Triggering: Advice on therapy/counselling? (Self-harm, substance abuse, suicidal thoughts)

[DanTheMan :P]

First of all, hey Teenhelp! It's been a while! I hope I've put this in the right sub-forum :P

After wanting to seek help from a mental health professional for longer than I care to remember, I had a particularly bad comedown after taking MDMA on multiple occasions in quick succession. I'm no expert but for anyone that doesn't know, it quickly depletes your brains stock of seratonin, so if you don't take a long break between using it, you basically just use it all up. But the thing is, I'd been tempted to arrange an appointment before in the days following a night out on it because I feel so low, but never quite went through with it, so I almost did it on purpose so that I'd feel so down I wouldn't even think twice about it, and get everything off my chest when I feel like I really need to. (Disclaimer: I definitely don't promote the use of drugs, please don't take them!)

For whatever reason I thought when I emailed the mental health department of my uni I'd get an appointment within a few days, but it was actually about a 6 week wait. This is actually probably a good thing because I wanted to ask you guys about it, as I'm terrified! My main worry is confidentiality: in what situations are counsellors/therapists (I'm not sure of the difference or which kind of professional I'll be seeing) allowed to break confidentiality? A) because I want to be entirely honest about substance use (I've been using weed on a near daily basis while I'm at uni for about 18 months, as I often struggle to sleep because I can't shut my brain off, and I regularly use it during the day for the same reason, I'm tired of fighting my own mind, and mdma more recently when I go out as I'm such a socially anxious person and it's almost like a cure for being me) and I obviously don't want that going back to my parents or university lecturers. And the other reason is I've been having what I would describe as intrusive suicidal thoughts - whenever I don't have any kind of distraction, be it work, music (although my headphones just broke) or weed tbh, because like I said it stops my mind from constantly racing, I just start thinking I want to kill myself, just all the time. And I really don't want to kill myself, honestly, but I can't stop thinking about it if I don't have a distraction, and I don't want to get taken to hospital or something, and I don't want to mention any of this to me parents because they both have so so many different stresses at the moment, and our relationship is already fragile. As well as the fact that I've opened up to one of my friends when I was on mdma about my mental health recently and they've all started treating me differently and I HATE it, (just to clarify - they've made more of an effort to be inclusive with me and be nice to me and stuff, but now all I can think is that they're only ever inviting me to hang out because they feel sorry for me and don't really want to) so I really don't want my parents tip-toeing around me like I'm a ticking time bomb. And yeah, they're both so stressed I don't think they could handle something like that.

But yeah Im rambling slightly now, but my main fear is that I'll be entirely honest with whoever I see and as soon as I mention suicidal thoughts they'll immediately report it. But honestly I feel like I really need this, I'm SO skeptical of self diagnosing myself with anything because I feel like it isn't fair to people to do have mental illnesses to go around claiming I do, but if nothing else I'm confident I suffer from anxiety and it's really starting to take ahold of my life... The thought of not having earphones worries me because now I'll be alone with my thoughts every time I'm not in the house. And for the second year in a row, I'm running the risk of practically ruining my life by not doing uni work. I managed to get an extension on 3 essays that were due in over Christmas at the start of February (because I lied to my course leader, that was a great feeling, she was so nice to me) which I'm pretty sure is actually not allowed, and yet I have still managed to not do one of them. It seems ridiculous to moan about my own procrastination but I feel like I can't help it? I go to the library so often and just don't get anything done, and I failed my first year last year because of it, and failed dramatically. But I just become numbed to it? Like I get so stressed about everything in my life, and in the end stop caring about any of it. I spent the entirety of my £1500 overdraft last year in a few months, and my parents paid off the majority of it for me which I really didn't expect, and I've spent nearly all of it again, and Im so annoyed at myself for it because I know that's such a selfish thing to do, but it's also worrying me because I'm going home in a few days and they're going to want to check my account to make sure I haven't spent all of the money they've already paid off once. But yeah, it gets to the point where I just don't care about it anymore, and instead of doing the work I need to do in order to not get kicked out of uni I spend money I don't have on substances that just eventually make me feel worse in the long run, and just don't care about it. And whilst I've been really trying not to buy weed for the last few days I've been thinking about self harm more and more lately, and whilst I really don't want any more scars, being stoned is one of the few things that stop the urges, so I'm left to choose between one self destructive habit or another...

I didn't expect to go on like that, but yeah if anyone could tell me about the confidentiality thing (in the UK) that'd be great! Thanks!

[Kate*]

Not from the UK, but I think the policies are pretty much the same. The only times they can break confidentiality is if you threaten to harm yourself or someone else. Suicidal thoughts are confidential unless you can give details of how, when and where etc. or if you threaten to hurt or kill another person, and mean it, give specific details. So, they aren't going to tell your parents about your drug use or your suicidal thoughts unless they're convinced you will go through with something.

I am not from the UK but from what I know the confidentiality rules are generally the same. The only time they can breach confidentiality is if you are a danger to yourself or others.

For example, if you are going to harm yourself and have a plan/date/are an imminent risk then they would breach confidentiality and, at least here, they usually just try and get you to agree to go to a psych hospital instead of resorting to notifying the authorities.

