Can’t talk to therapist about suicidal ideation

[PhoebeFriends]

I’m in week 6 of Cognitive Analytical Therapy (CAT), I’d not heard about it before - overall it is going well and the therapy and therapist are the best I’ve had in 30 years of having depression.
But,
I still have suicidal ideation- some days worse than others - on therapy day I am super positive.
I think I am encountering transference and I can not talk to my therapist about this. I have mentioned it once - he went through the IAPT protocol of phoning the core team etc and I felt like I had let him down.
Today I am again reaching the lowest point. I know what to do to keep safe but I want advice on should I bring this up again in therapy or how do I bring it up.
Typing this out is helping me think just say it but I know when the session arrives because my mood has changed I will freeze again.
I have contacted the samaritans for the last few weeks and that helps but I feel so pathetic and such a burden and stupid for having the chance of therapy and not being able to address this.
CAT is a very structured therapy and I feel by bringing this up I am wasting time and going of plan. I want to be better but right now the desire to not exist is so strong.
What and how do I say what I am feeling? I think I’m worried that if I bring it up again by saying my thoughts out loud they will become reality and I will act on them.

Please do tell your therapist. If typing your thoughts helps, could you print out your post and hand it to them at your next meeting. Nothing bad will happen. Everything that is done will be to keep you safe.

You are not a burden and you are not wasting time. The time spent is valuable. You are valuable.

It's your therapy and you shouldn't feel forced into the model. If it is easier, could you write a letter to explain how you feel? CAT is big on letters and you could write it before the session when you don't get the transference thing you mentioned.

Thank you both for responding

Agree that you shouldn't feel like you are forced into the model to the point where you can't say anything. If you feel you can't talk to your therapist then your therapist is crap.

They should be the one person you can talk to about anything. I honestly can't think of something I couldn't tell him.

@nothingcanhurtmewithmyeyesshut I know I should be able to - I guess I just go for it - are you able to just speak? Do you have any advice as to how ?
I feel totally pathetic but also a bit because my instant reaction to you saying he must be crap made me feel so defensive of him. I clearly have some weird stuff going on here which is making me feel I am beyond help.

If you think you will freeze, I would write down what you’ve just told us. The fact you feel you are letting them down etc…
How you are feeling today, the suicidal thoughts etc…

And then hand it over to them at the start of the session.

Imo if you don’t feel safe enough to tell your therapist, then there is an issue that needs to be looked at.
If after telling your therapist (even in writing) and working though whatever is an issue you still can’t bring that problem, then I’d say they are the wrong person for you.

Btw, you are not beyond help because you feel defensive of your therapist.
As you said yourself, this just means there is something going on. It’s up to your therapist to bring that up and solve it with you.

Thé will be a crap therapist IF they can’t actually solve the issue AND let you carry on with the therapy with them.
Worth remembering that sometimes there is nothing ‘wrong’ with the therapist, nothing ‘wrong’ with the patient. It’s just that the two of them don’t work well together.

@IllForTooLong therapy is online - face to face as it were but virtual so I can’t hand a letter over. I would have to write it and read it. As it goes I always have a few pages of notes in front of me and try to say/ read at least something.
He really is the best therapist I have ever had - I think if I had seen him years ago my life would be so much better now. He has helped me understand and realise so much about myself.

I think that is part of the problem- I don’t want to let him down - but also I am putting too much belief in him and his ability to rescue me.

I spend so much time during the week talking to him in my head - I have told him this - and this helps in a way but makes it t hard when I see him face to face.
I do this with others - in work situations etc - rehearse what I will say and then can’t say it.
At my age this inability to have a normal, free flowing conversation makes me feel I’ve failed at the social norms of life.

Absolutely tell your therapist, just an idea but if you can maybe say, I'm really struggling to bring this to you but I know how important it is that I'm open/authentic with you or You could even say you felt a block to being able to tell him and that your not sure why. Sometimes just naming the block is enough to start the talk you need to have and maybe tend to any transference etc. I know it takes vulnerability to speak these things & strength too. You can do it xxxxx

@IllForTooLong following the CAT model, I will have a finite 24 sessions with him. I am already anxious about these ending - with over half left…

You can screen share or email your letter

@Joelijane thank you - that sounds doable for me - I can’t believe I am agonising over coming across as critical - that is part of my identified problem - I need to say that too.
I am going to go for it and cope with the next step ….I hope.

