how do I keep my son alive?

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Question:  Last week my 22 year old son tried to kill himself.  He survived and now he claims he is ecstatic to be alive and he will never try something like that again.  He wants go off his medication (his point is it clearly didn't prevent a suicide attempt) and he really does not want to go to therapy.  He wants to handle it all on his own.  He made a crisis plan with a therapist but I just don't feel like that is enough.  What can I do?  

Answer:  Try to force a 22 year old to do something they don't want to and get ready for a colossal failure.  Instead find out what does work for him and help him get greater access to that kind of support.  

In general people do not make suicide attempts because they want to die, they want to escape from the pain they are in and they cannot concieve of any other way.

If we start with the postulate that overwhelming suffering leads to suicide attempts we have two goals:  suffering management, suffering prevention.  

For most people we lessen the discomfort of their symptoms (depression, anxiety, etc..) through medication and learning coping skills.  We prevent the suffering from re-occurring or decrease it in the long term through exploring it's causes in therapy.  This process does not work for everyone.  


It sounds like for your son the concept of therapy and medication = feeling weak and exposed.  Most young men feel like accepting help makes them a failure in some way.  If we cannot get him to change that feeling we must find out what other kinds of support we can surround him with that will work. 


Many people struggle with weight loss because they assume it will mean denying themselves all the food they love, feeling hungry, and the kind of exercise that they equate with torture.  When they learn that change does not have to equal suffering they can make great strides.

Talk to your son, find out which aspects of counseling he dislikes most and which ones he might be okay with.  If he likes talking to friends but hates talking to strangers then help him make a list of which friends he can talk to about which issues.  A major key to relapse prevention with any issue is having a person you are connected with who you can have 24 hour access to and tell anything.  Even if your son was working with a therapist having a "sponsor" who he could, and would call if he was struggling is key.

The next step is to make sure that go-to person can handle the challenge and will call for help (even 911) if the situation overwhelms them.  

People who will not consider medication need a physical method to produce some of the brain chemicals that will give them a boost.  My first choice would be Yoga, and second would be any martial art.  We want your son to have access to a soothing technique that can use a lot of energy and calm at the same time.  We want something that he can do by himself at 3 AM because when people are alone and do not have access to their support network they are at the greatest risk for suicide attempts.


Jogging is a wonderful thing but if you try to do it in the middle of the night you get arrested.

In short, you should be nervous.  No matter how good your son claims to feel right now he will feel overwhelmed again.  You cannot force him to take supports he does not want so the best thing you can do is find out what supports he will take and use and give him as much of them as you can.  Communicate with him and his support network regularly and look for changes in sleep, energy, mood.  If you think something is wrong ask directly.  You might risk offending him, but that is better than risking losing him.

The good news is if he can learn some coping skills that get him through the roughest times his suffering will always wane.  Every hard times he survives will be a memory to help keep him afloat through the next bout of suffering.  It may never become easy, but it does get easier as long as he finds the support that works for him. 

no time for therapy

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Question: My wife is anxious, sad, and irritable much more often lately and I finally got her to agree that counseling might be a good idea, but she keeps saying she has no time for it. She is very busy with work and the kids. How can I help her find time for this.


Answer: Any person who claims lack of time is their main reason for not doing something is holding back their real reason. Lack of time is just an excuse. We make time for the things that are really important. Do you think anyone feels they have time for chemotherapy? How about dialysis? These things do not fit well into our schedules either and yet if someone tried to claim they did not have time to do something that would keep them alive we would have them institutionalized.


I am a very busy person and often I do not have time to work out. BS! While I am busy I could always choose to drop on the floor and do a few push ups and sit ups. Allowing myself to believe I am too busy keeps me safe from the guilt I would feel if I admitted my real reason; I don't want to work out. Even if I did want to I would rather do something else more, like sleep, eat, watch TV.... We all have priorities we all make choices. So why isn't becoming emotionally healthy at the top of everyone's priority list?


One of the best quotes I ever heard was that offering someone therapy is like giving them an aluminum ladder out of hell. It is horrible where you are but to take and grab on to something that is going to burn you is hard to get yourself to do.


There are two major threats that therapy brings with it: What if it doesn't work, and perhaps scarier, What if it does work?


What if it doesn't work: People like to have a plan of last resort. Like a "do not break glass in case of emergency" plan and they are afraid if they use the worst case scenario plan and it does not work they will have nothing, no hope at all. Often they will tell themselves that they will go to therapy if it gets "bad enough." And in the meantime they wait and suffer, enduring more damage by the day, needlessly. If therapy doesn't work they might have spent time, money, and exposed themselves to some weirdo who might judge them, or tell them to change things in their life that they can't or don't want to change. Going to a therapist represents a much bigger risk than most people realize, until they think about going themselves.


