Monday, October 31, 2011

Ask the Doc: How do I talk to my therapist about suicidal thoughts?

Sometimes I think it would be better for everyone if I wasn't around. I don't think I'd ever kill myself, but I'm worried that if I tell my therapist about it she'll have me committed to the hospital. Can she do that?

First, I'm sorry to hear that you're feeling that way. You'd probably be surprised at how many people share that feeling with you on any given day. One of the things that I've learned in my work as a therapist is that it is nowhere near uncommon to have suicidal thoughts once in a while. According to the American Foundation for Suicide Prevention, nearly a million people make a suicide attempt each year. For every one of those attempts, there are many more people in the situation you describe - not really wanting to die, but wondering how it would be to just not exist. We call this "abstract suicidal ideation" in psychology parlance, and it's a very uncomfortable thing to experience.

What you need to know is that your therapist is very willing to talk to you about what you're thinking, and unless you are unwilling to say that you'll keep yourself safe, she's not about to send you to the hospital. I've had clients who have had significant suicidal thoughts for months at a time, and the last thing I wanted to do was have them hospitalized. The fact is that, even though they were thinking about suicide and what it would mean, they were also continuing to function at work, at school, and in their relationships, and they were willing to keep themselves safe with a plan that we had worked on together.

Saying "I wonder what it would be like to kill myself" or "I've thought about suicide" are big flashing red warning signs for people around you, and I can certainly understand why you're keeping them to yourself around friends and family. Your therapist looks at things differently than your friends - that's why they're your therapist. Times like these are what we train for. We learn to ask questions about your level of intent, about whether you've got a specific plan, and about what you've got in your life that prevents you from acting on your thoughts. We learn to work with you to determine your level of risk, and to make a safety plan that fits your personality and your lifestyle.

If you truly don't feel as though you can keep yourself safe outside the hospital, that's another story. Don't keep that information from your therapist, because suicide is a permanent solution to what often turns out to be a set of temporary problems. But, if you know you're safe, and you need to pour your feelings out to someone without fear of overreaction, please talk to your therapist. Human life is a beautiful, valuable thing, and we're here to help you get the most out of it. To do so, we need to know what's going on with you. All of it.

One final note: if you're considering suicide, or just feel pretty awful, and you don't have a therapist, today is the day to start your search. As I said, life is beautiful. Consider this an opportunity to show yourself the love you'd show to a friend in the same situation, and get some help getting back on the path.

Best wishes, and thanks for reading!

*Thanks to reader Melinda F. for the suicide stat update!

Today's Assignment 10/31/11

Countless studies reveal the benefits of meditation. It's great for your physical and mental health and well-being. But, as with many things that are good for us, we often don't take the time.

Today's assignment is a quick and easy "walking meditation" that you can do at any point in your day. At some time today, when you're walking in your office, at the store, or at home, take a minute and change your mindset a little. Notice your breath... inhale and exhale with conscious intention. As you do this, as you breathe easily and deeply, focus on your feet and how they feel each time one strikes the ground. Feel the ground support you and help you on your way. Feel your feet working to keep you moving. Each step is a moment of conscious, centered gratitude to the universe.

I know that some of you have sore feet - the bane of modern, shoe-wearing existence. Take that moment to have some compassion and forgiveness for the pain, and some acceptance that your feet are doing the best they can for you.

Walking is a miraculous act. If you're lucky and abled enough to walk, give thanks. If you aren't someone who can walk, but can still get around, that's where to find the gratitude.

Happy Monday. Thanks for reading!

Sunday, October 30, 2011

Today's Assignment 10/30/11

When it comes to politics, my future father-in-law and I are on opposite sides of the spectrum. I delight in doing things like signing him up for emails from the Obama campaign. He returns the fire with an email volley of his own. Ours is a good-natured version of what has become an increasingly polarized political landscape. There's a difference, though. I think we learn a little from each other every once in a while.

It's easy to get swept away in rhetoric, and in defending "your side." When he writes me, I do my best to listen. I very much respect him as a person (his love for his children and his wife is abundant and clear), and I owe him the respect of listening to what he has to say. People express who they are through what they believe, and the world has shaped his opinions just as the world has shaped mine. In listening with an open mind and an open heart, I learn more about who he really is, and about what makes him tick.

Today's assignment might be tougher than it sounds. Take 5-10 minutes and listen, REALLY listen, to what the "other side" has to say. Drop your defensive stance and your exhaustive store of political facts, and just listen with compassion. Listen for THEM, not for YOU. Try this with politics, with religion, with "who was the best Dr. Who?," and you just might learn something you didn't know.

As always, I'd love to hear how it goes!

Saturday, October 29, 2011

Today's assignment 10/29/11

This one is all about appreciation and gratitude. We all have that mental list of people who create things that bring us joy - artists, musicians, writers, and others - and we often don't express that joy directly to them.

Today's assignment is to do just that - write a letter, make a post, drop an email to someone who has touched your life with their creativity. It might be a million-selling author, or maybe it's that woman who sells your favorite jewelry on Etsy. No matter who it is, open your heart and tell them why your world is better with them in it.

Don't expect a reply. This isn't about your need for contact. This about passing along your joy and gratitude.

Say something beautiful to someone who makes your world a better place through their creativity. That's your assignment for today!

Friday, October 28, 2011

Today's Assignment 10/28/11

Take five sticky notes. On each one, write "you're beautiful just as you are, and I love you." Put them in places where you'll see them every day - computer monitor, fridge, bathroom mirror.

People often resist these exercises for being "goofy." I often wonder if that's really where the resistance is.

Many of us have spent much of our lives learning less positive self messages. This is just a little tiny mind hack to start turning that around.

Happy Friday! Let me know how this goes!

