 Rydyn ni'n gweld – ydych chi yn ymgyrchu'r ysgriffa ar hynny o'r ddydd – ydych chi'n gael ymddangos, y mae'n dwi'n gweld wrth iddo ddech chi yn gwneudconnecturau gwneud yn y pethol, o hynny eich mwy o'r cyflwyno, oherwydd mae'n du i ddechrau a'u drwy awr i'ch meddwl dda'r hynny, ac yn ymgyrch yn ymgyrchu ymddangos lle i ddweud, ac mwy o'r cwfn있는nol y dyparol! I would get more phone calls and more referrals and more people wanting therapy over the winter months. Steve's North Active Disorder. Yeah. We demystify what goes on behind the therapy room door. Join us on this voyage of discovery and co-creative conversations. This is The Therapy Show, behind closed doors podcast with Bob Cook and Jackie Jones. Welcome back to episode 80 of The Therapy Show, behind closed doors with myself Jackie Jones and the formidable Mr Bob Cook, a wealth of knowledge. And in this episode we're going to be talking about dealing with suicidal issues in the therapy room. And an important podcast and I would think, well I'm a son, that if you took a comparison and a bunch of psychotherapists, Manchester colleagues, I would think every one of them, every one of them has had training in this subject area, hope anyway. And if they're working clinically, would have encountered people talking about what I call suicidal ideation or even talking about action again. And some therapists, I think it's becoming higher in number, are waking up and finding out that clients have killed themselves or attempted to or carried out some of their thoughts. So it's moved from suicidal ideation to the action of those suicidal thoughts. Now in my professional career I certainly occurred many many many times, of course talking about suicidal ideation and once the client actually killed themselves and that was a hugely pivotal time in my professional career for many different reasons. But that's that level and nearly all therapists will work with and will identify with, you know, talking with clients about their suicidal ideation and be hugely impacted and often take to supervision their fears and anxieties, because that person will action it. I mean you must have been in this world. It was one of my biggest fears, you know, training and when I first started practicing on my own, yeah, definitely. And since you've gone through that and you've been a therapist for a long time, you must have worked with therapists for suicidal ideation and thoughts, haven't you? Yeah, yeah, the conversation comes up more than I care to mention in the therapy room, yeah. I was doing, as I said I don't work clinically anymore, I do the assessments and I had three or four assessments today in fact and one of them was talking about I'd come in and I'll pass on to another therapist, that's what the assessment's about. And she said she'd been so triggered, you know, by recent death and public life and that has had a huge effect of her. And one of her major problems, if not the major problems, was dealing with the fear of anticipatory loss. In other words, if so loss everywhere around her. Yeah, and for some people that's how it feels, particularly like you said, you know, in previous podcasts coming out with a pandemic and everything, I think it's been in our vision more so than ever over the past couple of years. And as I said, and I think I said in previous podcasts, the suicidal rate specifically in men, young men, is higher than it's ever been. Yeah, shockingly so, yeah. And for everybody listening, I'm sure they can identify with working people's suicidal issues and the impact of that and how they do and I've just heard from you, there's one of your fears. Yeah. How did you get through that? Or if you have. It's still, I suppose it is still a fear and it is still, you know, always at the back of my mind, you know what I mean, dependent on the topics that come up with the client. But I think experience is, is quite good. Do you know what I mean? As a newly qualified psychotherapist, it's frightened the life out on me. It's not so much a taboo topic, if that makes sense. I think the more often it comes up in therapy and it's talked about, the less anxious I got about it. Yeah, yeah, yeah. It certainly was with me. And one of the things that I learned very quickly, the people likely to act out their suicidal thoughts are not the people who talk about their suicidal thoughts. Now that might be a rare exception to that, but in general. There's always an exception to every rule, but I agree. Yeah, in general, people who talk about their suicidal thoughts rarely act out because they've been in the space, the containment, an opportunity to share their fears, to talk about where that's come from. They started to understand where that's come from, and therefore developed the more resilience and TA terms adult to be able to make sure that it stays in the well as their fantasies. Yeah. So it's the people who never talk about it. And again, you know, you know, for people listening, it might be a trigger us discussing this, but for me, there's always a fantasy about ending it when