Agree with @NutellaEllaElla. You can screen share and let them read a document instead.

@NutellaEllaElla - you would think but therapy is from IAPT and the app used does not allow the patient any access - I also don’t have an email address for him that would receive messages - he can email me but it is a “do not reply to this..”
if I need to make contact it is via a phone call to the core team and I leave a message.

I am so stupid - I have just gone back to my map - it is there in black and white - I want to do the right thing but can’t and then let issues go unresolved.
I can’t believe how incapable I am of seeing what is right in front of me. There really is little hope I am going to get where I want to/ need to be if I don’t wake up and get a grip.

You've just seen it though, that's progress. Next thing to do is to decide how you want to act.

I’m not very familiar with CAT, so I can’t say how much the structure of it as a therapy might be contributing to your block in discussing your suicidal ideation. I’m curious about how you feel you’d be letting the therapist down by acknowledging those feelings. I’m also noticing that it seems hard to express feelings that don’t seem ‘present’ in the moment - how is it when you try to remember how it felt when you were at your lowest point? Does the therapy session include any mood questionnaire of any kind? For example, PHQ9? Sometimes people feel they ‘should’ demonstrate recovery to the therapist and that can be for many reasons: you like them and want to please them; you’re picking up a sense they might be judged on their therapy outcomes with clients; you’re afraid if you acknowledge suicidal feelings it will impact your therapy or trigger interventions you don’t want. Do any of these strike a chord?

Does the service have a generic customer contact email or send a question/comment bit on website? You could call and ask see if you can send the letter as an attachment and have it passed along. Or write it in short paragraphs and hold it up to the camera for the therapist to see. Don't beat yourself up, you've identified a problem that's a positive step, next step find a way to move forward, little step by little step.

So if you feel defensive of him, you clearly have a strong bond. That isn't weird, it's a very intimate relationship. Not intimacy as we usually encounter it but intimate nonetheless.

What is holding you back? Is it his reaction you're afraid of? ARE you afraid?

I think your first step is to identify the emotion present. You can't talk to him; why?

You feel like you're going off plan. Why is going off plan undesirable? Fear? Guilt? Anxiety? Lack of trust? What is the underlying emotion here?

I would write him a letter and in the session, either ask for an email address to send it to or hold it up to the camera so he can read it on the screen.

I've often given my therapist letters or handed him my journal to read a few pages if I'm having trouble voicing something or can't find the words.

I usually CAN talk, I just need prompting or for him to raise the subject or lead the conversation.

I did it! I just jumped in straight away - stopped mid sentence but kept all your advice in mind and kept on going. I feel more positive now about dealing with the suicidal ideation but relieved that I have started the journey in tackling it.
He did mention that I will need to start thinking about how I will be when therapy ends - it is time limited - I thought it was 24 weeks but it’s actually 16. I am half way there so my next ask will be how will I manage?
But I don’t want to spend the rest of the sessions dealing with the fear of loss.
My rationale head knows I am idealising him because his role is to listen to me and help me. I know this is very different from the day to day reality of who he is. I don’t however want to become critical of him as a self-defence method but I am going to be so sad when sessions end.
The good thing is I know I can bring this up now the flip side is the sense of loss.
I need to get the balance right to avoid seeking further therapy to get over the loss of this therapist.

Well done! It is hard when your sessions are over, my first therapist was an IAPT therapist and I had 12 sessions. I was really brave until he hugged me goodbye then I cried my eyes out.

I found a private therapist to continue with and I think I'd struggle finishing right now as I am very very attached to him but session are open ended so no fixed end date. We'll be done when we're done.

Thank you @nothingcanhurtmewithmyeyesshut I just hope I will be able to find a private therapist as good as him - I have been through so many but I guess it will be worth it in the end.

Does he work in private practice as well as NHS? I know mine does see NHS patients once a week at the hospital. You might be able to continue with him as a private patient.