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I wish Tdocs would be specific with 'risk'


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I wish psychs would just say what they mean in terms of what 'risk' means to them.

I’ve had psychs in the past who have taken issue with me self harming. Others don’t. One said ‘I’d rather you self harm because it means you’re trying to stay alive and keep from going to a place where you might kill yourself’ whereas another thought it was the end of the freakin world and would go into risk mode of telling everyone and taking my blades and shit.

Now I have to deal with a new psych who won’t tell me which fence she sits on. I want to be able to talk to her about it. Especially as I don’t see getting through til I see her next without it. I don’t know if she’s team, ‘don’t do that or else’ or just ‘I don’t want to tell you that its okay because its not, but also I understand it just means you’re having a really hard time and are doing that best you can to cope’.

Just be specific. Please? ‘Hurt yourself’ can mean one of two things ‘self harm’ the act of hurting oneself to elevate emotional pain without the intention of dying or ‘suicide’ the act of trying or succeeding to take ones own life. It's really frustrating, I like to be honest about this stuff, like if I’m trying to get help, I might as well right? But I can’t be if I don’t know this stuff. I have ask straight out multiple times & got no real answer.

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I'd find that kind of inability to give a clear answer to be disconcerting. I know that I've definitely done better (and worried less, therefore less anxiety, therefore more resourceful to be able to use other coping methods) when I can be really clear with my healthcare team about what's going on in my mind and where the line is for each of them about needing to take action on my behalf even if I don't want them to.

I wonder if your psych is taking it from more of a contextual approach in that each episode of self harm might be different with regard to its intent, severity, outcomes, etc, and wouldn't want you to feel betrayed by a generalized answer. Or maybe she's afraid you'll try to hide information from her if you think she'll take protective action? IDK. It seems like you've tried to talk directly about the issue itself. I wonder what might happen if you talk about your frustrations with her lack of clear answer, and also phrase it a little differently so it's less focused on self-harm and more focused on "under what circumstances would you need or feel the need to get other people involved in my care based on an assessment of danger? and how do you define danger? where is that line for you?"

 

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I've had similar issues, but more with therapists/psychologists than with psychiatrists. One of the psychologists I used to see I could discuss pretty much anything with and he always erred heavily on the side of privacy over safety. Nobody else I've seen is like that and everyone is always at least somewhat unpredictable in some areas, unlike him. I've gotten better help in many ways from other therapists, and having them occasionally do something against my wishes for safety reasons isn't universally all negative or a complete overreaction, but I've become significantly less open about how I really feel as a result of this.

Also, the repeated and often very extended hospitalizations for mental health reasons combined with having unsuccessfully tried far too many psych meds and getting unsatisfactory results from the whole experience has led to me feeling very strongly that it is pointless to keep trying and I'd rather be much less honest in general in order to avoid relatively pointless hospitalizations (something that inevitably will lead to me getting stuck in a long-term facility, which I don't want - and even short term hospitalization is just not worth the costs, financial and otherwise, and I always feel like I'm just wasting resources that would be much better used/needed for other people, even if I do temporarily improve from hospitalization).

I'm veering off topic at this point and into yet another existential crisis. I'll shut up now.

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Thanks Wooster, they seem like reasonable things she might be doing, who knows. They seems like a good approach I might try, I would like to know in general as well. I can definitely relate to what you're saying too, I kinda want to self harm to just be like well let's see what happens. God my brain sucks.

JustNuts it is good to know where you stand, we don't do long term hospitalisations/its really rare so at least I have that on my side, plus no one will admit me for more than 24 hours anyways, tbh.

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So I gave her a note that basically said what you had, she said that it's if I have a certain plan for a close date, ect. Just the standard stuff. I had also self harmed this week so I told her & it was fine. She wants to check in about it & my suicidal risk ongoingly now though. Thanks.

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My experience has been that as I've grown older (and am a self-sufficient adult, no longer a teenager dependent on my parents), my doctors are less likely to lose it over self-harm. Then again, I've been seeing progressively more experienced doctors.

I've been burned, though, by not knowing where the line is. As a result, I err toward the side of sharing less, even after having straight up conversations defining boundaries.

Good job talking with your tdoc about this, it's not easy to confront someone who is being unclear.

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