I just admitted to my therapist that I've been cutting. What happens now?
October 24, 2008 7:29 AM   Subscribe

OK. I just admitted to my therapist that I have been cutting and having some dark thoughts. He was about to go into a session when he answered my page. He's calling me back later and we have an appt scheduled for Monday. I'm not in any immediate danger FYI but I'm very worried and anxious what actions might be taken. He said he thought a conversation between him and my psychiatrist was in order, and I agreed to that. I've read the questions about "I told my therapist I want to kill myself, will I get committed" and there is some useful info there. But I want even further specific information about what comes next. What am I in for? What should I expect? Will this change the therapy dynamic? He knows I'm a past cutter but I have always assured him it is in the past. Now I've admitted to six weeks of lies by ommission. What happens now? I've never told anyone about this, and I'm a little freaked.
posted by anonymous to Health & Fitness (17 answers total) 4 users marked this as a favorite
It's ok, and its going to be ok. You are in a safe place, in fact the perfect place for this sort of thing. The lying - therapists deal with this all the time. It's not about them, its about you. It's a sign of great progress when you can make breakthroughs like this. Your therapy from this point forward will really change once you start being more open and honest with yourself. I wish you the best of luck.

I'm not sure what's going to happen, but I know that you are facing the right direction, and that's going to make all the difference.
posted by iamkimiam at 7:51 AM on October 24, 2008 [1 favorite]

Perhaps a silly metaphor, but think of this as if driving in a car. It is a lot safer to look out the windshield ahead of you than to focus on objects in the rear view mirror.
posted by netbros at 8:07 AM on October 24, 2008

I doubt any "actions will be taken" as reaction to your cutting admission. My doctors (at least in my case) are not worried about my cutting being suicidal- they know that self harm is often very separate from suicide. Don't worry, these are professionals. You're on the right path!
posted by sunshinesky at 8:35 AM on October 24, 2008

Kudos to you for calling in help when you needed it! Really, I mean that. You did a very hard, brave thing.

The dynamic of therapy may change in that now your therapist has more information and can develop a more appropriate treatment plan. You may find that he wants to begin exploring how you feel when you engage in this behavior, what happens before to trigger it, and what happens after. Self-harm is a coping mechanism. It's not a good coping mechanism, and it's not one I'm sure you want to continue using. Your therapist will help you find better ones.

In the meantime, do something nice for yourself.
posted by zizzle at 8:37 AM on October 24, 2008 [1 favorite]

It should really depend on whether you and your therapist think it's something that you need to focus on. It's something you'll need to discuss and agree on. For me, when I was in therapy, it really wasn't a big deal; it came up on occasion but it wasn't something that my therapist and I worked on specifically.

It sounds like it's important to you, so I'd guess that it's something you'll both want to talk about more. This isn't going to be something your therapist or psychiatrist haven't encountered before, and I don't think that it'll need any specific intervention if it's not putting you in real danger. What you may find useful is a discussion with your therapist about all this stuff. It's probably going to be more informative to find out how he thinks it'll change the therapy dynamic and how he sees the therapy progressing after this. Therapy isn't something you receive - it's something you engage in - so reaching agreement on these things will be important.

Good luck, and I hope therapy works out for you.
posted by xchmp at 8:55 AM on October 24, 2008

They might work to change your meds.

It's a good thing that you told him so he can help you. It's a very hard thing to talk about and he's not going to blame you for not opening up to him 100% right away. Therapy is about progress and working on these kinds of things.

Best of luck.
posted by sondrialiac at 9:25 AM on October 24, 2008

No advice to give but I just wanted to tell you how awesome I think you are. I don't even know you but I know what kind of bravery that took and how you must really want to get better so I am really in awe of your strength. Admitting that you need help is often that hardest part so try not to be nervous and focus on getting well. I know it doesn't mean that much from a stranger but I'm very proud of you.
posted by pearlybob at 10:02 AM on October 24, 2008 [3 favorites]

I have no experience with therapy, so this is an actual question for the people who do:

Would it make sense to leave him a message telling him these concerns?
posted by small_ruminant at 10:08 AM on October 24, 2008

In my experience it's better to wait to talk in person, so the therapist can ask you questions and respond to you--especially if the therapist is going to speak with you soon.

It might be a good idea, though, to write down your concerns so that you remember them when you talk to your therapist again.
posted by sondrialiac at 10:29 AM on October 24, 2008

2nd iamkimian - therapists know that it takes time to develop enough trust to tell them the things that are really hard to talk about. He is not going to be angry or take offense at the lying, he is going to be encouraged that this is a big step forward. I think that if it affects the dynamic it will be in a good way because you won't have to be anxious about keeping your secret from him. Also, while the focus of the therapy may shift, your therapist is not going to change his personality or his way of relating to you. Think about your experiences with him - he is going to continue to relate to you the way he has. The same things that earned your trust (maybe caring, supportive, helpful, nd/or safe) will still there when you see him on Monday. If you trusted him with your secret, trust him to respond in a way that will be therapeutic for you.
posted by metahawk at 12:30 PM on October 24, 2008

Calm down.

