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throwaway2018-2

One of the things that really scares me about working with a therapist is that I have suicidal thoughts a lot. Like, I don't deserve to be alive or that I want to die. I'm still pretty productive, make a good salary, was recently promoted. I'm scared that if I were really open about these feelings, something bad would happen, that I could be hospitalized. Which feels like a real step backwards to me. A step towards not actually getting better.

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You didn't say what country you're in.

If you're in England you can write an advance directive saying that detaining you under the act would be harmful, and you can work out who your "nearest relative" is and make sure they say to the AMHP "I object to the section". These don't make it impossible to hospitalise you, but they do make it much harder.

But, importantly, you deserve help. And you don't need to disclose suicidality. You can just say that you feel very low, that you feel desperate.

There's good evidence that cognitive behaviour therapy is effective for about 60% of the people who use it. You may want to think about combining it with medication.

If it makes you feel better, I seriously doubt a (certified) one will do that. The smart ones realize that hospitalization can really derail your life and make you an even higher suicide risk.

Additionally, there is a big difference (in my opinion) between suicidal thoughts and actually acting on those thoughts.

Just from reading your post it doesn’t sound like you have much to worry about.

Suicidal ideation is different than having a plan and access to the method to follow through.

It’s when ideation proceeds to having a timeline and decision to die by suicide is when hospitalization is absolutely necessary. At the end of the day, if I a person wants to die by suicide, there is very little anyone can do about it.

I doubt a bad therapist would not report ideation and risk it in the US. Specially a not very good therapist, as seem to be norm in a country where their effectiveness is diminished everywhere in favour of promoting the unrealistic benefits of psychologist and drugs (which they will prescribe in day one)

I agree with jakegarelick, a good therapist will not hospitalize you.

What matters is for you to talk.

Why would anybody not deserve to be alive? Life is fundamentally nonsensical, and our struggle / cross ( depending on how you see it ) is to put meaning into it. This is why life is at the same time a tragedy and a liberating experience.

We are ephemeral, and not this important at the individual level. Only thing that matters is not harming others, eventually doing good to others if we are lucky, and finding joy in little things ( intellectual endeavours, earthly pleasures, art, sunsets, you name it ).

If it can help, a reading that helped me when I was deep in depression in my 20's was the The Gay Science, by Nietzsche. Don't read it in one go. Keep it with you, and read a few aphorisms every day. Some three liners aphorisms from Nietzsche made more impact in my life than everything else I read combined. This book literally saved my life.

  a good therapist will not hospitalize you

In the USA, anyway, a therapist is legally required to intervene if s/he sees the patient as a threat to harm himself or others.

It's more of an imminent threat thing than "I want to die sometimes"; the latter is very common for therapists to encounter and help their patients work through. (Ideally — not all suicidal feelings can be worked through.)

You can find therapists who has remote sessions over internet. If you're worried about someone acting against your will, you can have a Skype session without revealing your real name. Even with someone in another country - if your primary language is English, you have lots of options.

You can't get things prescribed this way. But it doesn't sound like that's an issue here.

To be considered suicidal, I believe you need to have formulated a plan. Feeling worthless or not wanting to be alive is not the same, that's just bread and butter depression.

This is incorrect.

People can be suicidal - can have suicidal ideation - without having an active plan.

Thoughts of "I feel trapped", "I feel hopeless" are red flag signs even if the person doesn't have a plan at that moment.

It's probably a good idea to remember that bad advice about suicide can cause death.

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