What if it does work: People often grow to count on their negative coping skills. Many self injurers call their behavior "their best friend." Gamblers often enjoy gambling. If therapy works they may not be able to do this thing they have counted on anymore. Most people are successful in many areas of their lives and part of them may believe that if they lose their suffering they may lose the vital ingredient that made them successful in the first place. "If I wasn't anxious maybe I would become a fat lazy slob and let everything fall apart."


Another danger of counseling success is the fear of regret. If we have been suffering for a long time we convince ourselves there is no solution. If it turns out that there was a solution and we did not need to be suffering we feel like fools for having wasted so much time. Many people would honestly rather continue to suffer than feel the pain of regret.


The idea that anyone cannot find an hour a week to make their emotional health a priority is ridiculous. Even if you do not live near any therapist there are counselors and life coaches who will work with you over the phone or over the Internet.


If you can give counseling one work week, 40 hours, and you are working with a therapist who is a good fit for you, it will change your life for the better. 40 sessions may seem like a lot, (and you should know if the therapist is a good fit for you in 4 sessions) but ask yourself how many hours it took to get to feeling the way you are. 4000? 40,000? An investment of one work week is a small price to pay to potentially make a change that can transform your life and the lives of those who care about you.


You cannot force your wife to make time for counselling. But you can tell her that watching her continue to suffer is very painful for you, find a way to get all of her extra jobs covered for that hour window once a week, so that not having time can no longer be her excuse.

Do I NEED therapy?

Dear Maigler, I just finished my freshman year of college and it kinda sucked. I broke down talking to my Mom the other day and now she is pushing me to go talk to a therapist. I’m not emotionally unstable I just had some stress. What would a therapist do for me anyway?

Noneed Fortherapy

Dear Noneed,

You probably don’t NEED a therapist. 90% of the people I have worked with in my career do not NEED a therapist, in that they would not die, or even have a terrible life if they did not seek counseling. I think the problem is the way you are approaching the issue. The question is not do you need therapy, but instead could you benefit from it?

For years I have worked with clients who have been resistant to the idea of counseling. I make them answer a series of questions:
Why would anyone want to talk to a social worker?

I don’t know. They have problems.

Doesn’t everybody have problems, why wouldn’t they just talk to their friends?

Maybe they think their friends don’t have any knowledge about that stuff or it is embarrassing.

Yeah, a social worker may have more experience and knowledge talking about a particular subject, but that isn’t the main thing most people like about it. Have you ever had a friend and then later you weren’t friends with them any more?

Yeah, so what you’re saying is the therapist or social worker will keep things to themselves.

Absolutely. whatever a person says to me in a session I cannot say anything about it to anyone unless it involves a person hurting themselves, hurting someone else or anything to do with abuse of children or the elderly, in which case I’m a mandated reporter. If I break confidentiality for any other reason I can be reported to the state and lose my license.

How about this, are friends ever biased? Ever had a friend who didn’t like your girlfriend, or who didn’t get along with your other friends?

Yeah

That is the real beauty of talking to a social worker/counselor. I’m not part of your life. We don’t hang out. If you and I talk and you don’t like what I have to say you can walk away and never see me again. It doesn’t work that way with friends. They have a stake in your life. If they want you to go to University of Vermont with them and you want to go to UC Boulder, they are going to try to influence you. I just help people decide what they want.

Did you brush your teeth this morning?

What?! Yes!

Did you look in the mirror while you were brushing your teeth?

I guess. I don’t know. Probably, yes.

What does the mirror do for you?

It helps you see if you missed a spot, or if you have toothpaste on your face

But it doesn’t reach out and wipe it off for you does it?

No

I’m like a mirror. I don’t fix people, or change them, or judge them. I just help people to see the things in their life that they are too close to. I’m not smarter or better than the people I work with, I’m just a tool that people can choose to use or not.

Who is the best golfer in the world?

Tiger Woods

And you know what? Tiger Woods has a golf coach. It isn’t because he isn’t a good golfer. It is because even the best there is can do better if he is willing to accept support.

I believe every person could benefit from counseling/therapy/life coaching. Many people take the suggestion that they seek counseling as an insult. I urge you not to see it that way. Realize that you don’t get extra points in life for suffering and if counseling could help instead of saying why me, maybe you should say why not me?