If you must, give an emergency call and ask him the same questions you asked here on mefi. There is nothing to be afriad of. Once you have control over your fears, it will be a lot easier to deal with the other stuff. As long as you are brave enough and persistent enough to try to work your way out of this and avoid self destruction, things can only get better from here. If your doctor makes you feel uncomfortable in any way, you should switch doctors immediatley. Otherwise, they can be part of the problem.

It is not likely that you will be committed to a psych ward, but it is a possibility. They will probably increase any medication dosages, etc. but if you do not feel comfortable admitting lies to your current doctor, switch doctors as soon as possible and start fresh. Make the next doctor see the better more improved you. Going from cutting yourself to openly admitting to several lies and recognizing the problem, then trying to prevent the problem, is a huge step. If you want to get rid of the idea/branding of the old you, get rid of anything from that past life. These changes will be a reminder of the better person you are becoming.
posted by johannahdeschanel at 12:37 PM on October 24, 2008

Good grief! Is that supposed to be reassuring?!
posted by small_ruminant at 2:05 PM on October 24, 2008

Is that supposed to be reassuring?!

Probably not, ruminant, but this is AskMe and not ReassureMe.

With no offense to johannahdeschanel, I don't think it was a great answer... not so much for the "likelihood of being committed" thing, which I can't speak to, but for the (imo) wrongheaded "switch doctors and act healthy" and "purge everything about your old life" advice.

But even where I think it's wrong, it's as valid a response as any; we shouldn't be holding back on answers that we think are truthful, just because they're also harsh.
posted by Riki tiki at 2:54 PM on October 24, 2008

I was committed to a psych ward once for a few days. It seems totally inconsistent how it's decided. I had admitted to several doctors/psych people before and after that incident that I was suicidally depressed and had plans on how to carry it out, but I was only committed that one time. Because it was a Catholic hospital, they were afraid for my soul (apparently).

At the time, I just wanted a change of meds, but they freaked out on me.

Sorry, that probably doesn't help. I second what other people here are saying about doing the business over the phone and asking the doc up front about commitment likelihood. FWIW, I don't think it's all that likely unless you state detailed plans about doing something in the near term.

The whole process really isn't very scientific.
posted by wastelands at 3:24 PM on October 24, 2008

You did the right thing. That's all you need to tell yourself over the weekend. If your therapist thought you needed to be hospitalized, he would not have waited to have a Monday appointment with you.

You feel very anxious now because you told someone an important truth about yourself. You're vulnerable because something that was a secret is now exposed. Just know that you must have trusted your therapist enough to tell him this very important thing, and let yourself be comforted by that trust. Be proud of yourself - this is a very big step you've taken. This should deepen your therapy relationship, as you're putting more of yourself into it.

Therapists are all different, and how yours responds will depend in part about his sense of you and how much experience he has with people who cut and think suicidal thoughts. If this is all new to him, he might get a little freaked out. But the fact that he scheduled you for Monday instead of insisting that he sees you right away implies to me that he's not freaked out.

On Monday most likely he will talk to you about the relative seriousness (meaning life-threateningness) of your thoughts and moods and behavior. He'll want to know if you are putting yourself in any risky situations (e.g., drinking while driving, walking on rooftops, going through dangerous neighborhoods) or if you are able to act in such a way as to care for your safety during the time between sessions. He'll also probably be curious about why you hid this and what made you decide to stop hiding it. This is important because he'll want to know if he can trust you to tell him when you're doing dangerous things or thinking dangerous thoughts in the future.

The question you need to ask yourself is not what will my therapist do to me, but what will you do to yourself. *Are* you going to be safe over the weekend? Do you have a social support system you can use to keep yourself safe? Can you make sure you don't drink/do substances, etc? Try not to isolate yourself where this anxiety will eat away at you. This will show both you and your therapist that you can manage yourself and be safe even when you're feeling vulnerable. And if you *do* decide that you aren't able to keep yourself safe over the weekend, don't hesitate to call him back to get the attention that you need.
posted by jasper411 at 3:58 PM on October 24, 2008 [1 favorite]

I don't mean to be harsh but if I did not think I could tell my doctor anything under any circumstance imaginable, I would seek a new one immediately. Allowing yourself to try to seek comfort or guidance or even clarity from someone who makes you feel like you need to lie is wrong. It is not your fault. It is not his fault. It is simply not a good match. I would still say to focus on the core issues, but if the communication issue is getting in the way, try to deal with that somewhere in your top priority list. Stop blaming yourself. You deserve to have someone who will listen to everything you have to say without making your shoulders cringe up to your ears with anxiety.
posted by johannahdeschanel at 9:18 PM on October 24, 2008

johannahdeschanel writes:I don't mean to be harsh but if I did not think I could tell my doctor anything under any circumstance imaginable, I would seek a new one immediately.

I think that's valid feedback, but one piece of information that's missing is how long the poster has been seeing this therapist. If it's only been the 6 weeks, then it's reasonable that they are still developing a relationship. I don't think any therapist expects people to come totally clean within the first few sessions.

To the OP: You are not going to be punished - that's not what therapy is about. When you see your therapist on Monday, be sure to relate these concerns. You probably feel a bit freaked because you were finally able to step out of your comfort zone and admit some scary things outloud. That's great progress, but it might not feel great.

Best of luck. These things are hard.
posted by dryad at 12:05 PM on October 25, 2008 [2 favorites]

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