you feel life is so bad. Oh, it's, you know, it's human nature, if you will, that you wanted to end however you see that end being. I know, you know, in my training, we did a lot of work around escape hatches. And, you know, what that means for somebody. So it is something that I bring up in conversation in the therapy room. I think it's a really important what you've just said, and I was going to say that you beat me to it, which is about people listening to this. Please make sure you talk about it to the best supervisor or whatever. Yeah. And at the same time, it's really important to talk about this subject because of the, the, you know, increasingly, I find clients want to talk about their fantasies and often they're dark. Yeah. By talking about the dark thoughts, of course, they're allowing light in. Yeah. 100%. Yeah. And I think I do agree with you, you know, that it's the ones that don't express the feelings in the therapy room, you know, and not wanting to talk about it. I completely agree, you know, with the young men and everything, and I think that's kind of been drummed into men to not talk about their mental health that much so they don't feel able to, you know, without stereotyping the military. And, you know, I know that you were in the forces. My son was in the forces. You know, if they spoke about it, it was frowned upon, you know, not that long ago, really. Oh, absolutely. You're absolutely right. We have a culture, especially with men, of being strong. Yeah. And not expressing emotions. And in the forces, that's drummed even more like boarding school. Yes. Yeah. I was in the forces, particularly, you know, as well. I was in the forces, I say, from the age of 18 to 20, two years before I got out. And yes, I mean, so I experienced that culture you're talking about. Yeah. It wasn't one of the most, you know, more unhappy parts of my life, but I understood, you know, other things from my history which took me there. But in terms of this podcast, yeah, absolutely people couldn't talk about emotions that culture didn't allow them to. Yeah. And then the other side of that, you know, touching on the previous podcast is that women are hysterical and talk about the problems all the time. So there's very much a division and a stereotypical way of looking at males and females. Without. Without. And I was just thinking recently, I know, publicly to really big. Gary Speed was one of them. He was a footballer when he was the Welsh manager. And also another well-known figure recently committed suicide. And what is a striking factor is that people were porting back on the suicide to a to 100% said, well, I would never have thought of that. I would never have thought he and there was no, they never talked about it. Yeah, no inclination, no clues. Never know. I was thinking, you know, about the one client who did action, the suicide for my frame and for my clinical practice. I went to the funeral and the biggest theme was huge amount of people there. But the biggest thing when people come up and talk to me was from all the different factions of her friend was, well, I would never thought this about her. She was mentioning, she was always larger. All of the party and everything, yeah. I had many different factions and that was the common theme. And, you know, and the other thing I learned very slowly over the years, on this side of the continuum, not about, you know, suicide, radiation, is that people can explain if they're going to kill themselves, they will. Find a way. But they won't talk about it. That's the sad part. Yeah. So, any therapists are on this extreme. You know, I went through a stage of blaming myself for a while, until I realised, until I eventually integratively integrated it all. Some of this was my thought, but then I realised eventually that, A, they're very secret about it. And B, they will find a way to kill themselves, but it took a long, long, long, long time to get to that position. That's that side of it. Majority of the people listening here though, I want to say to you, you're going to, you're going to hopefully give space for people to talk about their suicidal ideations. And it's those people that are not likely to move over to action, because you've given them a space to actually go to the dark side and, you know, there's some lighting. And it's from that place that therapists, that I always felt very privileged to be able to, hopefully in my small way, allow the space for them to, to talk about those fears and anxieties and re-listen to valued, as seen as an important person listening to their darkest fears, which meant they were never likely to actually do that. And I think overcoming the fear as a therapist is one of the things that we do personally need to work on. It's kind of like that age old thing that if I bring it up or I talk about it, I'm reminding them of it and I'm kind of giving them the idea that they might want to do that sort of thing, which is completely backwards because, like you said, it's freeing up the space to be able to talk about it. I'm sure