I want to be taken seriously, but . . not THAT seriously.

March 4, 2011 8:37 AM

So, I need to find a therapist, but I need to figure out how to bring up the things I want to address without setting off a series of unfortunate events.

I am pretty sure I'm depressed. I think I probably have been, on and off, but right now circumstances are such that I'm pretty sure. There are additional family, probably genetic things at play that I want to talk about, but at least one of them is hot-button (panic button?).

1. A close female relative basically spent her entire life in what I can only describe as deep paranoia/persecution complex. Basically, everyone hated her and everyone was trying to get away from her, etc. As my stressors have increased lately, I've seen some of this "crazy" manifesting in my thoughts and words. DO NOT WANT.

2. Another close relative (same side of the family) committed suicide fairly young (before 50). The best way to put the way I feel is that I really, really understand that he wanted out because he was overwhelmed and couldn't find a way out. I don't want to kill myself, but I have thought about it, and sometimes things seem so insurmountable that I would love to disappear - but any sort of "disappearance," I recognize is going to be its own set of problems. However, I'm pretty sure my fairy-tale solution shouldn't be shuffling off this mortal coil. It's a little bit freaking me out lately.

I DO NOT WANT OR NEED TO BE COMMITTED. I'm not a danger to myself. I just dislike these thoughts and ideations and I want to feel good again. The one time I've tried to bring this up to someone in the past they were way too cavalier about it, like, oh well you're not going to off yourself so you're fine . . which . .no. Not so much.

How do I talk about this to a therapist so that I'm taken seriously but without getting into a situation I don't want?

posted by anonymous to Health & Fitness (21 answers total)

If you can talk to a therapist about what you're thinking and feeling mostly and then towards the end mention (if s/he doesn't already ask) 'There's some relevant family history that you may want to know about' and say what you said here.

Honestly, it is probably entirely unrelated that you're depressed and your family members had some mental illness issues.

I cannot imagine that mentioning your family would get you committed.
posted by k8t at 8:45 AM on March 4, 2011

You're extremely unlikely to be committed for telling a therapist that you understand the motives for someone's suicide. You are not a danger to yourself or others. Emergency psych beds are hard to come by and they're not cheap, and they're not going to use one on someone who is not in immediate danger.

Absolutely tell the therapist about your family medical history. To do otherwise just leaves unnecessary roadblocks in your treatment.
posted by rtha at 8:48 AM on March 4, 2011 [7 favorites]

Find the right therapist. Seriously, someone who dismisses you because you're not a danger to yourself like that just isn't doing a good job. If things were alright you wouldn't be in their office.

One thing that helped me was that my wife was telling me how she thought I was acting all depressed and stuff. When I went in I got to say it that way instead of just that I thought I was that way. Might not have helped with the diagnoses at all, but it was easier for me to say that she told me those things.

Assuming you're not a minor, and if you're really not a danger to yourself, then you probably won't be committed without your consent. So the big worry here is to get someone who will take you seriously enough.

Like you, I'd thought about it. I got lucky the first time and went to a therapist who took me seriously enough to send me to a psychiatrist who took me seriously enough to give me Pristiq. That combined with knowing that my thought patterns weren't normal have been great.

MeMail if you need it.
posted by theichibun at 8:49 AM on March 4, 2011 [1 favorite]

I don't know where you are, but I know in a lot of the UK there is more demand on mental health beds than supply - so you have to be very, very seriously mentally ill to be committed.

Even if that isn't the case where you are - those aren't 'panic button' issues; they're something you want to talk about, but you are your own person, you're not them. You're not a danger to yourself just because family members have had serious mental health problems. If we went around committing people because a family member had serious mental health problems the mental health system would collapse overnight.
posted by Coobeastie at 8:53 AM on March 4, 2011

Before answering, please read these parts carefully:

"I don't want to kill myself, but I have thought about it, and sometimes things seem so insurmountable that I would love to disappear - but any sort of "disappearance," I recognize is going to be its own set of problems. However, I'm pretty sure my fairy-tale solution shouldn't be shuffling off this mortal coil."

"I just dislike these thoughts and ideations and I want to feel good again. The one time I've tried to bring this up to someone in the past they were way too cavalier about it, like, oh well you're not going to off yourself so you're fine . . which . .no. Not so much."

Based on this, I think that the OP is letting us know that in addition to the family history, there are other thoughts and feelings that they would like to express to a therapist without fear of being put in forced treatment. OP has a very valid concern and the fear is valid. People are sometimes subject to incarceration, forced treatment programs, forced drugs and electroshock therapy based simply on what they say to a therapist or doctor about their thoughts or feelings.