Thursday, October 27, 2011

Today's assignment 10/27/11

Send a quick text or email to someone, telling them that you're glad they are in your life. Choose someone who wouldn't immediately expect that from you.

Wednesday, October 26, 2011

Today's Assignment 10/26/11

I've been doing a "Today's Assignment" for my friends on Facebook, and it dawned on me that it would be a lovely addition to the Doc Blog. So, let's go!

Today's Assignment: Listen patiently, with compassion. Don't worry about what it means for you. Think about what it means for them.

Saturday, October 22, 2011

Ask the Doc - Am I burning my therapist out?

Life has been a struggle for me lately. It seems like all I ever bring into my therapy sessions is an endless parade of bummers. Sometimes I worry that I'm too much for my therapist. Is that possible? Can too many bad events burn my therapist out?

The one thing I can tell you for sure is that you're not alone in your concern. It's easy to see your therapist as someone who is "paid to hear bad news." That feels pretty unbalanced. You certainly don't want a therapist who tells you all of their problems, but it can feel strange to just dump yours on someone.

I can't speak for every therapist, of course, but I've had conversations with plenty of clients who worry that they're bringing me down. Many colleagues deal with the same questions from clients, and we talk about what that means. Sometimes, concern about sharing things with your therapist can be a sophisticated defense against getting to what really bugs you. Sometimes you're just dealing with a social norm that doesn't apply to the therapy setting. Whatever the reason for it, undue concern for your therapist's well-being can definitely get in the way of getting your therapy work done.

I can honestly say that, while I think of my clients and their worries between sessions, I am infinitely more satisfied with the job I'm doing when a client "burdens" me than when they protect me. For many people, that act of "protecting" people is what has stood in the way of their ability to fully experience their emotions. And I firmly believe that until we can accept and experience our true emotions, we can't live a full and balanced life.

If you broke your finger, would you try and protect your physician's feelings by pretending that it didn't really hurt that much? Would you understate your pain so your doctor didn't go home and worry about you? Likely not. While it's okay to show physical pain in our culture, mental pain is a much more complicated subject. And as a therapist, it's my job to provide a comfortable and trusting environment with well-defined boundaries so you can fully experience your emotions without thinking that it's causing problems for me.

I'm much more tired after a day of trying to turn a casual conversation into something worth my clients' time than I am after a fully-connected, fully-disclosing session with someone who is really doing the therapy work. That's what I'm there to do. There's a lot of satisfaction that comes with feeling as though you have really helped someone by connecting with them.

This doesn't mean that your every visit to the therapist should include wailing, teeth-gnashing and the rending of garments. But, if you need to get there and you're worried that it will be too tough for your therapist, it's time to have an open and honest conversation about that very thing during your next session.

Thursday, October 20, 2011

Overcoming your fears

I was interviewed for a post on Lifehacker that ran this morning. Good information from several sources, including yours truly!

If you're here from that post, welcome! Please feel free to stick around for a while. I'm easy to find at if you've got any questions or comments.

Wednesday, October 19, 2011

Ask the Doc: How much should I email my therapist?

In this day and age, I use email for as much as I can. Sometimes I've got a question for my therapist in between appointments. Should I email her?

Therapists, like pack mules or carrier pigeons, sometimes have more trouble than most when it comes to grappling with modern accoutrements like computers and smartphones. I'm not sure why that is - with 4 teenagers around the house I have had to stay caught up or perish - but it seems like the psychology profession lags a little in this area.

That being said, your therapist should have a well-defined email policy, just like all of her other policies. For me, I draw the line at scheduling via email, and here's why. Email, as you know if you've ever used it (ha!) can be a very tricky medium when it comes to understanding emotional intent and emphasis. My work is all about emotion, and my concern is that one of us will misinterpret something that's said in a letter. Also, establishing an expectation that email will be returned sets up the potential for further misunderstanding. As I've said in the past, it is important to me that I treat all clients the same, and that all my clients understand my therapeutic "frame."

I have had clients express dismay that I won't engage in long email conversations between sessions, because their previous therapist was available 24/7 for them. They'd write, the therapist would respond. Some even continue the conversation after they are no longer a client. This is dangerous ground to tread, given the artificial immediacy of electronic communication, and sets the therapist up for possible ethical violations. Once someone is your therapist, that's their role. Converting clients to friends or confidantes via email is a very slippery slope.

So, in short, scheduling = yes. All other communication, especially therapeutic or just "saying hi," = no.

And, if you have any questions about this post, feel free to drop me an email, because I'm not your therapist. :)

Sunday, October 16, 2011

Real life gratitude practice

Yesterday, my 12-year-old daughter and I were in my car, leaving the grocery store parking lot. As I started turning left on the green light, I saw a white blur out of the corner of my eye. Seconds later, we were crunched by a big white Dodge RAM pickup.

I was glad I'd caught a glimpse of him as he swung around a slower car and tried to make the light. I was able to turn away from the main impact, and my daughter and I walked away, mostly unscathed. She's got no soreness, and doesn't even seem that affected by the wreck. I'm banged up a bit, most likely because I was able to see him coming and that tensed me up.

I write a lot about gratitude here, and I really like to practice what I preach. So, here's what I'm thankful for:

First and foremost, I'm thankful that no one was injured.

I'm thankful that the guy who hit us was covered by insurance.

I'm glad it wasn't my fault.

I'm thankful for the reminder that cars, for the most part, are big scary things. I'll bear that
in mind next time I feel like my light rail commute is taking too long.

I'm glad that I had my car as long as I did. I loved that car. It will be missed. I'm also
thankful for the reminder that things are just that - things. A car can be replaced. People can't.

And, I'm thankful that this unfortunate event has brought me back to my blog. I hope you've missed it as much as I have. Life's too short not to blog!

More soon!