Posted by Peter S on November 11, 2000, at 21:03:19
In reply to Re: Uhh.....welll......., posted by coral on November 11, 2000, at 12:22:21
Dear Coral,
You may have misunderstood what I was getting at. I was not saying that his responsibility was to try and hospitalize me. If you have ever dealt with suicidal people, which I have (I worked in a crisis clinic for a year), you know that there are certain factors that make suicide more likely. These factors include: previous attempts, a plan, intent, means (for example access to a gun), family history of suicide, history of unremitting depression, and lack of social support.
If someone goes into a crisis clinic and says they are suicidal, they would probably not hospitalize them as a "danger to self" unless they demonstrate the first three: a plan, means, and serious intent. (Most public hospitals wouldn't accept the person unless these conditions were met anyway)
When I was suicidal I had intent, a plan, but not the means (a gun). So it seems very easy to say the therapist is absolved of legal responsibility for doing anything.
Ethicial issues are a little more subtle, however according the the ethical code (upon which one's license is based) one of the primary responsibilities is to "do no harm". I would contend that it is harmful to predict something as unknowable as suicidal action. There are many cases of people who kill themselves with absolutely no indication of any of the above factors. So noone (especially a therapist) should ever say something like "I don't think you're going to do it". After talking with him that day, I felt more at risk than before. And no I didn't do it- but if someone had given me a gun, who knows? It is incredibly arrogant and unethical to make statements based on statistics- I would call it gambling with people's lives. There is always the "see I told you so" vindication- but what about the next time, or the next client who may be a little more impulsive?
Ethically, a therapist must try and reduce the odds of someone's killing themselves as much as possible. This means fully exploring it and giving as much support as possible. If for whatever reason they have difficulty doing this, they should not have a license.
I hope this clarifies what I was trying to say. And no I am not going to write a letter to the Ethics Committee. After talking with him, I think he knows that it was inappropriate and I'm sure that he didn't mean overtly to cause any harm. But next time I think he will be more cautious and when it comes to suicide, being cautious is the best policy.
Peter
> Dear Peter,
>
> Please forgive me if this post seems insensitive to you.
>
> Unquestionably, a trusting relationship between you and your therapist is crucial to recovery. If that relationship does not exist, and the difficulties are not due to the inherent process of therapy, find another therapist immediately. It seems most considerate and responsible for you to let the therapist know your concerns.
>
> Now, to the potentially insensitive part... the fact is you didn't commit suicide, so the therapist was right on that point. (This is NOT to minimize suicidal risks.) On the other hand, had your therapist considered you to be at risk for suicide, he would have been required to take immediate steps, which probably would've included involuntary hospitalization.
> As far as his never having been depressed, for me personally, that would not be a detriment if I felt trust and competence with him. I wouldn't expect an endocrinologist to have diabetes to effectively treat diabetes.
> During therapy, I told my therapist that I was having suicidal thoughts and he said that he'd expect that, given the relapse of my depression. I've also told him that I'd given thought to killing my sister. Therapy requires a significant amount of judgment on the therapist's part and a significant amount of mutual trust between the client and therapist. In my case, he made a judgment that I would neither commit suicide nor kill my sister, and he was right. I trust him and feel free to say whatever's on my mind to him. If I felt that by indicating suicidal thoughts, I'd wind up involuntarily committed, I'd never open my mouth in therapy. My point is that if your therapist isn't helping you and you're certain that you're not resisting hearing difficult things in your therapy, fire him. Without trust, the therapy is doomed. I fired my first therapist after three sessions without a backward glance, so please don't hear me to be saying that therapists are gods and always right.
> Good luck,
> Coral
>
>
>
poster:Peter S
thread:47978
URL: http://www.dr-bob.org/babble/20001102/msgs/48690.html