But not all therapists or doctors believe in medicalizing mental health issues to such an extreme, and many do believe in patients rights to make choices about their treatment or options. In the US today, in most hospitals if you go to a doctor and say you've been thinking about suicide and came up with a plan but don't intend on doing it, they will force you into in-patient treatment with or without your consent. I speak from experience about this because it's happened to a family member.
posted by jardinier at 9:04 AM on March 4, 2011 [2 favorites]

I think most doctors/therapists would put you on meds before putting you in a hospital bed.
posted by L'Estrange Fruit at 9:40 AM on March 4, 2011

In the US today, in most hospitals if you go to a doctor and say you've been thinking about suicide and came up with a plan but don't intend on doing it, they will force you into in-patient treatment with or without your consent.

The key part of that sequence is "came up with a plan". Vague thoughts about suicide or wishing one were dead or gone are extremely common and very unlikely to result in involuntary commitment. It's when a patient indicates that he or she has a concrete plan for his/her suicide that the "threat to yourself" flag goes up.

If there are aspects of your depression or family history that you feel especially anxious about disclosing, perhaps don't lead with those. You should feel comfortable confiding in your therapist, and if at the first session you don't feel good about opening up, keep the more private details to yourself and try out another therapist next time.
posted by unsub at 9:47 AM on March 4, 2011 [7 favorites]

Most therapists aren't involuntary-hospitalization-happy. Most are concerned about the actual human being they're speaking to, and what would be the best and most helpful way to address their symptoms. Most will do a very serious and thorough assessment of your risk level for potentially harming yourself, and will recommend an increase in outpatient treatment (twice a week sessions, and/or a psychiatrist, and/or maybe a support group) and social support (encourage you to see the helpful people in your life more); the first step is generally not "HOSPITAL NOW AND YOU HAVE NO CHOICE". It's pretty stressful for a therapist to actually "have someone committed", and I'm sure that many are considering the potential for a malpractice suit if they were to jump to that decision.
posted by so_gracefully at 9:49 AM on March 4, 2011 [2 favorites]

It might not have been a concrete plan, but I had definitely had how it could happen thoughts go through my head. And not just vague "I could slit my wrists" stuff either. There were "I could just run into this wall" while I was driving home over a bridge thoughts too. It's one thing to have the thoughts when the tools aren't within your reach. It's another when it involves the car you're driving at that very moment.

There was no mention of hospitalization with either person I talked to.
posted by theichibun at 10:01 AM on March 4, 2011

Legally, it is actually quite difficult to have someone committed against their will. Nothing you've written in this post indicates that you would fit the criteria for an involuntary psych hold. Being encouraged to check in for in-patient therapy? I can't speak as to whether or not a therapist would bring that up, that's entirely possible, but there's absolutely nothing here that sets off alarm bells for being checked in involuntarily.

I've been to several therapists for Major Depressive Disorder - some were awesome, some made things worse. What really helped me was seeing my primary care doctor first, getting on anti-depressant medication, and then following that up with therapy. YM, of course, MV. Your primary care doctor is a good person to use as a sounding board for issues like this and will be able to refer you to a therapist. You may not have luck with the first therapist, but keep at it until you find someone you feel comfortable with.

Your family history is relevant in terms of piecing together the total puzzle of factors that influence your life, and thus by extension, your depression, but you absolutely stand no greater chance of being involuntarily hospitalized for it. I have family members who are way, WAY off the deep end and some who have been treated and some who haven't, and to my therapists this has just been another piece of information that helps them see what could be going on. It's never, ever been an issue in terms of "Oh, your relative committed suicide, you could too." I've never had that happen.

Best of luck to you. It's very hard to start down the road of treating depression, those first steps are always the most difficult to take. It seems so totally overwhelming, but truly all you need to do right now is to call your doctor and make an appointment to talk about depression. From there, things will start moving on their own.

Take care of yourself and let us know via mod how things turn out, if you can.
posted by sonika at 10:02 AM on March 4, 2011 [1 favorite]

It may help you to write out some things beforehand and bring two copies (one for you, one for the therapist) to the first appointment. This can be especially helpful if you're worried that a) you'll forget something, b) the conversation will turn to something else, voluntarily or involuntarily, c) you will be too nervous to bring something up.

A side benefit of doing that is that you will likely appear much more organized and thoughtful about your needs and potential treatment. Self-awareness is pretty big, especially if you have a complex history and have considered any type of self-harm. But I think you'd be hard-pressed to find someone with depression who HASN'T thought about suicide at one point or another. The way in which you describe this, carefully, can help you figure out the proper response.