we've all at some point wanted an experience to end. You know, I suffered from postnatal depression with all of my three kids and it got worse and, you know, I used to have these horrible thoughts about my children dying. It's, you know, it wasn't a conscious thought, it would just pop in my head at certain times if, you know, the first time they slept through the night, I don't go and look at them because I thought they died in the sleep. Just because we're having a thought doesn't mean that we're going to action it. A lot of time we don't have control over the thoughts that pop in our head. I think that's a really important point, what you just said there, just because we have these intrusive thoughts doesn't mean that we'll act them out. Yeah, but to be able to explore them and to talk, you know, without fear of judgement or anything for me is fantastic. Yeah, it's one of the most important parts of my therapeutic life that have allowed people to have that space to be able to do that and be able to facilitate that. And as I talked to you, I'm thinking, gosh, I reflect on that in a very proud way that I have been able to facilitate that for people to talk to those dark peers of those lives and find some light and be able to have some understanding. So there's a different context for them. Yeah. And I think what one of the things that I have done with certain clients is to to draw up a weekly contract with them, not literally draw up a weekly, but to have a verbal contract with them. That between sessions, they won't and not just, you know, take their own life, but self harm. If I think, you know that they are self harming outside in the therapy room that we will do a verbal contract that between each session and literally every session we will we contract. Which for me again is an opening to have that conversation with somebody. Because self harm comes in lots of different forms. You know, whether that's alcohol or, you know, hurting themselves or under the one different ways taking risks. Absolutely. Absolutely indeed. Yeah. I mean, if I can help people explore things you're just talking about there, I've done a pretty good job. Yeah. Now, for a lot of therapists in my hits on things from their own history, therefore they need to go to therapy to process that so they are able to stay with the person from adult. Yeah. Because we will talk about really fundamentally deep things here because you started off. I think the podcast was something I really agree with is for many, many people. It's like it might be turned like an escape plan. Things very, very, very, very wrong. At least I can kill myself. Of course, you know, a lot of people I'm sure perhaps think that way. Part of the therapist's duty, I believe, is to help the person to share those fantasies so they never become reality. Yeah. Without fear of being judged or ridiculed. Yeah. I think we... Without anything in a way, it's about normalising that to a certain extent. But again, because we don't talk about it a lot. We don't know what is normal if there is such a thing and what isn't. Yeah. I can safely say, I don't know what normal is after all these years. But we all use the word. I don't know if I do use the word much, but I do know what you mean. I do think any therapist listening to this will have dealt with people talking about their dark times and their fantasies, suicide or ideation. There's nothing to be frightened of that by the therapist. In fact, you'll be doing a wonderful job to provide those contexts and containment. You can always take this to your own therapist if it hits on real difficult times for you. Yeah. I think it's really apt that we're talking about this on the run up to Christmas as well. Because it is quite an intense period of time where if over the last year your life has changed and you're looking towards Christmas thinking you're going to be on your own and lonely. And what's the point? And then it's new year and everybody else is celebrating and everything. You know, I don't know again what the statistics are, but this time of year, because the days are going darker and the nights are longer, it does impact on us. Well, I do know the statistics. So you're going to have a choice of two days here as an answer, but I'm going to give you the chance. So which day do you think, statistically I'll talk about, is the day where there's most attempted suicides? There's something about Blue Monday, isn't there? Which is what? New Year's Eve. Is it? Yeah, I can believe it. You go into A&E on New Year's Eve. Yeah. There'll be lots of things happening. It'll be Mayhem. Yes. There'll be many, many, many people attempting to deal with drug opieces, alcohol poisoning and attempted suicides. Yeah. It's too much. And all this way, as psychotherapists, you know, that's when we take a break around the festive periods. Serious. You know, we might not see claims between Christmas and New Year, which again, you know, for some, that we're not having that connection and that regularity impacts on them. Well, that's a completely other