[Celyn]

I am from the UK

As the previous people have said, often times everything is confidential unless you are at a serious risk of harming yourself (suicidal thoughts don't count unless you have a plan or intend to act on the thoughts) or a serious risk of harming others. The first session is often just finding out what you are struggling with, what you would like to achieve, what (if any) counselling/therapy techniques you have tried that worked/don't work and of course talking about confidentiality. You can also ask for examples of when confidentiality will be broken, if that helps. You may also want to check out FRANK for more information regarding drug advice.

I'm also glad to hear that you opened up to a friend about your mental health. It's not easy and I do understand the worry of thinking they are involving you more because they feel sorry for you, but chances are they may not have been aware of how much you were struggling and now realise that and want to look out for you. Your parents may be stressed with their own issues, but I'm sure they care about you and would want you to get help and support, regardless what they are going through.

I think that honesty is the best policy, especially when it comes to mental health. It doesn't matter whether you get a diagnosis or not, if there are things bothering you, they are always worth seeking help for, more so if they are affecting your daily life. It definitely sounds like you are struggling with uni work, feeling numb and wanting to self-harm and think that it was good of you to seek help now, rather than later.

Hope counselling helps you to get through all of this

[del677]

Counselors love a client who is honest like you want to be.

Drug use is common among college age students. Counselors are used to it. They hear it all the time. It's usually just a symptom of deeper problems, and it's the deeper problems that counselors want to uncover and treat. People use drugs to escape, because they are sad, or something about life is overwhelming.

(The good news is drug use qualifies you for all the support that people need to heal the underlying issues so they can feel better and no longer feel the need to use drugs.)

Your parents are stressed? Well there's a trigger right there! Emotions are contagious. Their stress can spill over onto you.

Stress can trigger all sorts of body problems. Stress also triggers relapse. Much of treatment is about learning ways to mitigate stress. Need to reduce causes of stress, and have frequent periods of stress-free relaxation.

To mention thoughts of suicide, just always add that you have no intention of actually doing it right now. Thoughts of suicide are common and usually transitory in nature, meaning they come and go. As long as the counselor understands the whole truth, that you have no intention of actually doing it, then you're fine.

He may give you some phone numbers to call in case it gets worse. It's good to have options set up, such as people you can call who can help avert a crisis just by being someone you can talk to. Often just talking to someone for a while can get me through a rough moment.

Counselors know people won't come and talk with them if they don't keep things confidential, so they tend to be adamant about maintaining confidentiality. They don't report drug use because that would be detrimental to the whole process of helping the people they are there to help. Same with thoughts of suicide. Thoughts are fine; actions are not. As long as they are just thoughts it's good to know about them as they indicate something is wrong that needs fixing. Just clarify that you have no intention. Heck that's why you're at the counselor! Because you'd rather not and wish to find an alternative solution to this problem. A counselor is going to love having you as a client because you are so open and honest and you understand yourself so well and understand there's a problem and just need some guidance on how to go about fixing this. (One thing that helps is talking about it, get it out in the open, so just explaining to a counselor the problem is half the cure right there!)

One treatment is to join other people who will understand and accept you as you are because they've been there themselves. People who have recovered from similar problems are the best as they understand in a way no one else can. This is what support groups are for. Just being in the presence of other people who you know completely understand and accept you helps relax the emotional part of the brain.

Having social anxiety certainly doesn't help. Possibly a support group might be overwhelming. Or it might be fantastic! Really depends on the size of the group, how structured it is, and who the other people are.

Another treatment for anxiety is mindfulness meditation, qi-gong, tai-chi, yoga. These techniques attempt to activate the parasympathetic nervous system. Another way I just learned of is when we activate the parasympathetic nervous system we increase blood flow to our limbs, such as our hands, and our hands warm up slightly. So another way to learn how to activate your parasympathetic nervous system is to attach a biofeedback thermometer to your finger and then concentrate on warming your hands by using your mind. The biofeedback tells you when you succeed. I was told these devices are available at amazon.com for $30.

Long term repeated activation of the body's parasympathetic nervous system can lead to a true lessening of anxiety. The brain heals itself, strengthens itself, and anxiety literally decreases, making these mind exercises worth the effort. (Plus they are relaxing so it ends up being it's own reward.)

Thinking about self-harm? Have you tried any antidepressant medication? It really worked great for me once I found the right one for me. It sounded like a stupid idea when it was first suggested to me, but the doctor talked me into trying it, and now I think it's great because I feel so much more "normal" (whatever that is, it's like trying to describe what it's like to not have the flu to someone who's been sick their whole life. It feels much better!)

Most important thing I learned the hard way is I don't ruminate on thoughts of "impending doom" no matter how real they may be, because I learned that will just make me sick and then it becomes a self-fulfilling prophecy. So I refuse to allow myself to be stressed over life and how my life might be ruined, because I know that will ruin my life. (See how that's sort of circular? I refuse to enter that spiral.)

(I suspect your friends actually do want to hang out with you, and the thought that they don't want to is likely just a thought you have. People like helping other people in need. It's built into our DNA to be that way. As long as the other person says, "Thank you for helping me," that's candy to their ears. It's like, "Man that feels good! I just helped someone!")

Best wishes. Sounds like you're already on the path toward healing. (Counselors love helping people heal. It's why they chose this business.)

[DanTheMan :P]

Thank you so much everyone for your replies, I genuinely feel so much more comfortable about going now, and to be honest it can't come quick enough! I'm sick of being at war with my own mind, so I'm glad the added worry of their response is gone, I'm so grateful