Example: I was at a really, really crappy point in my life during college (13 years ago -- geez, I'm old) and did NOT want to be in that situation anymore. I described it in a way similar to yours: I wanted to "hibernate," where nobody would bother me and I didn't have to think about anything or have any responsibilities, even in keeping track of myself.

The key is that even though you want to escape, and it feels desperate, you a) are stopped by seeing that it would hurt other people or ruin certain situations, b) HAVE NOT MADE A PLAN, including the preliminary steps of thinking about a general method. You can clearly see that this is a permanent solution to a temporary situation -- and yes, your "temporary" situation may have been going on for a very long time with no end in sight, but that's why you're at the therapist's office, and you want to be better.

Think about your responses to questions such as these:
--Why am I seeking treatment NOW? (More recent or acute things, triggers, etc.)
--What are some long-term issues that I've been dealing with? (Family or relationship stuff in general, patterns in your life, etc.)
--What are some contributing factors? (Use of substances, life-changing events such as divorce or death of someone close to you, family history of illness -- mental or otherwise)
--What do I want to get out of treatment? (Better relationships with people, looking into possible medication strategies, learning strategies to cope with anger/anxiety/self-defeating feelings, etc.)
--What are some things that have helped me or discouraged me in the past when I have tried to deal with these issues?
--How do I prefer to be dealt with? (Direct, blunt, obliquely, comfortingly, etc.?)
--How can I tell that someone is listening and paying attention to me? What is important to me in that sense?

You know there are loads of us MeFites out there who have been in similar situations and want to give you their support. We're here; there's help. You can do it.
posted by Madamina at 10:22 AM on March 4, 2011 [5 favorites]

There are some great suggestions here, especially to really think about what you want from your therapist, write it down and bring it with you. If they won't help you with those goals, they're wrong for you. You've identified clearly in your question that you just want to feel better. And as Madamina says, there are lots of people who have dealt with this who are there to support you. And there are many ways you can go about finding that support and healing yourself. Don't forget also that no matter the social pressure, you can break up with your therapist at any time and find another one.

For more inspiration about ways to overcome the stigma, and resources for finding community have a look at this article about Mad Pride in the NYT.
posted by jardinier at 10:29 AM on March 4, 2011

I think if you tell your therapist what you've put in this askme (you could even print it out and bring it with you), it would be a good start. There's a huge gap between "I have considered suicide" and "I am a clear and present danger to myself and others." The former is, honestly, a lot more normal - particularly but not exclusively among depressed folks - than one might think. If you're accurately describing your level of suicidal thoughts and (general lack of) planning, you will not be faced with the suggestion of inpatient treatment.

... and on preview, Madmina just knocked the answer out of the park so I'm going to stop my pitching right here.
posted by rmd1023 at 10:34 AM on March 4, 2011

You're unlikely to be committed unless, in my experience, you've threatened suicide or become an obvious danger to yourself and someone (yourself included) has called the police.
posted by The Great Big Mulp at 10:39 AM on March 4, 2011

Seconding unsub's suggestion that you be open to trying out more than one therapist - it may take a few consults before you find a good fit. Madamina's list of things to think about and bring up is terrific. I would also tell whoever you meet early on that in your prior experience you found your therapist dismissive, and that you're also concerned about someone not really hearing you and overreacting.
posted by paindemie at 10:43 AM on March 4, 2011

In most states the bar to hurdle to commit someone is exceptionally high. As Mulp said, it's usually a requirement that there be an imminent danger to harm yourself or others. While there's some short-term options in some states, the odds that a professional is going to exercise them against someone who is seeking help of their own free will I would say is pretty much zero.

Are you honestly worried about this as something you see possibly happening or are you using it as an excuse not to get treatment? As someone who avoided coping with my own depression for years I'm saying that not as a judgment but as a recognition that sometimes we go out of our way to find techniques to avoid change.

What's up with the big mess o help/resources we discussed putting together for people in need? I don't see a link in the FAQ. The wiki has pages on resources and psych recommendations.
posted by phearlez at 10:48 AM on March 4, 2011

I've lived with depression since I was quite young, and the feelings you describe—of being overwhelmed, of wanting to escape, to disappear—are very familiar to me. I've also been to any number of counselors, therapists, psychologists, psychiatrists, and discussed these feelings with them, and I've never been involuntarily committed to any kind of institution.