story. And of course, very true. Yeah. Most therapists I know take a break. Yeah. I can see their own families, their own parents, their special ones. And often you are absolutely right. Don't when they're therapy groups or they don't, they stop their clinical practices for two weeks. And it's a time when often people may feel unsupported. And I think what you're talking about here, which is holidays, buys into this in a big way. And I know, you know, statistically, if we look at the year as a whole, but for me, I found that over the summer, you know, certain clients would drop off because, you know, the days are longer and it's sunny and the mood lifts and everything feels better in the summer months. And then as the nights start to get longer, I would get more phone calls and more referrals and more people wanting therapy over the winter months. Seasonal effective disorder. Yeah. Yeah, seriously. Yeah. With SAD. And a lot of people will report how, you know, it's a continuum of seasonal effective disorder from, you know, I don't remember the actual terms, but highly affected to traits, if you like. And I think it's a very real thing that people get affected, affected by, you know, the movement from summer into autumn to the winter months. And the lead up to Christmas and Christmas and New Year is the time where often people's suicide radiations, their darkest times come to the forefront. Yeah. Because it's a very reflective time somehow. You know, we do look back over the past year and it's like, you know what I mean, Ebenezer Scrooge and the Ghost of Christmas Past and all those sorts of things. We do tend to do that around the festive period. Yeah, it's a, it's a, I was talking about what you said about therapists taking holidays in those two weeks. And those for another podcast, but, you know, holidays really impact clients. Yeah. Yeah. But, you know, for our own self care, we do need to take a break at certain times of the year and we're entitled to have a break, but it's managing that. Yeah. That's the bit, I think. It's how you manage the holiday. Yeah. Because otherwise we're in the process. We're solely responsible for people, keeping people alive or we're solely responsible for their mental health or we're solely responsible. And when you get that sort of Father Christmas phenomena, we are in the land of unreality, I think. And that's not healthy. One of the things I often talk about, not necessarily with clients, is that I can only be responsible for myself. Do you know what I mean? We can't be responsible for our clients. It doesn't work that way. No, it never should do that. I'm not somebody who believes in infantilisation. I believe in autonomy. And helping people be resilient to be able to deal with loss or deal with the times you're talking about. It's an interesting topic. And like you said, that in a therapist's working life, they will come across this at some point. Always. And in fact, if they didn't, there's something wrong. Yeah. They're not going deep enough in therapy. Just touching the surface. Of course, it's a really important point because therapists who've had loss in their history or death in their history, which is really impeccable, which hasn't been resolved or looked at or healed or whatever way you want to do it, may unconsciously defend themselves against talking about these pivotal areas we're talking about here. And therefore, it's a different type of therapy. I'm sure I avoided it for quite a while when I was newly qualified. Yeah. It wasn't a topic that I felt comfortable or equipped to talk about. You know, for many months, I would have thought, yeah. That was a good thing. And I preach this to everybody that I loved about my training was that I was seeing clients while still under the Institute. For me was a big thing, that handholding and that support in the first two years of seeing clients to me was invaluable. Yeah. No, I understand that. Okay. And I think the next video is on holidays, isn't it? I think following on from this one. Yeah. How to deal with holidays. No. Yeah, because I know we touched on this podcast. But thank you and the listeners of this podcast, allowing us to talk about such a sensitive subject. And if it has triggered anything, I'll please talk to someone. Yeah. Or take it to supervision or both. Yeah. So the next one is called what's next? The next one is how to deal with holidays. Oh, number 81. Yeah. On the run up to Christmas. On the run up to Christmas. Absolutely. I said to you earlier. I hope you're shopping ready for it, Bob, and you've greeted the nearest and dearest in your life. Oh my gosh. The thought a bit already because I've got a reconstructed family and there's so many, so many people coming round. It is a lead up to Christmas. That's a good way to phrase it. Until next time, Bob. Thank you. Yeah. Take care. Take care. Bye. You've been listening to the therapy show behind closed doors podcast. We hope you enjoyed the show. Don't forget to subscribe and leave us a review. We'll be back next week with another episode.