the day, this is how I have experienced all of this.

You mentioned that I may need some time to think about what you have said and what choice I want to make, and I feel unsure of what the timescale for this is, and whether or not you are expecting me to come to session while I work it out for myself.. I don’t even know if I’m meant to show up on Wednesday or not.

I really do hope that we can talk about this soon and find a way forward, whichever direction that path takes.

xx

Talking Openly About Suicide

Posted by What It Takes To Be Me in Countertransference, Family, Friends, Psychology, Psychotherapy, Psychotherapy with A, Suicidal Ideation, Suicide, The Therapeutic Relationship and tagged with , , , , , , , , , , , , , , , , , , , , , , , , , ,

I hadn’t meant to leave it this long, but life got in the way, in a very real fashion.

Two weeks ago my life was turned upside down; a decision was made about me which affects my entire future. It was made by someone who doesn’t know me and without meeting with me or even letting me know that this decision was being made –.

I don’t feel quite ready to write about the details just yet, because I am still trying to process it. Also, it is excruciatingly painful to think about, hurtful far beyond anything I have ever experienced before. If this decision were to stand.. well, it is truly major, life-changing, stuff, and has hit me straight in the heart.

The past two years I’ve been on a very specific path, and now someone has taken an enormous, big, black boulder and placed it on what was already a twisting, winding and steeply uphill path, completely blocking my way forward. And, sadly, this is not a stumbling block that I can simply scale or find an alternative way around – I am completely and utterly dependent on the person who placed it there to remove it.

Therapy has been challenging since my last post. The honeymoon is definitely over. For both A. and for me. But in a strange way, that is probably for the better. Although this has required me to be braver than I have ever been in my therapy before, has pushed me to open up more than I ever have, in spite of the very real fears I have regarding what that will do to A., it hasn’t been without benefits; two weeks ago, after three and a half years of seeing A., I cried for the first time in session. It wasn’t a massive cathartic kind of outpouring of raw emotion, but it was real and naked.

In today’s session I made myself be brave again, forced myself to talk about something that is incredibly hard to talk about, something which isn’t easy to broach in an open and honest way.
The last two weeks, ever since that boulder cut off my way forward, I have been carrying a piece of paper in my journal, which I have been wanting to give to A. but haven’t quite had the courage to do it, because of what the implications of handing her that piece of paper are.

For whatever reason, when I first began seeing A. she never asked to have my personal details – you know – address, next of kin, contact info for my GP – the usual stuff. She has had my email and mobile number, because I’ve emailed and texted her a few times, but no more than that.

Since this boulder was dropped in my way things have been, well, pretty dire. It wouldn’t be unfair to say that my life has been hanging in the balance. And although I am trying to challenge this decision that has been made, it has also forced me to consider the possibility that it may not be changed, no matter how many valid reasons there are for that to be done. And, everyone who is close to me, who knows what this is all about, also realise that if that were to happen – if that decision were to stand – well, it would amount to having the one thing that has always meant more to me than anything else being taken away from me. It would mean taking all hope from me.

And without hope, I can’t live. I don’t think anyone can.

I have talked to A. about this in session; that if hope is taken from me, I can’t go on, and I think that she, too, can see that this is a very very serious situation. I have told her that if what is about to happen were to happen, I would come to session and I would say goodbye – and it really would be goodbye. I have talked about ending my life before, and it’s never been done lightly, but I think this time, it is almost tangibly different, and I think it is obvious both to myself and to A. that there is a very real risk that this time, it could really happen. And, I think that the thought of that scares her, that it really scares her. I think it scares her nearly as much as it scares me.

So, today, when I finally gave her that piece of paper, a piece of paper which doesn’t look like much to the world; some contact details written on the back of a random re-used calligraphy practise sheet, it was a key moment in our work together. I explained to her how I had wanted to give her this piece of paper in the last two weeks, but that it has just felt too hard, because, of what went along with it; the reality that if I were to go missing – as many friends and loved ones as I have, and as often as I talk to them – my sessions with A. are really the only things which are regular enough to trigger a definite knowledge that something was amiss. The way I put it to A. was that, were I to not show up for a session – having not missed a single session in three and a half years – and, were I to not get back to her, should she ring to find out where I was, there would probably be good cause for concern; just reason to suspect that I have taken drastic action to end my life, that this time I probably won’t be coming back.

A. went quieter than she ever has when I was saying this. I mean, she doesn’t talk a huge amount generally, but this silence felt completely different, felt like she was holding her breath, unsure of what to do with this. Frozen. Not uncaring or distant, but in a paralysed kind of way. All the colour completely drained from her face. And it really frightened me, because I’ve never experienced A. reacting in that way to anything I’ve said in all these years.

I can understand it; as I’ve said many times before, therapist or not, she is only a person like everyone else, and having worked with me for as long as she has – as closely as she has – of course it would be extremely frightening to hear me, in so many words, put her in a position where she would be responsible for raising the alarm that I may have killed myself, to make the decision to send police round to my place.

I know that having a client kill themself is every therapist’s worse nightmare, and yet, the nature of their chosen profession means that they necessarily have to find a way to stay with a suicidal client, in the hope that they will never have to deal with an actual suicide.

I truly regret having to put A. in this position; it was not an easy thing to do – I care about her, deeply – of course I do – and I worry immensely about what it may do to her, were she to have to actually do what I am asking of her.

But I had to have that conversation with her. There was no way around it.

I did make it very clear that I am not going to kill myself today or tomorrow or even at all, unless I know that all possible avenues of having this decision, which has brought me to this very sharp edge, have been exhausted. That I would not do it without knowing that all hope has been truly extinguished.

I’m not sure that made A. feel any better, but, maybe, at least for a little while, she can rest more easily.

Maybe I can, too?

xx