You're concerned about these feelings, and you want to communicate that concern to a professional, but you don't want to accidentally overstate things and give the impression that you're closer to the brink than you actually are. So here's what you say:

"Sometimes I struggle with thoughts of suicide. I don't make plans or have elaborate fantasies, and I'm not worried that I'd actually do it—but even just thinking about it is freaking me out. I know it's unhealthy, and I want to stop."

A professional (in many jurisdictions) is legally and ethically obligated to report someone who intends to hurt herself or someone else. Thoughts are not intent. Be clear about the nature of your thoughts, be extra clear about your lack of intent, and assuming you've sat down with someone competent, you'll get the care you need.

MeMail me if you want to talk about this further, and hey—good luck.
posted by Zozo at 11:43 AM on March 4, 2011

My suggestion would be to start with someone who is unlikely to view mental health through such a medicalized lens. I see a gestalt therapist (who I think is a social worker by way of credentials, though she might be a psychologist?). In the 5-6 months I've been going, diagnoses, pathologies, and the Mental Health Industrial Complex have not come up (despite my private opinion that I could possibly. It seems like that's really not the preferred approach within my therapist's discipline.

That said, if she felt that my problems were more medical in nature, I'm sure she would refer me to someone else. But I have confidence that we would work together and that she would respect the fact that I am a full human being with a right to determine my own medical treatments.

An additional suggestion would be to be honest at your initial session about why you are looking into therapy. If you are seeking therapy because you are having suicidal ideations, that will definitely be an immediate concern. However, if you are seeking therapy for low level depression, or because negative thoughts are preventing you from living the life you want to live, or whatever reason you or anyone else might seek therapy*, start there. Answer intake questions honestly. Let the therapist do his/her job. As long as you don't go in there all, "I'm interested in therapy because I have this concrete plan to kill myself", you're probably fine.

*I've actually had thoughts of suicide in my past (not directly leading up to therapy or since I've been in therapy). This has never come up with my therapist. It's just not relevant to what we're doing. I don't even recall a specific question in my intake about past mental health history or family mental health histories.
posted by Sara C. at 2:57 PM on March 4, 2011

I'm in therapy, have been very depressed, and also worked on a suicide hotline and really: The PLAN is what tips you from ideation/low risk behavior to high risk/call 911 behavior. I'm almost reluctant to draw that kind of line with the worry that people who are suicidal will hide their plan in fear of people intervening, but it's pretty widespread knowledge that having a plan tips you to high risk, not a huge secret.

As others have said, it is HIGHLY unlikely that anyone can or will try to force medication on you. If a doctor or therapist recommends any course of action you don't agree with, please try a second opinion. Don't let anyone bully you into any course of therapy or medication you are not comfortable with.

As a sufferer of mental illness or not, just as people generally, our greatest strength is our freedom to make our own decisions. Even in the darkest places, knowing you have this decision will carry you through. But the decision needs to be for yourself, and for whatever you honestly believe will get you to a healthy place, because that's the only way to live life.
posted by sweetkid at 5:18 PM on March 4, 2011

You just need to be clear about two things, for yourself and with the therapist -
1. you are seriously concerned about some of your thoughts recently and you want help - (What you describe sound like signs of mental illness that need treatment. It is good that you are not procrastinating about this.)
2. while you sometimes think that it would be nice to disappear, you do NOT want to commit suicide, you want to get better. If you are not an immediate risk to yourself, there is no reason for forcible commitment. There could be some future risk if you don't get treatment, but that is why you are there.

You have two things going for you - you recognize the problem and you are committed to changing your situation. I am not a doctor but your situation seems hopeful. I wish you the very best.
posted by metahawk at 10:21 PM on March 4, 2011

Wanting to disappear to stop the suffering is not the same as, "I'm hoarding medication" or "I just bought a gun." I have PTSD and drug-reistant depression and have wanted to just be gone. When my psychatrist asks me if I'm having suicidal thoughts I answer honestly that I don't feel suicidal but sometimes I want to be done with it all. I think lots of people feel that way at times and I don't see harm coming to you by talking about it. You certainly won't be hospitalized against your will for saying, "I've thought about not being here." And there is no doubt the fact that you had a family member commit suicide is *not* going to get you hospitalized, even if you wanted to be hosptialized.

I also don't see you having a hard time getting a (good) therapist to understand how difficult things are and that you want to be taken seriously about your concerns. As others have suggested, you might want to consider the idea of going to just one session, remembering that if you don't feel heard you don't have to go back.
posted by orsonet at 12:26 PM on March 5, 2011